Videothoracoscopic Surgery Research Articles

Robotic Lobectomy Learning Curve Has Better Clinical Outcomes than Videothoracoscopic Lobectomy.

Introduction: The robotic-assisted (RATS) lobectomy learning curve is usually measured compared to an established videothoracoscopic (VATS) surgery program. The objective of our study is to compare the learning curves of both techniques. Methods: We performed an intention-to-treat analysis comparing the RATS vs. VATS lobectomies. Surgical time, conversions, complications, number of lymph nodes (LNs) and lymph node stations harvested, chest drainage duration, length of stay, readmissions, and 90-day mortality were compared between both groups. The learning curve was assessed using the CUSUM method. Results: RATS cases (30) and VATS cases (35) displayed no significant differences. The RATS learning curve was completed after 23 procedures while the VATS curve required 28 interventions. Complications appeared in four RATS procedures and in eight VATS patients. No differences in the number of LNs and harvested LN stations were reported. Four patients were readmitted in the RATS group, and eight in the VATS group. No 90-day postoperative mortality was observed in either group. The RATS group reported fewer chest tube days (3 (2-5) vs. 5 (4-5.8), p = 0.005) and hospital days (4 (3-6) vs. 5 (4-6), p = 0.023). Conclusions: The RATS curve appears shorter than the VATS curve. RATS lobectomies resulted in reduced chest tube duration and length of stay during the learning time period.

Thymus Surgery Prospectives and Perspectives in Myasthenia Gravis.

The thymus is a lymphoid organ involved in the differentiation of T cells, and has a central role in the physiopathogenesis of Myasthenia Gravis (MG). This connection is proved by a series of changes in the level of neuromuscular junctions, which leads to a decrease in the amplitude of the action potential in the post-synaptic membrane. Because of this, the presence of anti-cholinergic receptor antibodies (AChR), characteristic of MG, is found, which causes the progressive regression of the effect of acetylcholine at the level of neuromuscular junctions, with the appearance of muscle weakness. The thymectomy is a surgical variant of drug therapy administered to patients with MG. In the case of patients with nonthymomatous MG, thymectomy has become a therapeutic standard, despite the fact that there is no solid scientific evidence to explain its positive effect. Videothoracoscopic surgery or robotic surgery led to a decrease in the length of hospital stay for these patients. This paper aims to synthesize the information presented in the literature in order to create a background for the perspectives of thymectomy.

Clinical study of thoracoscopic assisted different surgical approaches for early thymoma: a meta-analysis

ObjectiveThe efficacy and safety of subxiphoid thoracoscopic thymectomy (SVATS) for early thymoma are unknown. The purposes of this meta-analysis were to evaluate the effectiveness and safety of SVATS for early thymoma, to compare it with unilateral intercostal approach video thoracoscopic surgery (IVATS) thymectomy, and to investigate the clinical efficacy of modified subxiphoid thoracoscopic thymectomy (MSVATS) for early anterior mediastinal thymoma.MethodsOriginal articles describing subxiphoid and unilateral intercostal approaches for thoracoscopic thymectomy to treat early thymoma published up to March 2023 were searched from PubMed, Embase, and the Cochrane Library. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated and analyzed for heterogeneity. Clinical data were retrospectively collected from all Masaoka stage I and II thymoma patients who underwent modified subxiphoid and unilateral intercostal approach thoracoscopic thymectomies between September 2020 and March 2023. The operative time, intraoperative bleeding, postoperative drainage, extubation time, postoperative hospital stay, postoperative visual analog pain score (VAS), and postoperative complications were compared, and the clinical advantages of the modified subxiphoid approach for early-stage anterior mediastinal thymoma were analyzed.ResultsA total of 1607 cases were included in the seven studies in this paper. Of these, 591 cases underwent SVATS thymectomies, and 1016 cases underwent IVATS thymectomies. SVATS thymectomy was compared with IVATS thymectomy in terms of age (SMD = − 0.09, 95% CI: −0.20 to − 0.03, I2 = 20%, p = 0.13), body mass index (BMI; SMD = − 0.10, 95% CI: −0.21 to − 0.01, I2 = 0%, p = 0.08), thymoma size (SMD = − 0.01, 95% CI: −0.01, I2 = 0%, p = 0.08), operative time (SMD = − 0.70, 95% CI: −1.43–0.03, I2 = 97%, p = 0.06), intraoperative bleeding (SMD = − 0.30. 95% CI: −0.66–0.06, I2 = 89%, p = 0.10), time to extubation (SMD = − 0.34, 95%CI: −0.73–0.05, I2 = 91%, p = 0.09), postoperative hospital stay (SMD = − 0.40, 95% CI: −0.93–0.12, I2 = 93%, p = 0.13), and postoperative complications (odds ratio [OR] = 0.94, 95% CI: 0.42–2.12, I2 = 57%, p = 0.88), which were not statistically significantly different between the SVATS and IVATS groups. However, the postoperative drainage in the SVATS group was less than that in the IVATS group (SMD = − 0.43, 95%CI: −0.84 to − 0.02, I2 = 88%, p = 0.04), and the difference was statistically significant. More importantly, the postoperative VAS was lower in the SVATS group on days 1 (SMD = − 1.73, 95%CI: −2.27 to − 1.19, I2 = 93%, p < 0.00001), 3 (SMD = − 1.88, 95%CI: −2.84 to − 0.81, I2 = 97%, p = 0.0005), and 7 (SMD = − 1.18, 95%CI: −2.28 to − 0.08, I2 = 97%, p = 0.04) than in the IVATS group, and these differences were statistically significant. A total of 117 patients undergoing thoracoscopic thymectomy for early thymoma in the Department of Thoracic Surgery of the Second Hospital of Jilin University were retrospectively collected and included in the analysis, for which a modified subxiphoid approach was used in 42 cases and a unilateral intercostal approach was used in 75 cases. The differences between the two groups (MSVATS vs. IVATS) in general clinical characteristics such as age, sex, tumor diameter, Masaoka stage, Word Health Organization (WHO) stage, and intraoperative and postoperative conditions, including operative time, postoperative drainage, extubation time, postoperative hospital stay, and postoperative complication rates, were not statistically significant (p > 0.05), while BMI, intraoperative bleeding, and VAS on postoperative days 1, 3, and 7 were all statistically significant (p < 0.05) in the MSVATS group compared with the IVATS group.ConclusionThe meta-analysis showed that the conventional subxiphoid approach was superior in terms of postoperative drainage and postoperative VAS pain scores compared with the unilateral intercostal approach. Moreover, the modified subxiphoid approach had significant advantages in intraoperative bleeding and postoperative VAS pain scores compared with the unilateral intercostal approach. These results indicate that MSVATS can provide more convenient operation conditions, a better pleural cavity view, and a more complete thymectomy in the treatment of early thymoma, indicating that is a safe and feasible minimally invasive surgical method.

EP07.03-04 Non-Small Cell Lung Cancer in Obese Patients: Comparison of Open, Robotic and Videothoracoscopic Surgery. A Multicenter Retrospective Series

EP07.03-04 Non-Small Cell Lung Cancer in Obese Patients: Comparison of Open, Robotic and Videothoracoscopic Surgery. A Multicenter Retrospective Series

A different approach in primary spontaneous pneumothorax surgery: Lateral pleurectomy technique and results

Background: Primary Spontaneous Pneumothorax is a disease with a frequent recurrence rate. The uniportal videothoracoscopic surgery approach is the standard treatment for air leak and recurrence prevention. In common practice, apical pleurectomy is used after apical wedge resection. Our study aims to examine the results, especially the recurrence rate, of the lateral pleurectomy and apical pleural abrasion combination technique applied as an alternative to this technique.Methods: A total of 50 patients who underwent uniportal videothoracoscopic surgery for primary spontaneous pneumothorax between November 2018 and May 2021 were included in the study. The follow-up period for recurrence of the patients was 12-42 months. Age, gender, pneumothorax side, operation indication, Body Mass Index, smoking history, incision length and location, air leakage and tube thoracostomy duration, Verbal Numeric Pain Scores, post-operative length of hospital stay, complications, and recurrence data were recorded.Results: Of the 50 patients, 44 (88%) were male, and 6 (12%) were female, with a mean age of 22.3±5.9 years. Surgery was performed from the existing drain site in 32 (64%) cases and the former drain scar in 11 (22%) cases. The mean duration of tube thoracostomy was 2.7±0.97 days, and the mean length of hospital stay was 3.6±0.89 days. Complications developed in 2 (4%) cases, and recurrence was observed in 2 (4%) cases.Conclusions: Lateral pleurectomy with the apical pleural abrasion technique is easy to apply and reduces the possibility of undesired hemorrhagic drainage. We believe that the lateral pleurectomy technique is safe, easily applicable, and less risky in terms of hemorrhage.

Nadir görülen bir pnömotoraks olgusu: katamenial pnömotoraks

Endometriozis, uterus dışında endometrial glandlar ve stromanın bulunması olarak tanımlanır. Endometriozisin pulmoner tutulumu da görülebilmekte olup, en sık katamenial pnömotoraks kliniğiyle karşımıza çıkar. Çalışmamızda 38 yaşında nüks pnömotoraks nedeni ile opere edilen kadın hasta sunuldu. Cerrahi tedavi amacıyla videotorakoskopik cerrahi ile akciğer rezeksiyonu yapılan olguda diafragmatik plevrada endometriozise bağlı olduğu düşünülen lezyonlar saptandı. Pnömotoraksa sebebiyet verdiği düşünülen bu lezyonlar videotorakoskopik cerrahi ile tedavi edildi ve hastanın 2 yıllık takibinde rekürrens saptanmadı. Endometrozisli hastalarda pnömotoraks geliştiğinde katamenial pnömotoraks akılda bulundurulmalı, nüks gelişmesi durumunda ise videotorakoskopik cerrahi ile tanı ve tedavide başarı sağlanabileceği unutulmamalıdır.

Chronic chest pain and paresthesia after video-assisted thoracoscopy for primary pneumothorax.

BackgroundThis study aims to identify clinical and surgical risk factors for chronic chest pain and paresthesia after video thoracoscopic surgery for primary spontaneous pneumothorax.MethodsWe retrospectively collected the data of 1,178 consecutive patients <40-years-old undergoing video thoracoscopic surgery for primary spontaneous pneumothorax in 9 Italian centers in 2007–2017. Cases with <2-month follow-up were excluded, leaving 920 patients [80% male; median age: 21 (IQR, 18–27) years] for statistical analysis. The following risk factors for chronic chest pain and chronic paresthesia were assessed by univariable and multivariable Cox regression model: age, gender, cannabis smoking, video thoracoscopy ports number, pleurodesis technique (partial pleurectomy/pleural electrocauterization/pleural abrasion/talc poudrage), chest tube size (24/28 F), postoperative chest tube stay.ResultsBlebs/bullae resection with pleurodesis was performed in 732 (80%) cases; pleurodesis alone in 188 (20%). During a median follow-up of 68 (IQR: 42–95) months, chronic chest pain developed in 8% of patients, chronic chest paresthesia in 22%; 0.5% of patients regularly assumed painkillers. Chronic chest pain was independently associated with partial pleurectomy/pleura abrasion (P<0.001) and postoperative chest tube stay (P=0.019). Chronic chest paresthesia was independently associated with pleurodesis by partial pleurectomy (P<0.001), chest tube stay (P=0.035) and 28 F chest tube (P<0.001).ConclusionsAfter video thoracoscopic surgery for primary spontaneous pneumothorax, the incidence of chronic chest pain and paresthesia was significantly lower when pleurodesis was performed by pleural electrocauterization or talc poudrage, and chest tube was removed early. A 24 F chest tube was associated with lower risk of chronic chest paresthesia.

Comparison of Videothoracoscopy and Thoracotomy in Surgical Treatment of Pulmonary Hydatid Cyst Disease.

To evaluate the outcomes of videothoracoscopic and open surgeries for pulmonary hydatid cysts. Descriptive study. Department of Thoracic Surgery, Faculty of Medicine, Balıkesir University, Turkey, between May 2015 and March 2020. Patients who underwent surgery for pulmonary hydatid cysts were evaluated retrospectively, for the age, gender, symptoms, cyst size and localisation, preferred surgery, duration of surgery, the extent of the intraoperative bleeding, duration of the chest drainage, hospitalisation time, and postoperative complications. The relationship between the categorical variables was examined with the Chi-square and Fisher's exact tests and the relationship between the non-parametric data and continuous variables with the Mann-Whitney U-test. A total of 60 patients included in the study; 23 underwent videothoracoscopic surgery and 37 had thoracotomy. There were no statistically significant differences between groups as gender, age, location and size of cyst. The videothoracoscopic surgery has superiority to thoracotomy group in terms of lower duration of operation, less perioperative bleeding (p = 0.005), early chest tube removal and lower hospitalisation time (both p <0.001). But there were no statistical difference between groups in complication rates (p = 0.340). Videothoracoscopic removal of pulmonary hydatid cyst is a safe and advantageous procedure comparing to thoracotomy. There is a need for prospective studies with a larger sample size. Key Words: Hydatid cyst, Thoracoscopic surgery, Thoracotomy, VATS.

Use of Robotics in Surgical Treatment of Non-small Cell Lung Cancer.

Robotic-assisted videothoracoscopic surgery (R-VATS) has become increasingly popular and widely used since its introduction and is nowadays considered a standard treatment approach in many centres for the treatment of non-small cell lung cancer. R-VATS was initially developed to overcome the drawbacks of VATS by offering surgeons more flexibility and three-dimensional optics during thoracoscopic surgery. The effectiveness of R-VATS lobectomy regarding oncological outcomes, morbidity, mortality, and postoperative quality of life (QoL) has been shown in an increasing number of studies. More recently, these results have also been corroborated for sublobar resections, more specifically for segmentectomy. However, no well-powered, multicentre randomized trials have been performed to demonstrate the superiority of R-VATS compared with open surgery or conventional types of VATS (total VATS, uniportal VATS, etc.). The majority of the evidence currently available is based on non-randomized studies, and many studies report conflicting results when comparing R-VATS and conventional VATS. Moreover, there is a lack of data regarding the cost and the cost-efficiency of robotic surgery compared with VATS and open surgery. Current evidence suggests that R-VATS costs are higher than VATS and that a deficit can only be prevented when up to 150-300 thoracic surgery procedures are performed annually. Finally, robotic-assisted laparoscopic surgery showed better ergonomics and reduced musculoskeletal disorders compared with non-robotic laparoscopic surgery.

CIRUGÍA TORÁCICA VIDEOASISTIDA UNIPORTAL EN DOS CENTROS UNIVERSITARIOS. EXPERIENCIA INICIAL

Introducción: Uno de los mayores avances de las últimas décadas en la cirugía de tórax ha sido el desarrollo de la cirugía mínimamente invasiva.Objetivos: Describir la experiencia en videotoracoscopía (VATS) uniportal de miembros del equipo de Cirugía de Tórax de la Universidad de Chile en 2 campos clínicos, (Clínica Las Condes y Hospital Clínico de la Universidad de Chile).Material y métodos: Se estudiaron 105 pacientes sometidos a VATS uniportal entre enero de 2016 y enero de 2019. Los datos se analizaron de manera retrospectiva considerando variables demográficas (edad, sexo) y clínicas (diagnóstico, cirugía, estadía hospitalaria, días de pleurostomía, conversión, y complicaciones). Resultados: De las 105 cirugías realizadas, 28 (26,6 %) correspondieron a cirugías mayores complejas lobectomías y segmentectomías anatómicas. En 4 pacientes se agregó un 2º puerto, uno se convirtió a mini toracotomía y uno a toracotomía (5,7% conversión global). La estadía hospitalaria fue en promedio 3,07 ± 3,1 días y el promedio de mantención de pleurostomía de 2,67 ± 1,61 días. Siete pacientes (6,6%) presentaron complicaciones post operatorias. Un paciente falleció por progresión de su enfermedad, no hubo mortalidad relacionada a la cirugía.Discusión: Las contraindicaciones de la VATS uniportal son las mismas que en la VATS multipuerto. En manos experimentadas, las complicaciones en cirugía por puerto único son bajas. Impresiona tener menos dolor post operatorio, menor estadía hospitalaria y reintegración precoz a las actividades diarias comparado con la VATS tradicional.Conclusiones: Se presenta la primera serie de VATS uniportal publicada en Chile. Los resultados obtenidos son comparables a los observados en la literatura. Su implementación y desarrollo requiere de una curva de aprendizaje similar a cualquier nueva técnica quirúrgica.

Bronkojenik ve Perikardiyal Kistin Eş Zamanlı Videotorakoskopik Rezeksiyonu

Primary mediastinal cysts are rare, congenital and benign lesions originating from various embryological tissue types. However, it can present with similar clinical and radiological findings at almost every age. We present this case to emphasize that two separate mediastinal cysts originating from different embryological origins in different compartments of the mediastinum are extremely rare and that these cysts can be simultaneously resected by videothoracoscopic surgery.

Uniportal-Single Incision Thoracoscopic Access for Pulmonary Hydatid Cysts

Objective: Pulmonary hydatid cyst is caused by Echinococcus Species and has high prevalence in low and middle income countries. Surgery remains the gold standard method for this parasitic pulmonary disease. Here, we report 20 cases of pulmonary hydatid cysts that underwent minimally invasive videothoracoscopic surgery. Methodology: All the patients who underwent minimally invasive complete thoracoscopic removal of pulmonary hydatid cysts in our clinic, which were recorded in the hospital database had been extracted. Clinical properties and complications of the surgeries were analyzed retrospectively. Results: Minimally invasive method was performed in all 20 cases. The mean duration of operation was 95 minutes (min-max: 45-175), and the mean length of hospitalization was 3.55 days (min-max: 2-7). The complication rate was 15% (n=3) and there was no recurrence in 6 months of follow- up. Conclusion: Videothorascopic pulmonary hydatid cysts removal seems to be a safe and useful method. This method is applied in all suitable patients with pulmonary hydatid cysts.

Long-term oncological outcome in thymic malignancies: videothoracoscopic versus open thymectomy

Complete resection is the standard of care for thymic malignancies. There is still a debate about the optimal surgical approach for thymic tumors, particularly regarding long-term oncological outcome. This study aimed to compare videothoracoscopic surgery (VTS) with open surgery for thymic malignancies, regarding perioperative and long-term oncological outcomes. A prospective study ran from 2010 to 2019. Patients with thymoma or thymic carcinoma underwent complete thymectomy via VTS or open surgery and were followed up. The long-term oncological outcome was disease recurrence. There were 29 patients in the VTS group and 35 patients in the open group with an average follow-up period of 80 months. The VTS approach significantly shortened operative duration (89.7 versus 116.9 min), caused less blood loss (56.9 versus 176.3 ml), reduced pain score (4.8 versus 6.7), and shortened chest drainage duration (2.1 versus 3.1 days) as well as hospital stay (5.1 versus 7.7 days). The two groups were comparable in long-term oncological outcome (two recurrences in the VTS group and one in the open group). Compared to open surgery, VTS leads to superior perioperative outcomes and a comparable long-term oncological outcome. The authors advocate the VTS approach as a routine option for the surgery of thymic malignancies. Videothoracoscopic surgery is less traumatic and has faster recovery times than open surgery, with a comparable long-term oncological outcome.

Case Report on Acute Bacterial Mediastinitis and its Management through Videothoracoscopic Surgery

Case Report on Acute Bacterial Mediastinitis and its Management through Videothoracoscopic Surgery

The approach to the spontaneous pneumothorax in period of compulsory public service

Aim: There is air in the pleural space without an external effect in the case of spontaneous pneumothorax, and it is important in terms of treatment, clinic, and underlying diseases in thoracic surgery. In this study, it was aimed to present the approach to the patients with spontaneous pneumothorax in the period of compulsory public service. Material and method: The patients who were treated with spontaneous pneumothorax between June 2017 and January 2018 in our clinic were included in this study. Gender, age, smoking status, type of treatment and length of hospital stay were recorded. Result: 18 patients (2 female, 16 male) were included in the study. Eleven of the patients (61.1%) were smoking. Surgical treatment was applied to 7 (38.8%) of the patients. As a surgical approach, videothoracoscopic wedge resection and partial pleural decortication in 5 patients, videothoracoscopic bulla ligation and partial pleural decortication in 1 patient and thoracotomy bulla ligation in 1 patient were applied. Ten patients were treated with tube thoracostomy and one patient was treated with nasal oxygen. Complications did not occur in the patients. Conlusion: Spontaneous pneumothorax is a disease requiring urgent diagnosis and treatment. The purpose of the treatment is to provide the lung totally expanded and to prevent recurrence of pneumothorax. Tube thoracostomy is usually the first approach, but we recommend that the videothoracoscopic surgery can be used in the conditions of the public hospital because of its advantages for the patients who have surgical indications.

Robot-assisted thoracic surgery in Colombia: a multi-institutional initial experience.

Robotic assisted videothoracoscopic surgery (RVATS) adoption has increased worldwide from 3.4% in 2010 to 17.5% in 2015. However, in Latin America, the literature is limited to a report of a series of 10 patients who underwent RVATS lobectomy and one case report of an RVATS thymectomy from Brazil. This is a retrospective review of all RVATS performed in Bogotá Colombia since 2012. A single thoracic surgeon (RB) performed all the operations at three institutions: Clínica de Marly, Fundación Clínica Shaio and Instituto Nacional de Cancerología. Preoperative, intraoperative, postoperative and pathology report variables were included. Patients were analyzed in three groups: robotic RVATS pulmonary resections, RVATS mediastinal surgeries and other RVATS procedures. Descriptive statistics were used to report the median and interquartile range (IQR) of the continuous variables, and number and percentage were used to describe categorical variables. The association between total operative time and the year the surgery was analyzed using a linear regression model. Forty-seven patients underwent RVATS pulmonary resections; 72.3% (n=34) of these patients underwent a RVATS lobectomy. The median total operative time was 220 (IQR: 200 to 250) minutes, 6.4% (n=3) had intraoperative complications, and the most frequent histologic diagnosis was adenocarcinoma (n=24, 51.1%). Of 18 patients who underwent RVATS mediastinal surgeries, 50.0% (n=9) had RVATS thymectomy, the median total operative time was 195.5 (IQR: 131 to 221) minutes and two patients (11.1%) had intraoperative complications. The linear regression model of the association between total operative time and the year the surgery showed a 10.3 minute reduction per year (P=0.006). This is the second series of RVATS published in Latin America and the first published in Colombia, with comparable perioperative results to other reports.

P2.16-25 Lower Hiliar Lymph Node Upstaging in Early NSCLC Vats Surgery is Related to Tumor Location and Does Not Afect Survival

Nodal upstaging after early stage lung cancer surgery is not only inevitable, but it is also considered a quality marker for surgical lymphadenectomy. Underdiagnosis of pN1 has important significance and leads to undertreatment. Lymphadenectomy has been questioned in video thoracoscopic surgery (VATS) since its description. Recently some authors published lower pN1 upstaging incidence after VATS resection compared to open thoracotomy. We want to evaluate the rate of upstaging in our centre after starting a VATS program. All patient who required an anatomical resection for non-small cell lung cancer (NSCL) in our department have been retrospectively reviewed. Patients were divided in two groups in relation of the performed surgical approach, thoracotomy (THO) and VATS. Both groups were compared in terms of gender, age, smoking history, comorbidities, lung function, histology, clinical stage and tumour location. Rate of hilar lymph node upstaging (pN1) and mediastinal lymph node upstaging (pN2) were compared between both groups. Univariate and multivariate analysis was performed to identify independent risk factors for pN1 upstaging. Overall survival was compared between both techniques in pN0 patients. Between January 2011 and October 2017, 1.081 lung resections were carried out in our centre. 323 of those were anatomical resections for early stage (≤ IIB) non-small cell lung cancer (NSCLC). There were no differences among groups except for FEV1, previous history of Diabetes Mellitus, tumour size and location (p<0.05). pN1 ratio was 20,5% in THO vs. 8,6% in VATS (p < 0,05) when performed accesses was compared. No differences were observed regarding pN2 upstaging (6% in THO and 6,5% in VATS; p>0,05). Only gender and centrality were identified as independent risk factors for hiliar lymph node upstaging in a multivariate analysis. For those patient with no upstaging (pN0) there were no survival differences comparing open and VATS approaches. In our series pN1 upstaging is less frequent in VATS than in open surgery. When analysed, tumour centrality has shown to be an independent risk factor for hilar upstaging. Additionally central tumours were much more prevalent in open surgery group. In conclusion, lower incidence of unnoticed pN1 in VATS surgery could be related to a selection bias, because thoracotomy was preferred when tumour considered central. Furthermore, the fact that no differences on survival in pN0 patients were detected suggests that no patients have been underdiagnosed and in consequence undertreated.

Les standards de la prise en charge chirurgicale des cancers bronchiques non à petites cellules

Primary lung cancer is responsible for the most cancer-related deaths in France: 30 000 deaths every year. The only curative treatment remains oncologic surgery. The objective of this article is to review actual standards in surgical treatment of non-small cell lung cancers.An initial assessment of operability is mandatory by a cardiac and respiratory evaluation. It is important to determine if the type of resection planned is compatible with the patient’s general condition: pneumonectomy, simple lobectomy, sleeve lobectomy, segmentectomy or wedge resection. The extent of curative surgical resection has evolved with the 8th edition of primary lung cancer classification and the new pathologic classification of adenocarcinomas.Different surgical approaches, with each their benefits and their disadvantages, are available for the surgeon to choose between: conventional thoracotomy, muscle-sparing thoracotomy, videothoracoscopic surgery and robotic-assisted surgery. Patient care is more and more oriented toward inclusion in enhanced recovery after surgery protocols.

Videothoracoscopic surgery before and after chest tube drainage for children with complicated parapneumonic effusion

ObjectivesTo evaluate the effectiveness of videothoracoscopic surgery in the treatment of complicated parapneumonic pleural effusion and to determine whether there is a difference in the videothoracoscopic surgery outcome before or after the chest tube drainage. MethodsThe medical records of 79 children (mean age 35 months) undergoing videothoracoscopic surgery from January 2000 to December 2011 were retrospectively reviewed. The same treatment algorithm was used in the management of all patients. Patients were divided into two groups: in group 1, videothoracoscopic surgery was performed as the initial procedure; in group 2, videothoracoscopic surgery was performed after previous chest tube drainage. ResultsVideothoracoscopic surgery was effective in 73 children (92.4%); the other six (7.6%) needed another procedure. Sixty patients (75.9%) were submitted directly to videothoracoscopic surgery (group 1) and 19 (24%) primarily underwent chest tube drainage (group 2). Primary videothoracoscopic surgery was associated with a decrease of hospital stay (p = 0.05), time to resolution (p = 0.024), and time with a chest tube (p < 0.001). However, there was no difference between the groups regarding the time until fever resolution, time with a chest tube, and the hospital stay after videothoracoscopic surgery. No differences were observed between groups regarding the need for further surgery and the presence of complications. ConclusionsVideothoracoscopic surgery is a highly effective procedure for treating children with complicated parapneumonic pleural effusion. When videothoracoscopic surgery is indicated in the presence of loculations (stage II or fibrinopurulent), no difference were observed in time of clinical improvement and hospital stay among the patients with or without chest tube drainage before videothoracoscopic surgery.

Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct.

Spontaneous pneumothorax (PNTX) is a common disease frequently operated at specialized thoracic surgery units. Videothoracoscopic surgery (VATS) has become the standard for treatment and recurrence prevention. While there is broad consensus regarding indications and techniques of PNTX surgery, postoperative risks and consecutive patient behavioral advice have not been sufficiently elucidated. Single-center cohort analysis of 641 patients operated for primary PNTX by VATS over 10 years. Putatively recurrence-prone lifestyle activities (smoking status, flying habits, and scuba diving) and actual occurrence of recurrences were correlated. Follow-up rate was 46% (279/607 patients). Mean time interval between primary operation and follow-up was 61 (range: 5-177) months. In 10 patients (3.6%), a PNTX recurrence was observed. Regarding postoperative risk behavior reported at follow-up, 28% of patients were active smokers (15 ± 7 cigarettes/day), 59% traveled by plane repeatedly, and only two patients did scuba diving (0.7%). Low body-mass-index was associated with an increase in PNTX recurrence, whereas smoking, flying, and scuba diving could not be identified as risk factors. In our study, none of the supposed "classic" lifestyle-associated risk factors for PNTX recurrence after VATS proved to be a significant threat. Postoperative patient behavior might not be constrained by overcautious medical advice.