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Advanced Surgical Technologies for Lung Cancer Treatment: Current Status and Perspectives. ENGINEERED REGENERATION 2022. [DOI: 10.1016/j.engreg.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Li Z, Li Y, Wang L, Duan L, Gonzalez-Rivas D, Jiang G, Chen C. Management of calcified hilar lymph nodes during thoracoscopic lobectomies: avoidance of conversions. J Thorac Dis 2019; 11:657-663. [PMID: 31019752 DOI: 10.21037/jtd.2019.02.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Our objective in this paper is to introduce a new method for handling calcified hilar lymph nodes during lobectomies by video-assisted thoracoscopy that effectively avoids arterial injury and possible conversions. Methods The 12 cases in this study were initially evaluated as eligible and were subsequently scheduled for thoracoscopic lobectomies. However, calcification of the hilar lymph nodes was discovered during the operations, and its presence hampered the conventional process of pulmonary artery dissection. To avoid vessel injuries and subsequent massive bleeding, we developed two techniques specific to the position and exposure of the target vessels and nodes. The space between the bronchus and lymph nodes is exposed by sharp dissection ("scissor first") either before or after suturing the artery. These techniques are illustrated in detail. Results Seven male and five female patients participated in this study, with an average age of 72.5 years. We performed five right-upper lobectomies, three right-middle lobectomies, three right-lower lobectomies, and a left-lower lobectomy. Using this new technique, no conversions to thoracotomy occurred. The average operation time was 125 minutes, the mean blood loss was 275 mL, and no intra-operative massive bleeding occurred. Two patients experienced minor complications, one pulmonary infection and another postoperative subcutaneous emphysema. Conclusions The proposed "scissor first" technique provides an effective solution for the thoracoscopic management of calcified hilar lymph nodes, and is a safe and effective method for avoiding arterial injury and conversion.
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Affiliation(s)
- Zeyao Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yingze Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Long Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Liang Duan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.,Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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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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Yang SM, Hsu HH, Chen JS. Recent advances in surgical management of early lung cancer. J Formos Med Assoc 2017; 116:917-923. [DOI: 10.1016/j.jfma.2017.07.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022] Open
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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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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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Kim HK, Choi YH. The feasibility of single-incision video-assisted thoracoscopic major pulmonary resection performed by surgeons experienced with a two-incision technique. Interact Cardiovasc Thorac Surg 2014; 20:310-5. [PMID: 25476456 DOI: 10.1093/icvts/ivu405] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study evaluated the safety and feasibility of a single-incision video-assisted thoracoscopic surgery (VATS) major pulmonary resection performed by surgeons experienced with the two-incision technique. METHODS Consecutive patients who underwent single-incision VATS major pulmonary resection from March 2012 to May 2013 were included. The fifth intercostal space was incised (3-5 cm) at the anterior or posterior axillary line according to the tumour location. RESULTS In total, 60 patients (39 men, 21 women; median age, 61 years; interquartile range, 53-69 years) were included in this study. Malignant lung disease was diagnosed preoperatively in 56 patients (93%) and benign disease in 4 (7%) patients. Lobectomy was performed in the majority of patients (n = 55), bilobectomy in 1, sleeve lobectomy in 1 and segmentectomy in 3. Four patients (7%) required a second incision, and conversion to thoracotomy was required in 2 (3%). In 50 lung cancer cases completed using a single-incision technique, the median surgical duration was 145 min (interquartile range, 90-182 min), and the total number of dissected lymph nodes per patient was 22 (interquartile range, 10-28 min). The chest tube was removed 5 days (interquartile range, 3-6 days) postoperatively, and there were no cases involving major perioperative morbidity or mortality. CONCLUSIONS Single-incision VATS major pulmonary resection is feasible, and following a two-incision technique learning period, may yield results similar to those obtained with conventional VATS lobectomy.
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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
| | - Young Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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