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Lee JH, Gu BM, Yong HS, Hwang SY, Kim HK. Initial Experience of Single-Port Robotic Lobectomy for Large-Sized Non-Small Cell Lung Cancer: A Single-Center Retrospective Study. Cancers (Basel) 2024; 16:3091. [PMID: 39272949 PMCID: PMC11394038 DOI: 10.3390/cancers16173091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/16/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
Single-port robotic-assisted thoracic surgery (SP-RATS) lobectomy using the da Vinci Xi system has been performed by several pioneers. However, due to the severe collisions and the steep learning curve, this approach is not yet widely used. This study aimed to evaluate the feasibility of SP-RATS lobectomy for large-sized non-small cell lung cancer (NSCLC). As we believe that for large-sized tumors it is reasonable to make a slightly larger incision, we performed SP-RATS lobectomy for large-sized NSCLC (greater than 5 cm) through a single incision (6-8 cm). Eleven patients underwent SP-RATS lobectomy using the da Vinci Xi system at our institution from April 2022 to May 2024. The median tumor size on computed tomography and on pathology was 6.6 cm [interquartile range (IQR), 6.1-7.5 cm] and 6 cm [IQR, 5.1-7.1], respectively. The median total operative time was 198 min [IQR, 159-260 min], and the median postoperative length of stay was 4 days [IQR, 4-10 days], with no major postoperative complications (≥grade III on the Clavien-Dindo classification). Our approach may combine the benefits of single-port surgery with those of robotic surgery and is safe, feasible, and may promote better outcomes in patients with large-sized NSCLC.
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Affiliation(s)
- Jun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea
| | - Byung Mo Gu
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea
| | - Hwan Seok Yong
- Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea
| | - Soon Young Hwang
- Department of Biostatistics, Korea University College of Medicine, Seoul 08308, Republic of Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea
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Song Z, Yuan Y, Cheng C, Luo Q, Cheng X. The learning curve on uniportal video-assisted thoracoscopic lobectomy with the help of postoperative review of videos. Front Oncol 2023; 13:1085634. [PMID: 37152033 PMCID: PMC10161897 DOI: 10.3389/fonc.2023.1085634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectivesVideo-assisted thoracoscopic lobectomy has become the preferred surgical approach in experienced centers, and uniportal approaches are becoming increasingly used. But the uniportal approach is still not widely applied presumably due to the learning difficulties of this complex procedure. The use of surgical videos may be helpful to accelerate the learning of this new techniques as in other fields. In this study, we aimed to analyze the learning curve of uniportal video-assisted thoracoscopic lobectomy with the help of postoperative review of videos.Methods114 patients with early-stage lung cancer who underwent uniportal video-assisted thoracoscopic lobectomy performed from 2020 to 2021 were reviewed in this study. We recorded the operation video for each patient and reviewed all the videos after surgery. The learning curves were assessed using cumulative sum analysis and the collected data of perioperative outcomes were assessed.ResultsThe CUMSUM curve showed its inflection points were around case 38 and 53. It was less compared with previous studies, which about 57–140 cases are needed to attain the proficient phase. The perioperative outcomes were similar in each phase, which included intraoperative blood loss (79.00 ± 26.70 vs 70.67 ± 26.64 vs 70.56 ± 27.23, p=0.0119), the length of hospital stay (3.60 ± 1.52 days vs. 3.23 ± 0.90 days vs. 3.06 ± 0.88 days, p=0.053), the rate of prolonged air leak and conversion to open thoracotomy. There was also no significant difference in the numbers and station of lymph node dissection among the three phases.ConclusionsUniportal video-assisted thoracoscopic lobectomy is a safe and reliable approach. Recording and reviewing the operation video could help the surgeon to improve deficiencies and refine the procedure.
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Lee DK, Kang SW, Kim HK, Kim HS, Kim H. Effect of sugammadex on chest radiographic abnormality in the early postoperative period after video-assisted thoracoscopic lobectomy. Turk J Med Sci 2020; 50:1236-1246. [PMID: 32366060 PMCID: PMC7491306 DOI: 10.3906/sag-2001-26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/04/2020] [Indexed: 11/18/2022] Open
Abstract
Background/aim Sugammadex, which offsets the effects of neuromuscular blocking agents (NMBs), has advantages over traditional reversal agents like pyridostigmine, as it enables fast and reliable recovery from neuromuscular blockade. This study compared the incidence of early postoperative chest radiographic abnormalities (CRA) between sugammadex (group S) and pyridostigmine (group P) following video-assisted thoracoscopic (VAT) lobectomy for lung cancer. Materials and methods We performed a retrospective cohort analysis by reviewing the medical records of patients who underwent VAT lobectomy at a single university medical center. We defined the early postoperative CRA as a characteristic appearance on chest radiograph up to 2 days after surgery. Arterial blood gas analysis (ABGA), surgical time, anaesthesia time, extubation time, and the total dose of rocuronium were analysed. Postoperative nausea and vomiting (PONV) and pain scores were observed until 2 days after surgery. Results A total of 257 patients underwent VAT lobectomy during the study period; 159 were included in the final analysis. Ninety patients received sugammadex while 69 received pyridostigmine. The incidence of early postoperative atelectasis was significantly lower in group S than in group P (26.7%, 95% CI: 17.5%‒35.8% and 43.5%, 95% CI: 31.8%‒55.2%, respectively, P = 0.013). The median dose of rocuronium was higher in group S than in group P (120 mg vs. 90 mg, P < 0.001). ABGA, extubation time, and PONV were similar in both groups. Conclusion Sugammadex decreased the incidence of CRA in the early postoperative period despite higher NMB consumption.
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Affiliation(s)
- Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung Wook Kang
- Department of Anesthesiology and Pain Medicine, Nowon Chuck Hospital, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyo Sung Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heezoo Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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On KC, Rho J, Yoon HY, Chang H, Yhee JY, Yoon JS, Jeong SY, Kim HK, Kim K. Tumor-Targeting Glycol Chitosan Nanoparticles for Image-Guided Surgery of Rabbit Orthotopic VX2 Lung Cancer. Pharmaceutics 2020; 12:E621. [PMID: 32635231 PMCID: PMC7407595 DOI: 10.3390/pharmaceutics12070621] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 02/07/2023] Open
Abstract
Theranostic nanoparticles can deliver therapeutic agents as well as diverse imaging agents to tumors. The enhanced permeation and retention (EPR) effect is regarded as a crucial mechanism for the tumor-targeted delivery of nanoparticles. Although a large number of studies of the EPR effect of theranostic nanoparticles have been performed, the effect of the change in the body size of the host on the EPR effect is not fully understood. In this regard, comparative research is needed on the behavior of nanoparticles in large animals for developing the nanoparticles to the clinical stage. In this study, we prepared fluorophore (indocyanine green (ICG) or cyanine 5.5 (Cy5.5))-conjugated glycol chitosan nanoparticles (CNPs) for comparing the tumor-targeting efficacy in VX2 tumor-bearing mouse and rabbit models. As expected, the CNPs formed nano-sized spherical nanoparticles and were stable for 8 days under aqueous conditions. The CNPs also exhibited dose-dependent cellular uptake into VX2 tumor cells without cytotoxicity. The half-life of the near-infrared fluorescence (NIRF) signals in the blood were 3.25 h and 4.73 h when the CNPs were injected into mice and rabbits, respectively. Importantly, the CNPs showed excellent tumor accumulation and prolonged biodistribution profiles in both the VX2 tumor-bearing mouse and rabbit models, wherein the tumor accumulation was maximized at 48 h and 72 h, respectively. Based on the excellent tumor accumulation of the CNPs, finally, the CNPs were used in the image-guided surgery of the rabbit orthotopic VX2 lung tumor model. The lung tumor tissue was successfully removed based on the NIRF signal from the CNPs in the tumor tissue. This study shows that CNPs can be potentially used for tumor theragnosis in small animals and large animals.
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Affiliation(s)
- Kyeong Cheol On
- Department of Life and Nanopharmaceutical Sciences, Graduate School, Kyung Hee University, Seoul 02447, Korea; (K.C.O.); (J.S.Y.); (S.Y.J.)
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea;
| | - Jiyun Rho
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul 02841, Korea;
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University Guro Hospital, Seoul 08308, Korea
| | - Hong Yeol Yoon
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea;
| | - Hyeyoun Chang
- Department of Cancer Biology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA;
| | | | - Jun Sik Yoon
- Department of Life and Nanopharmaceutical Sciences, Graduate School, Kyung Hee University, Seoul 02447, Korea; (K.C.O.); (J.S.Y.); (S.Y.J.)
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea;
| | - Seo Young Jeong
- Department of Life and Nanopharmaceutical Sciences, Graduate School, Kyung Hee University, Seoul 02447, Korea; (K.C.O.); (J.S.Y.); (S.Y.J.)
| | - Hyun Koo Kim
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul 02841, Korea;
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University Guro Hospital, Seoul 08308, Korea
| | - Kwangmeyung Kim
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea;
- KU-KIST Graduate School of Converging Science and Technology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul 02841, Korea
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Sihoe ADL. Uniportal Lung Cancer Surgery: State of the Evidence. Ann Thorac Surg 2018; 107:962-972. [PMID: 30300638 DOI: 10.1016/j.athoracsur.2018.08.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/21/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Uniportal video-assisted thoracic surgery (VATS) has generated much attention in recent years, but questions remain regarding the adequacy of evidence to support its use in lung cancer surgery. This review aims to explore what the currently published literature suggests the role of the uniportal approach may be and to critically appraise that literature. METHODS A systematic review was conducted using the Ovid Medline database to identify articles related to uniportal VATS. Articles were selected for review on the basis of ability to provide original clinical data on the role of uniportal VATS for lung cancer surgery. RESULTS The literature search revealed that only some publications on uniportal VATS provided original clinical data. Twenty-two articles were selected for review, including 9 case series and 13 comparative studies. No concerns about the safety of the uniportal VATS were noted. Some but not all comparative studies provided data suggesting that uniportal VATS may hold advantages over multiportal VATS in some simple clinical outcomes (such as reduced lengths of stay and postoperative pain). However, the quantity and quality of evidence thus far are limited. CONCLUSIONS It remains premature to declare superiority for uniportal VATS in lung cancer surgery. A higher level of evidence is needed, especially in investigating objective benefits and treatment efficacy of the single-incision approach.
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Affiliation(s)
- Alan D L Sihoe
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China; Division of Thoracic Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, China; Department of Thoracic Surgery, Tongji University Shanghai Pulmonary Hospital, Shanghai, China.
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Liu X, Chen X, Shen Y, Wang H, Feng M, Tan L, D'Amico TA. Learning curve for uniportal video-assisted thoracoscopic surgery lobectomy-results from 120 consecutive patients. J Thorac Dis 2018; 10:5100-5107. [PMID: 30233885 DOI: 10.21037/jtd.2018.08.87] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Uniportal video-assisted thoracoscopic surgery (VATS) is considered a technically demanding procedure. The learning curve, which directly influences the adoption of uniportal VATS, has not been described. In this study, we aimed to describe the learning curve for uniportal VATS lobectomy from our single center's experience. Methods Uniportal VATS lobectomy was started in October 2013 in Zhongshan Hospital, Fudan University. Since then, a total of 120 consecutive patients who underwent uniportal VATS lobectomy were retrospectively enrolled. Surgical videos were reviewed to determine the operation time, to which cumulative sum (CUMSUM) method was applied to evaluate the learning phases of the procedure. Accordingly, patients' clinical features in different phases were collected and compared to determine the learning curve for uniportal VATS lobectomy. Results Among the 120 consecutive patients reviewed from October 2013 to September 2014, the CUMSUM curve showed its inflection at patient number 44: the first 30 patients were in the ascending phase, the second 30 patients were in the plateau phase, and the remaining patients were in the descending phase. Comparable CUMSUM results were recorded both from upper and not-upper lobectomy. Intra-operatively, more repeated stapler attempts (73% versus 13% and 5%, P<0.001) and higher conversion rate (17% versus 7% and 2%, P=0.028) were recorded in ascending phase vs. the plateau phase and descending phase, respectively. Post-operatively, the morbidity, mortality and the length of hospital stay were similar before and after the learning curve cases. Conclusions In a center with conventional VATS experience, the learning period of uniportal VATS lobectomy was characterized by repeated stapler attempts, and the volume requirements would be approximately 30 cases to reach the performance plateau. Upper lobectomy seemed not more difficult to learn than lower or middle lobectomy in uniportal VATS.
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Affiliation(s)
- Xiaochuan Liu
- Department of Thoracic Surgery, Guangan People's Hospital, Guangan 638000, China
| | - Xiaosang Chen
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Thomas A D'Amico
- Department of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
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Abstract
This article addresses technical details of uniportal VATS segmentectomy by lung segments, suggesting available techniques for lesion localization and identification of the intersegmental plane. Long-term results and superiority have not yet been characterized in standard VATS for lung malignancy. Indications include almost all thoracic procedures currently performed by conventional multiport VATS. We review our experience and published literature on the feasibility of uniportal VATS segmentectomy.
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Affiliation(s)
- Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
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Hernandez-Arenas LA, Purmessur RD, Gonzalez-Rivas D. Uniportal video-assisted thoracoscopic segmentectomy. J Thorac Dis 2018; 10:S1205-S1214. [PMID: 29785295 DOI: 10.21037/jtd.2018.02.47] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Uniportal video-assisted thoracoscopic surgery (VATS) segmentectomy is a technically more complex procedure than uniportal VATS lobectomy, since a detailed comprehension of the segmental anatomy is required. Anatomic sublobar resection can achieve outcomes equivalent to lobectomy in selected patients with stage IA non-small cell lung carcinoma (NSCLC). In this paper we describe our clinical experiences and introduce the technical details of uniportal VATS segmentectomy, including expertise advice ("tips and tricks") in patient selection, positioning and incisions and technical highlights of the most common types of segmentectomies. Uniportal VATS segmentectomy is a demanding technique, safe and feasible in selected patients with good results in the literature that seems to be an acceptable alternative to conventional VATS or open thoracotomy when the surgeon completed the training period and learning curve.
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Affiliation(s)
| | - Rushmi D Purmessur
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, NHS Trust Foundation, Birmingham, UK
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruna Hospital, Coruna, Spain
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Han KN, Kim HK, Choi YH. Midterm outcomes of single port thoracoscopic surgery for major pulmonary resection. PLoS One 2017; 12:e0186857. [PMID: 29136038 PMCID: PMC5685603 DOI: 10.1371/journal.pone.0186857] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/09/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Single-port thoracoscopic surgery has widened the current minimally invasive surgical techniques toward more less invasive procedures in terms of reducing the number of incisions. However, the current status of oncologic outcome with this technique is not well known for lung cancer surgery. The purpose of this study is to evaluate the oncologic outcomes in early stage lung cancer for impact of the survival outcomes with our experience of conversion to a single-port approach from the conventional three-port approach. MATERIALS AND METHODS Retrospective data of patients who underwent thoracoscopic major lung resection for non-small cell lung cancer between January 2006 and June 2015 were analyzed. Patients' characteristics, perioperative outcomes, pathologic result, and postoperative follow-up data of thoracoscopic surgery were reviewed and surgical outcomes were compared between conventional three-port (n = 168), two-port (n = 68), and single-port thoracoscopic surgery (n = 203). RESULTS Of the 203 single-port thoracoscopic surgeries, we performed 167 single-port thoracoscopic lobectomy and mediastinal lymph node dissections. During the learning period of each thoracoscopic approach, the mean operation time for single-port thoracoscopic surgery (189±62 min) was not significantly different from those of two-port (175±46 min) and three-port (195±75 min) thoracoscopic lobectomy (p = 0.165). Perioperative outcomes including drain indwelling time (p <0.001), complication (p = 0.185) and conversion event (p = 0.911) were not worsened during learning period with two-port. Midterm survival (p = 0.753) and recurrence free survival (p = 0.656) of single port thoracoscopic lobectomy showed acceptable results compared with two- and three-port approach. CONCLUSIONS Single-port thoracoscopic surgery is safe and a feasible option for major lung resection in lung malignancy and this approach following experiences of two-port approach may yield similar oncologic results to those of conventional multi-port approach during thoracoscopic lobectomy.
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Affiliation(s)
- Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, Republic of Korea
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The predictive accuracy of sentinel nodes mapping in the setting of pulmonary metastasectomy. Clin Exp Metastasis 2017; 34:125-131. [PMID: 28062976 PMCID: PMC5337247 DOI: 10.1007/s10585-016-9834-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 12/28/2016] [Indexed: 02/07/2023]
Abstract
This is the first study to evaluate the feasibility of mediastinal lymph node dissection (MLND) based on sentinel lymph node (SLN) status during pulmonary metastasectomy. A total of 22 patients (16 men, 6 women; age 63.3 ± 7.01 years) who were candidates for metastasectomy through segmentectomy or lobectomy with MLND owing to cancers metastatic to the lung were enrolled in this study. Radiotracer was administered at the peritumoral region before surgery or soon after initiating surgery. During the operation, the radioactivity of the lymph nodes (ex vivo) was counted with a handheld gamma probe after MLND. Lobectomy was performed in 17 patients, and segmentectomy, in 5 patients. The number of dissected lymph nodes per patient was 14.4 ± 8.69 (range, 5–36). In all patients, the SLN could be detected, and the number of SLNs identified was 2.0 ± 1.15 (range, 1–5) per patient. Lymph node metastasis was identified in 3 of the 22 patients (13.6%), and none of the 3 patients with N1 or N2 disease had false-negative SLNs. SLN identification might be an indicator of whether or not MLND should be performed during pulmonary metastasectomy. However, further large-volume and multi-institutional studies are needed.
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Hao Z, Cai Y, Fu S, Zhang N, Fu X. [Comparison Study of Post-operative Pain and Short-term Quality of Life between Uniportal and Three Portal Video-assisted Thoracic Surgery for Radical Lung Cancer Resection]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:122-8. [PMID: 27009816 PMCID: PMC5999825 DOI: 10.3779/j.issn.1009-3419.2016.03.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
背景与目的 近年来在传统三孔胸腔镜的基础上,单孔胸腔镜术式发展迅速并渐用于肺癌根治性切除,其与传统胸腔镜术式相比的临床应用优势也为关注的热点。本研究针对单孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的影响进行初步探讨。 方法 选取2015年3月-2015年9月在我科同诊疗组连续行单孔胸腔镜(单孔组)或三孔胸腔镜(三孔组)肺癌根治术的非小细胞肺癌患者216例,其中单孔组115例,三孔组101例。对比两组的临床及手术资料,以视觉模拟评分(visual analogue scale, VAS)法评估两组患者术后第3天、第7天时疼痛的最小(VASmin-d3、d7)及最大(VASmax-d3、d7)值,肺癌治疗功能性量表(Functional Assessment of Cancer Treatment-Lung, FACT-L)中文版v4.0评测两组患者术前及术后三月的生活质量,对比两组术后三月切口麻木发生率及患者对切口外观的满意度。 结果 两组患者的一般临床资料无差异,均无围手术期死亡病例,单孔组手术时间(157.62±19.50)min较三孔组(116.00±17.32)min更长(P<0.001),但术后胸管置管时间和术后住院时间在单孔组[(4.37±1.65) d, (9.87±1.25) d]均明显短于三孔组[(5.54±1.57) d, (10.43±1.43) d](P=0.020, P=0.004);两组患者术后VASmin-d3无显著差异,但单孔组VASmin-d7及VASmax-d3、d7[(1.46±0.29), (3.75±0.54), (2.43±0.53)]均低于三孔组[(1.58±0.30), (3.93±0.51), (2.62±0.62); P=0.003; P=0.011; P=0.018]。FACT-L评分显示术后三月单孔组患者功能状态、情感状态和整体生活质量得分[(20.94±2.22), (19.88±1.70), (108.09±4.58)]均高于三孔组患者[(20.24±1.92), (19.36±1.67), (106.88±4.17); P=0.014; P=0.024; P=0.045],而生理状态、社会/家庭状态及肺癌相关症状评分两组并无差异。与三孔组比较,单孔组术后三月切口麻木发生率(24.3% vs 38.6%)更低(P=0.024),患者对切口的满意度更高(78.3% vs 65.3%, P=0.035)。 结论 与三孔胸腔镜相比,单孔胸腔镜肺癌根治术能够减轻患者术后疼痛,改善术后短期生活质量,在肺癌的外科治疗中有一定临床应用价值。
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Affiliation(s)
- Zhipeng Hao
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430030, China
| | - Yixin Cai
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430030, China
| | - Shengling Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430030, China
| | - Ni Zhang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430030, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology,
Wuhan 430030, China
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Han KN, Kim HK, Choi YH. Clinical innovations in minimally invasive surgery in Korea. J Thorac Dis 2016; 8:S627-30. [PMID: 27651938 DOI: 10.21037/jtd.2016.06.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Over the past decade, the surgical approach to treating thoracic disease has shifted to minimally invasive surgery. Without compromising the outcomes, this approach may lead to fewer resections and fewer incisions for those resections. Video-assisted thoracoscopic surgery (VATS) is a recent but major advancement that has become an established approach for major thoracic surgery. More recently, robotic surgery has been gaining recognition because it can overcome the limitations of VATS and encourage a minimally invasive approach. Indications and applications of many other innovative surgical techniques and strategies to improve overall survival have expanded rapidly. In this article, we do not represent all thoracic surgeries occurring in Korea and do not reflect the large active centers in the country. However, as one of the most innovative and active Korean centers for thoracic surgery and research, we reviewed our procedures and programs for thoracic surgery.
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Affiliation(s)
- Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Han KN, Kim HK, Lee HJ, Lee DK, Kim H, Lim SH, Choi YH. Single-port thoracoscopic surgery for pneumothorax under two-lung ventilation with carbon dioxide insufflation. J Thorac Dis 2016; 8:1080-6. [PMID: 27293823 DOI: 10.21037/jtd.2016.03.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The development of single-port thoracoscopic surgery and two-lung ventilation reduced the invasiveness of minor thoracic surgery. This study aimed to evaluate the feasibility and safety of single-port thoracoscopic bleb resection for primary spontaneous pneumothorax using two-lung ventilation with carbon dioxide insufflation. METHODS Between February 2009 and May 2014, 130 patients underwent single-port thoracoscopic bleb resection under two-lung ventilation with carbon dioxide insufflation. Access was gained using a commercial multiple-access single port through a 2.5-cm incision; carbon dioxide gas was insufflated through a port channel. A 5-mm thoracoscope, articulating endoscopic devices, and flexible endoscopic staplers were introduced through a multiple-access single port for bulla resection. RESULTS The mean time from endotracheal intubation to incision was 29.2±7.8 minutes, the mean operative time was 30.9±8.2 minutes, and the mean total anesthetic time was 75.5±14.4 minutes. There were no anesthesia-related complications or wound problems. The chest drain was removed after a mean of 3.7±1.4 days and patients were discharged without complications 4.8±1.5 days from the operative day. During a mean 7.5±10.1 months of follow-up, there were five recurrences (3.8%) in operated thorax. CONCLUSIONS The anesthetic strategy of single-lumen intubation with carbon dioxide gas insufflation can be a safe and feasible option for single-port thoracoscopic bulla resection as it represents the least invasive surgical option with the potential advantages of reducing operative time and one-lung ventilation-related complications without diminishing surgical outcomes.
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Affiliation(s)
- Kook Nam Han
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Koo Kim
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Joo Lee
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dong Kyu Lee
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heezoo Kim
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Ho Lim
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Choi
- 1 Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea ; 2 Department of Anesthesiology and Pain Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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Uniportal Video-Assisted Thoracoscopic Surgery. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0160-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Han KN, Kim HK, Choi YH. Comparison of single port versus multiport thoracoscopic segmentectomy. J Thorac Dis 2016; 8:S279-86. [PMID: 27014475 DOI: 10.3978/j.issn.2072-1439.2016.02.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUNDS Single-port thoracoscopic segmentectomy is a challenging option in the early stages of lung cancer. The purpose of this study was to determine the feasibility of single-port video-assisted thoracoscopic surgery (VATS) segmentectomy compared to conventional multi-port VATS. METHODS A total of 45 patients underwent pulmonary segmentectomy by video-assisted thoracoscopic surgery between March 2006 and October 2015. We analyzed the operative outcomes of segmentectomy by surgical approach (34 single-port versus 11 multi-port). RESULTS Twenty-three primary lung cancers (51.1%), 16 benign lung diseases (35.6%), and 6 secondary lung cancers (13.3%) were diagnosed and included in our study. In 29 malignancy cases (64.4%), the mean tumor size was 1.8±0.7 (range, 1-3.5) cm. Twenty patients (44.4%) underwent preoperative localization with hook-wire and radiocontrast. The most frequent operated segment was the left upper divisional segment (n=9, 30%). There was no significant difference in operation time (P=0.073), the number of dissected lymph nodes (P=0.310), intraoperative events (P=0.412), and the development of prolonged air leak (>5 days) (P=0.610) between the single-port and multi-port VATS segmentectomy groups. There was a reduction in postoperative morbidity (P<0.001) and hospital stay (P=0.029) in the single-port VATS group. CONCLUSIONS Single-port VATS segmentectomy for early lung cancer and benign lung disease, is a safe and feasible option for patients undergoing pulmonary segmentectomy.
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Affiliation(s)
- Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Han KN, Kim HK, Choi YH. Uniportal video-assisted thoracoscopic surgical (VATS) segmentectomy with preoperative dual localization: right upper lobe wedge resection and left upper lobe upper division segmentectomy. Ann Cardiothorac Surg 2016; 5:147-50. [PMID: 27134843 PMCID: PMC4827403 DOI: 10.21037/acs.2016.03.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/02/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Kook Nam Han
- Departments of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun Koo Kim
- Departments of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Ho Choi
- Departments of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Beyersdorf F, Lorusso R, Prêtre R, Siepe M. The EJCTS publication family is growing: the appointment of new editors for ICVTS and MMCTS. Interact Cardiovasc Thorac Surg 2016; 22:127-30. [PMID: 26795380 DOI: 10.1093/icvts/ivw003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - René Prêtre
- Department of Cardiovascular Surgery, CHUV, Lausanne, Switzerland
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Albert-Ludwigs-University Freiburg, Freiburg, Germany
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Beyersdorf F, Lorusso R, Prêtre R, Siepe M. The EJCTS publication family is growing: the appointment of new editors for ICVTS and MMCTS. Eur J Cardiothorac Surg 2016; 49:361-4. [PMID: 26764339 DOI: 10.1093/ejcts/ezv461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - René Prêtre
- Department of Cardiovascular Surgery, CHUV, Lausanne, Switzerland
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Albert-Ludwigs-University Freiburg, Freiburg, Germany
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Han KN, Kim HK, Lee HJ, Choi YH. Single-port video-assisted thoracoscopic pulmonary segmentectomy: a report on 30 cases†. Eur J Cardiothorac Surg 2015; 49 Suppl 1:i42-7. [PMID: 26612717 DOI: 10.1093/ejcts/ezv406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/19/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the feasibility of a single-port video-assisted thoracoscopic surgery for pulmonary segmentectomy in patients with malignant or benign lung diseases. METHODS Thirty patients (17 women; mean age, 61.7 ± 10.9 years) who underwent a single-port thoracoscopic segmentectomy were consecutively included in this study. A 2- to 4-cm incision was made at the fifth intercostal space on the anterior or posterior axillary line, depending on the tumour location. We investigated the postoperative outcomes according to the size of the incision (2 vs 3-4 cm) or the location of segmentectomy. RESULTS Fifteen primary lung cancers, 5 metastatic lung cancers, 1 pulmonary sarcoma, 7 cases of inflammatory lung disease and 2 benign lung tumours were diagnosed. A 3- to 4-cm incision was used in 16 patients (53.3%), and a 2-cm incision in 14 patients. The most frequent segment removed was the left upper division (9 patients, 30%). A single-port thoracoscopic segmentectomy was completed in all of the patients except one (96.7%). This 1 patient underwent lobectomy instead because the lesion was not found in the initial segment removed. The mean operation time was 159 ± 56 min, and no significant difference in the size of incision was observed (P = 0.651). The right middle and superior segments tended to require shorter operation times (97.1 ± 44.9 min) than the other segments (p < 0.001). One patient died (3.3%) because of septic shock. The chest tube drain was removed 4.6 ± 1.6 days after the operation. CONCLUSIONS This study results suggest that a single-port thoracoscopic surgery might be a feasible option for pulmonary segmentectomy with acceptable postoperative outcomes in the early stages of lung cancer or for benign lung disease.
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Affiliation(s)
- Kook Nam Han
- Departments of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Departments of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Joo Lee
- Departments of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Choi
- Departments of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Kim HK, Quan YH, Choi BH, Park JH, Han KN, Choi Y, Kim BM, Choi YH. Intraoperative pulmonary neoplasm identification using near-infrared fluorescence imaging. Eur J Cardiothorac Surg 2015; 49:1497-502. [PMID: 26503731 DOI: 10.1093/ejcts/ezv367] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/10/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Near-infrared (NIR) fluorescence imaging provides surgeons with real-time visual information during surgery. The purpose of this pilot trial was to evaluate the safety and feasibility of the intraoperative detection of pulmonary neoplasms with NIR fluorescence imaging after low-dose indocyanine green (ICG) injection. METHODS Eleven consecutive patients who were scheduled to undergo resection of pulmonary neoplasms were enrolled in this study. ICG (1 mg/kg) was administered intravenously 1 day before surgery, and the retrieved surgical specimens were examined for fluorescence signalling by using NIR fluorescence imaging system on a back table in the operating room. We analysed the fluorescence intensity, pathology, size, depth from the pleural surface and metabolic activity of the pulmonary neoplasms. RESULTS Fluorescence signalling was detected in all specimens except in one from a patient with primary lung cancer. Two false-positive cases that presented no residual tumour with obstructive pneumonitis, after concurrent chemoradiation therapy for primary lung cancer before the operation, were identified, and their fluorescence intensity was 8.6 ± 0.4. The mean fluorescence intensity of the eight pulmonary tumours was 3.4 ± 1.9, and these tumours did not differ in pathology, size, depth from the pleural surface or metabolic activity. CONCLUSIONS NIR fluorescence imaging could safely identify pulmonary neoplasms after the systemic injection of ICG. In addition, low-dose ICG is sufficient for NIR fluorescence imaging of pulmonary neoplasms. However, because the passive accumulation of ICG could not be used to discriminate tumours with inflammation, tumour-targeted fluorescence should be developed to solve this problem in the future.
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Affiliation(s)
- Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yu Hua Quan
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byeong Hyeon Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji-Ho Park
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Seoul, Korea
| | - Kook Nam Han
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yeonho Choi
- Department of Bio-Convergence Engineering, Korea University, Seoul, Korea
| | - Beop-Min Kim
- Department of Bio-Convergence Engineering, Korea University, Seoul, Korea
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Shen Y, Wang H, Feng M, Xi Y, Tan L, Wang Q. Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study†. Eur J Cardiothorac Surg 2015; 49 Suppl 1:i48-53. [PMID: 26464451 DOI: 10.1093/ejcts/ezv358] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/09/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In this retrospective study, we aimed to compare single-port (SP) and multiport (MP) video-assisted thoracoscopic surgery (VATS) for the surgical resection of non-small-cell lung cancer (NSCLC). METHODS Between October 2013 and October 2014, a total of 411 consecutive NSCLC patients who underwent VATS lobectomy in the Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, were enrolled. Propensity-matched analysis, incorporating preoperative clinical features, was used to compare the perioperative outcomes and analyse the safety and efficacy between SP and MP VATS lobectomies for NSCLCs. RESULTS There were 115 patients in the SP group, and 296 patients in the MP group from October 2013 to October 2014. Propensity matching produced 100 pairs in this retrospective study. During the operation, the lobectomy took less time in the SP than in the MP (65.7 ± 14.8 vs 81.3 ± 13.6, P < 0.001) group, while the duration of lymphadenectomy was longer in the SP group (29.6 ± 16.7 vs 17.4 ± 13.3, P < 0.001). The total operation duration, the volume of estimated blood loss (55.1 ± 9.0 ml vs 58.7 ± 7.1 ml, P = 0.22) and the length of postoperative hospital stay (4.7 ± 1.2 days vs 5.3 ± 1.4 days, P = 0.05) were similar between the two groups. Postoperatively, SP and MP groups showed similar results in terms of morbidity and mortality. CONCLUSIONS In comparison with conventional VATS, SP VATS lobectomy showed better safety and efficacy in the surgical resection of NSCLCs. Further studies based on larger populations and better methodology are required to determine its further benefits towards patients.
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Affiliation(s)
- Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Yong Xi
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai, China
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