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Luo K, Chen K, Li Y, Ji Y. Clinical evaluation of laryngeal mask airways in video-assisted thoracic surgery: a meta-analysis of randomized controlled trials. J Cardiothorac Surg 2024; 19:361. [PMID: 38915035 DOI: 10.1186/s13019-024-02840-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/14/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Endotracheal intubation is often associated with postoperative complications such as sore throat discomfort and hoarseness, reducing patient satisfaction and prolonging hospital stays. Laryngeal mask airway (LMA) plays a critical role in reducing airway complications related to endotracheal intubation. This meta-analysis was performed to determine the efficacy and safety of LMA in video-assisted thoracic surgery (VATS). METHODS The PubMed, Embase, Cochrane Library, Medline and Web of Science databases were searched for eligible studies from inception until October 5, 2023. Cochrane's tool (RoB 2) was used to evaluate the possibility biases of RCTs. We performed sensitivity analysis and subgroup analysis to assess the robustness of the results. RESULTS Seven articles were included in this meta-analysis. Compared with endotracheal intubation, there was no significant difference in the postoperative hospital stay (SMD = -0.47, 95% CI = -0.98-0.03, P = 0.06), intraoperative minimum SpO2 (SMD = 0.00, 95% CI = -0.49-0.49, P = 1.00), hypoxemia (RR = 1.00, 95% CI = 0.26-3.89, P = 1.00), intraoperative highest PetCO2 (SMD = 0.51, 95% CI = -0.12-1.15, P = 0.11), surgical field satisfaction (RR = 1.01, 95% CI = 0.98-1.03, P = 0.61), anesthesia time (SMD = -0.10, 95% CI = -0.30-0.10, P = 0.31), operation time (SMD = 0.06, 95% CI = -0.13-0.24, P = 0.55) and blood loss (SMD =- 0.13, 95% CI = -0.33-0.07, P = 0.21) in LMA group. However, LMA was associated with a lower incidence of throat discomfort (RR = 0.28, 95% CI = 0.17-0.48, P < 0.00001) and postoperative hoarseness (RR = 0.36, 95% CI = 0.16-0.81, P = 0.01), endotracheal intubation was found in connection with a longer postoperative awake time (SMD = -2.19, 95% CI = -3.49 - -0.89, P = 0.001). CONCLUSION Compared with endotracheal intubation, LMA can effectively reduce the incidence of throat discomfort and hoarseness post-VATS, and can accelerate the recovery from anesthesia. LMA appears to be an alternative to endotracheal intubation for some specific thoracic surgical procedures, and the efficacy and safety of LMA in VATS need to be further explored in the future.
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Affiliation(s)
- Kai Luo
- Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Kaiming Chen
- Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yu Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Ji
- Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Lee JH, Hong JI, Kim HK. Single-port robotic subcostal major pulmonary resection using the single-port robotic system. World J Surg 2024; 48:713-722. [PMID: 38501549 DOI: 10.1002/wjs.12051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/01/2023] [Indexed: 03/20/2024]
Abstract
BACKGROUND The da Vinci single-port system (SPS) (Intuitive Surgical, Sunnyvale, CA, USA) was designed for single-port (SP) surgery. Although we have reported our clinical outcomes using the SPS for a simple procedure in general thoracic surgery, major pulmonary resection had been performed only in cadaveric experiments to date. This study evaluated the feasibility of SP subcostal robotic major pulmonary resection using the SPS. Here, we present our initial clinical experience of SP subcostal robotic major pulmonary resection at our institution. METHODS Twenty-five patients with lung cancer underwent SP major subcostal pulmonary resection using the SPS between March and November 2022. Patient characteristics, intraoperative and perioperative outcomes were assessed. Questionnaires were used to evaluate patient satisfaction with the cosmetic results and quality of life through face-to-face or telephone interviews on postoperative day 30. RESULTS All patients underwent major pulmonary resection with complete radical resection (R0). Nineteen patients underwent lobectomy, whereas six patients underwent segmentectomy. The mean docking time and total operative time were 4.16 ± 1.19 min (range, 2.3-7.8 min) and 197.6 ± 55.33 min (range, 130-313 min), respectively. No patients underwent conversion to open thoracotomy. One patient required an additional assistant port due to severe pleural adhesions. CONCLUSIONS SP subcostal robotic major pulmonary resection using the SPS is feasible and safe. With the continuous development of robotic technology and surgical techniques, we believe that more complex general thoracic surgeries will be performed in the future using SPS.
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Affiliation(s)
- Jun Hee Lee
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jeong In Hong
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Szabo Z, Fabo C, Szarvas M, Matuz M, Oszlanyi A, Farkas A, Paroczai D, Lantos J, Furak J. Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years. J Clin Med 2023; 12:6457. [PMID: 37892595 PMCID: PMC10607362 DOI: 10.3390/jcm12206457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Non-intubated thoracic surgery has not achieved widespread acceptance despite its potential to improve postoperative outcomes. To ensure airway safety, our institute has developed a technique combining spontaneous ventilation with double-lumen tube intubation (SVI). This study aimed to verify the feasibility and limitations of this SVI technique. METHODS For the SVI method, anesthesia induction involves fentanyl and propofol target-controlled infusion, with mivacurium administration. Bispectral index monitoring was used to ensure the optimal depth of anesthesia. Short-term muscle relaxation facilitated double-lumen tube intubation and early surgical steps. Chest opening preceded local infiltration, followed by a vagal nerve blockade to prevent the cough reflex and a paravertebral blockade for pain relief. Subsequently, the muscle relaxant was ceased. The patient underwent spontaneous breathing without coughing during surgical manipulation. RESULTS Between 10 March 2020 and 28 October 2022, 141 SVI surgeries were performed. Spontaneous respiration with positive end-expiratory pressure was sufficient in 65.96% (93/141) of cases, whereas 31.21% (44/141) required pressure support ventilation. Only 2.84% (4/141) of cases reversed to conventional anesthetic management, owing to technical or surgical difficulties. Results of the 141 cases: The mean maximal carbon dioxide pressure was 59.01 (34.4-92.9) mmHg, and the mean lowest oxygen saturation was 93.96% (81-100%). The mean one-lung, mechanical and spontaneous one-lung ventilation time was 74.88 (20-140), 17.55 (0-115) and 57.73 (0-130) min, respectively. CONCLUSIONS Spontaneous ventilation with double-lumen tube intubation is safe and feasible for thoracic surgery. The mechanical one-lung ventilation time was reduced by 76.5%, and the rate of anesthetic conversion to relaxation was low (2.8%).
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Affiliation(s)
- Zsolt Szabo
- Doctoral School of Multidisciplinary Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Csongor Fabo
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Matyas Szarvas
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Maria Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, H-6720 Szeged, Hungary
| | - Adam Oszlanyi
- Department of Anesthesiology and Intensive Therapy, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Attila Farkas
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, H-9700 Szombathely, Hungary
| | - Dora Paroczai
- Department of Medical Microbiology, University of Szeged, H-6720 Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Jozsef Furak
- Department of Surgery, University of Szeged, H-6720 Szeged, Hungary
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Wang L, Ge L, Song S, Ren Y. Clinical applications of minimally invasive uniportal video-assisted thoracic surgery. J Cancer Res Clin Oncol 2023; 149:10235-10239. [PMID: 37269347 DOI: 10.1007/s00432-023-04920-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND In recent years, the field of minimally invasive thoracic surgery has experienced significant advancements driven by improvements in video-assisted thoracoscopic surgery (VATS) techniques and surgical instruments. These advances have given rise to uniportal VATS as a new area of exploration in minimally invasive thoracic surgery. This technique presents several potential advantages, including reduced access trauma, less postoperative pain, improved cosmesis, fewer complications, shorter hospital stays, and faster rehabilitation, ultimately leading to an improvement in patient quality of life. PURPOSE This article reviews the evolutionary history of minimally invasive thoracic surgery, highlights novel techniques, explores possible applications and obtained results, and discusses future prospects of uniportal VATS. CONCLUSION Experienced thoracic surgeons have demonstrated the capacity to perform uniportal VATS with a high level of safety and efficacy. Further studies are necessary to assess its long-term efficacy, address limitations, and enhance clinical decision-making for optimal treatment of thoracic conditions.
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Affiliation(s)
- Linlin Wang
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, No. 11, Beihai Street, Dadong District, Shenyang, 110044, Liaoning, People's Republic of China
| | - Lihui Ge
- Department of Health Management, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, HePing District, Shenyang, 110004, Liaoning, People's Republic of China
| | - Shiyuan Song
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, No. 11, Beihai Street, Dadong District, Shenyang, 110044, Liaoning, People's Republic of China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital & Tenth People's Hospital, No. 11, Beihai Street, Dadong District, Shenyang, 110044, Liaoning, People's Republic of China.
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Chen-Yoshikawa TF. Is it true that less is more in thoracic surgery? J Thorac Dis 2022; 14:3674-3676. [PMID: 36389325 PMCID: PMC9641330 DOI: 10.21037/jtd-22-951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/04/2022] [Indexed: 12/01/2023]
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Abdel Jalil R, Abou Chaar MK, Al-Qudah O, Al-Edwan A, Almajali O, Ababneh H, U'wais A, Al-Ghazawi M, Al-Najjar H, Abu-Shanab A. Early surgical and oncological outcomes during adoption of a single port VATS lung resection in a tertiary cancer center: a retrospective analysis. J Cardiothorac Surg 2022; 17:26. [PMID: 35236401 PMCID: PMC8890027 DOI: 10.1186/s13019-022-01777-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Background Video-assisted thoracoscopic surgery (VATS) is a safe and effective surgical approach for pulmonary resection. VATS can be accomplished with only a single incision, resulting in less postoperative pain and paresthesia, better cosmetic results, and greater patient satisfaction. Single-port VATS (spVATS) has become increasingly common for lung resection. We assess the early surgical and oncological outcomes after adopting this new technique at our tertiary cancer center as the first institution to do so in the country. Method Medical records for 257 patients in a tertiary cancer center, with a diagnosis of non-small cell lung cancer, pulmonary metastasis, or other chest-confined pathology, were accessed to obtain perioperative outcomes, pathologic results, post-operative follow-up data, and early surgical and oncological outcomes. All patients underwent spVATS for limited or major lung resection. Simple descriptive analysis was utilized. Results spVATS was either performed with curative intent (79.8%, N = 205), or as a diagnostic procedure (20.2%, N = 52). Resection types were subcategorized for curative intent group as limited (73.6%, N = 151), lobectomy (16.6%, N = 34), and complex (9.7%, N = 20). Resection with a negative margin (R0) rate was 100% for the primary lung cancer (PLC) patients and 97% for the pulmonary metastasectomy (PM) group. The complication rate was 5%. Three-year disease-free survival was 87% and 68.5% for PLC and PM group, respectively. The 3-year overall-survival was 91.3% for the PLC and 82.8% for PM. Operation duration showed a downtrend over the study period in each curative subcategory with a borderline difference in the limited resection (P value = 0.05).
Conclusion All the spVATS procedures were successfully performed without perioperative severe complications or mortality, regardless of complexity. R0 resection was excellent. Middle- and long-term efficacies of spVATS for lung cancer require further follow-up. With proper training, appropriate indication and meticulous application, adopting spVATS is safe and feasible technique that does not compromise surgical and oncological outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01777-y.
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Affiliation(s)
- Riad Abdel Jalil
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan.
| | | | - Obada Al-Qudah
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Ahed Al-Edwan
- Department of Anesthesia, King Hussein Cancer Center, Amman, Jordan
| | - Omar Almajali
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Hazim Ababneh
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Ahmad U'wais
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Munir Al-Ghazawi
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Hani Al-Najjar
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ahmad Abu-Shanab
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
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Wang K, Zhang J, Li J, Liu L, Tang Z, Du X. aBVA Procedure by Uniportal Video-Assisted Thoracoscopic Surgery for Right Upper Peripheral Lung Cancer: A Randomized Trial. Front Oncol 2022; 12:828432. [PMID: 35186761 PMCID: PMC8850830 DOI: 10.3389/fonc.2022.828432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 12/25/2022] Open
Abstract
Objective This study aims to determine the optimal dividing order of anatomic pulmonary resection under uniportal video-assisted thoracoscopic surgery (uni-VATS) for patients with right upper peripheral lung cancer. Methods Patients who met the eligibility criteria were randomly allocated into the aBVA and VAB groups. In the aBVA group, the surgical procedure proceeded from the posterior to the anterior region (from the deeper to the superficial site). In the VAB group, the dissection orders were vein first followed by arterial branches, followed by the bronchus. Clinical data were collected and analyzed. Results Sixty patients were randomly allocated to the aBVA group (n = 30) and the VAB group (n = 30). The operation time in the aBVA group (230.500 ± 68.360 min) was significantly shorter than that in the VAB group (305.600 ± 107.821 min) (p = 0.01). The blood loss in the aBVA group (104.000 ± 70.935 ml) was significantly lower than that in the VAB group (391.000 ± 625.175 ml) (p = 0.01). Two patients in the VAB group underwent conversion to 2-portal VATS. The number of lymph nodes (13.367 ± 5.436 vs. 10.333 ± 7.279, p = 0.072) and lymph node stations (5.067 ± 1.574 vs. 4.467 ± 2.345, p = 0.567) were comparable between the two groups. The differences in the postoperative drainage tube time (5.033 ± 3.113 vs. 6.467 ± 4.447 days, p = 0.278) and hospital stay (8.233 ± 3.390 vs. 9.433 ± 4.523 days, p = 0.361) were not significantly different between the two groups. Conclusion Compared with the VBA procedure, aBVA is easier for patients with right upper peripheral lung cancer who undergo uni-VATS lobectomy.
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Affiliation(s)
- Kaiying Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jian Zhang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jianglun Li
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Langbo Liu
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhongben Tang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiaojun Du
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Risk Assessment for Loss-of-Exercise Capacity After Lung Cancer Surgery: Current Advances in Surgery and Systemic Treatment. World J Surg 2022; 46:933-941. [PMID: 35006325 DOI: 10.1007/s00268-021-06427-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Considering advances in current post-recurrence treatment, we examined the prognostic significance of the number of risk factors for loss-of-exercise capacity (LEC) after lung cancer surgery, which were identified by our previous prospective observational study. METHODS Risk factors for LEC were defined as a short baseline 6-min walk distance (<400 m), older age (≥75 years), and low predicted postoperative diffusing capacity for carbon monoxide (<60%). Patients were classified as Risk 0/I/II/III according to the number of risk factors. The survival data were retrospectively analyzed. RESULTS Between 2014 and 2017, 564 patients (n = 307, 193, 57, 7; Risk 0/I/II/III) who underwent lung cancer surgery were included in the study. The number of risk factors was associated with smoking status, predicted postoperative forced expiratory volume in 1 s, histology, pathological stage, and adjuvant therapy. In a multivariate Cox regression analysis, compared to Risk 0, Risk I/II/III showed significant associations with overall survival (hazard ratios: 1.92, 3.35, 9.21; 95% confidence interval: 1.27-2.92, 2.01-5.58, 3.64-23.35; Risk I/II/III, respectively). In 141 patients with recurrence, molecular targeted therapies (MTTs) or immune checkpoint inhibitors (ICIs) were included in 58%, 47%, 32%, and 0% (Risk 0/I/II/III) during the course of treatment. In patients with MTT/ICI treatment, the estimated 1-year and 3-year post-recurrence survival rates were 88% and 58%, respectively. CONCLUSIONS Risk classification for LEC was associated with survival after lung cancer surgery, as well as post-recurrence treatment. The concept of physical performance-preserving surgery may contribute to improving the outcomes of current lung cancer treatment.
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Ugolini S, Coletta R, Lo Piccolo R, Dell'Otto F, Voltolini L, Gonfiotti A, Morabito A. Uniportal Video-Assisted Thoracic Surgery in a Pediatric Hospital: Early Results and Review of the Literature. J Laparoendosc Adv Surg Tech A 2022; 32:713-720. [PMID: 34990275 DOI: 10.1089/lap.2021.0180] [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: 10/19/2022] Open
Abstract
Background: Uniportal video-assisted thoracic surgery (U-VATS) is an implemented technique in adult surgery that may aid to extend offer the benefits of thoracoscopy to a wide number of pediatric patients. Materials and Methods: Consecutive cases treated between July 2019 and July 2021 were retrospectively analyzed. Simultaneously, a MEDLINE systematic search was conducted. Results: Twelve patients (median age 13 years, median weight 44.5 kg) underwent 4 major procedures (n = 2 lobectomy, n = 2 segmentectomy) and 11 minor procedures (n = 1 bronchogenic cyst resection, n = 4 apical wedge resections and pleurodesis for pneumothorax, n = 4 wedge resections for lung nodules, and n = 2 debridement for empyema). The median observed operative time was 77 minutes. We recorded one conversion to biportal VATS. No intraoperative complications or 30-day morbidity-mortality was reported. A rate of 40% adverse postoperative events was observed (Clavien-Dindo grade I-IVa). Visual analog scale for postoperative pain recorded a median value of 0 on days 1, 2, and 3. The systematic review provided 15 full-text articles reporting 76 pediatric interventions (4 major and 72 minor procedures); among them, 1 biportal conversion, 3 mild postoperative complications, and 1 redo surgery are presented. Conclusions: As emerged from the literature review, U-VATS remains scarcely adopted by pediatric surgeons. Its feasibility is supported by the four reported major lung resections plus the four cases added on by our series. Thanks to a more rapid learning curve over conventional VATS, the uniportal technique could be accessible to a wider number of centers.
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Affiliation(s)
- Sara Ugolini
- Department of Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence, Italy
| | - Riccardo Coletta
- Department of Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence, Italy.,School of Environment and Life Science, University of Salford, Salford, United Kingdom
| | - Roberto Lo Piccolo
- Department of Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence, Italy
| | - Fabio Dell'Otto
- Department of Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Luca Voltolini
- Department of Thoracic Surgery, University Hospital Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine (DMSC), University of Florence, Florence, Italy
| | - Alessandro Gonfiotti
- Department of Thoracic Surgery, University Hospital Careggi, Florence, Italy.,Department of Experimental and Clinical Medicine (DMSC), University of Florence, Florence, Italy
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital Academic Centre, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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Shi H, Shan Y, Yu G, Lu Y, Kong H, Jiang X, Shen Z, Sun F. Application of three-dimensional reconstruction technology combined with three-dimensional printing in the treatment of pectus excavatum. Ann Thorac Med 2022; 17:173-179. [PMID: 35968400 PMCID: PMC9374120 DOI: 10.4103/atm.atm_506_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/18/2022] [Indexed: 11/04/2022] Open
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Chen-Yoshikawa TF, Fukui T, Nakamura S, Ito T, Kadomatsu Y, Tsubouchi H, Ueno H, Sugiyama T, Goto M, Mori S, Ozeki N, Hakiri S, Kawaguchi K. Current trends in thoracic surgery. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:161-174. [PMID: 32581397 PMCID: PMC7276403 DOI: 10.18999/nagjms.82.2.161] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Thoracic surgery has evolved drastically in recent years. Although thoracic surgeons mainly deal with tumorous lesion in the lungs, mediastinum, and pleura, they also perform lung transplantation surgery in patients with end-stage lung disease. Herein, we introduce various major current topics in thoracic surgery. Minimally invasive surgical procedures include robot-assisted thoracic surgery and uniportal video-assisted thoracic surgery. Novel techniques for sublobar resection include virtual-assisted lung mapping, image-guided video-assisted thoracic surgery, and segmentectomy using indocyanine green. Three-dimensional (3D) computed tomography (CT) simulation consists of surgeon-friendly 3D-CT image analysis systems and new-generation, dynamic 3D-CT imaging systems. Updates in cadaveric lung transplantation include use of marginal donors, including donation after circulatory death, and ex vivo lung perfusion for such donors. Topics in living donor lobar lung transplantation include size matching, donor issues, and new surgical techniques. During routine clinical practice, thoracic surgeons encounter various pivotal topics related to thoracic surgery, which are described in this report.
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Affiliation(s)
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshinari Ito
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuka Kadomatsu
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Tsubouchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Harushi Ueno
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoshi Sugiyama
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Goto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Mori
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuhei Hakiri
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Kawaguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Furák J, Paróczai D, Burián K, Szabó Z, Zombori T. Oncological advantage of nonintubated thoracic surgery: Better compliance of adjuvant treatment after lung lobectomy. Thorac Cancer 2020; 11:3309-3316. [PMID: 32985138 PMCID: PMC7606006 DOI: 10.1111/1759-7714.13672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Video-assisted thoracoscopic (VATS) surgery contributes to improved survival, adjuvant chemotherapy delivery and less postoperative complications. Nonintubated thoracic surgery (NITS) VATS procedures improves immunological responses in lung cancer patients; however, there is no data regarding adjuvant chemotherapy delivery effectiveness following NITS lobectomies. In this study, we aimed to compare protocol compliance and toxic complications during adjuvant chemotherapy after intubated and nonintubated VATS lobectomies in non-small cell lung cancer (NSCLC). METHODS We retrospectively reviewed the medical records of 66, stage IB-IIIB NSCLC patients who underwent intubated or nonintubated VATS lobectomy and received adjuvant chemotherapy. RESULTS A total of 38 patients (17 males, mean age 64 years) underwent conventional VATS and 28 (7 males; mean age 63 years) uniportal VATS NITS. Both groups had comparable demographic data, preoperative pulmonary function, and Eastern Cooperative Oncology Group (ECOG) status. Among the intubated and nonintubated patients, 82% and 75% were diagnosed with adenocarcinoma, respectively. The incidence of adenocarcinoma and squamous cell carcinoma cases were similar in both groups; however, the pathological staging showed significant differences, as 5 (18%) nonintubated patients had stage IB lung cancer, compared with the intubated group (P = 0.01). Further distribution of stages was similar between the groups. We observed significant differences in chest tube duration and operation time in the nonintubated group (P < 0.01). Among nonintubated patients, 92% completed the planned chemotherapy protocol, compared to 71% of the intubated group (P = 0.035). Grade 1/2 toxicity occurred significantly more often in the intubated group (16% vs. 0%, P = 0.03) and there was a lower incidence of grade 4 neutropenia in the nonintubated group (0% vs. 16%, P = 0.03). CONCLUSIONS Our results showed that the nonintubated procedure resulted in improved adjuvant chemotherapy compliance and lower toxicity rates after lobectomy. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Oncological advantage of the non-intubated thoracic surgery: better compliance with therapy protocol. What this study adds NITS lobectomies contribute to better administration of adjuvant chemotherapy with the planned cycle number and dosage.
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Affiliation(s)
- József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Dóra Paróczai
- Department of Pulmonology, University of Szeged, Deszk, Hungary.,Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Szeged, Hungary
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13
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Moon Y. Initial experience with uniportal video-assisted thoracoscopic surgery for the treatment of lung cancer performed by a surgeon who did not have previous experience performing multiportal thoracoscopic surgery: a single center retrospective study. J Thorac Dis 2020; 12:1972-1981. [PMID: 32642100 PMCID: PMC7330296 DOI: 10.21037/jtd-20-242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background The purpose of this study was to evaluate the surgical outcome of uniportal video-assisted thoracoscopic surgery (VATS) for the treatment of non-small cell lung cancer performed by a surgeon who did not have previous experience performing open thoracotomy and multiportal VATS. Methods From January 2017 to December 2018, 85 patients underwent uniportal VATS anatomical pulmonary resection performed by one surgeon. The remaining 269 patients underwent multiportal VATS performed by other experienced surgeons. Clinicopathological characteristics and surgical outcomes of the uniportal VATS and multiportal VATS groups were compared. Results The uniportal VATS procedures included 7 segmentectomies, 66 lobectomies, 1 bilobectomy, and 1 pneumonectomy. There was no conversion to multiportal VATS or open thoracotomy. Patients who underwent multiportal VATS surgery were older, more often men, and more often smokers than those who underwent uniportal VATS. Other clinicopathological characteristics were not statistically different between the two groups. The number of dissected lymph nodes was higher in uniportal VATS than in multiportal VATS (16.8 vs. 14.6, P=0.030). Anesthetic time and operative time were shorter in uniportal VATS than in multiportal VATS (both P<0.001). Intraoperative blood loss was also less in the uniportal VATS group than in the multiportal VATS group (P<0.001). There were no statistical between-group differences in chest tube drainage period, hospital stay, postoperative complication rate, and operative mortality rate. Conclusions Uniportal VATS for pulmonary anatomical resection of non-small cell lung cancer performed by a surgeon without previous multiportal VATS experience yielded acceptable surgical outcomes.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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14
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Furák J, Szabó Z, Tánczos T, Paszt A, Rieth A, Németh T, Pécsy B, Ottlakán A, Rárosi F, Lázár G, Molnár Z. Conversion method to manage surgical difficulties in non-intubated uniportal video-assisted thoracic surgery for major lung resection: simple thoracotomy without intubation. J Thorac Dis 2020; 12:2061-2069. [PMID: 32642108 PMCID: PMC7330381 DOI: 10.21037/jtd-19-3830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background The major limitations of widespread use of non-intubated thoracic surgery (NITS) is the fear of managing complications. Here we present our practice of converting from uniportal video-assisted thoracic surgery (VATS) NITS to open NITS in cases of surgical complications. Methods The study period was from January 26, 2017, to November 30, 2018. Total intravenous anesthesia was provided with propofol guided by bispectral index, and the airway was maintained with a laryngeal mask with spontaneous breathing. Local anesthesia with 2% lidocaine at the skin incision, and intercostal and vagus nerve blockades were induced using 0.5% bupivacaine. For conversion with surgical indications, a thoracotomy was performed at the incision without additional local or general anesthetics. Results In 160 complete NITS procedures, there were 145 VATS NITS and 15 open NITS (9 conversions to open NITS and 6 intended NITS thoracotomies). In the 15 open NITS cases (2 pneumonectomies, 1 bilobectomy, 1 sleeve lobectomy, 7 lobectomies, 3 sublobar resections, 1 exploration), the mean operative time was 146.7 (105–225) and 110 (75–190) minutes in the converted and intended open NITS groups, respectively. There were no significant differences between systolic blood pressure (P=0.316; 95% CI, −10.469 to 3.742), sat O2% (P=0.27; 95% CI, −1.902 to 0.593), or propofol concentration in the effect site (P=0.053; 95% CI, −0.307 to 0.002) but significant differences in pulse (P=0.007; 95% CI, −10.001 to −2.72), diastolic blood pressure (P=0.013; 95% CI, −9.489 to −1.420) and in end-tidal CO2 (P=0.016; 95% CI, −7.484 to −0.952) before versus after thoracotomy, but there was no clinical relevance of the differences. Conclusions For conversion with surgical indications during the VATS-NITS procedure, NITS thoracotomy can be performed safely at the site of the utility incision without the need for additional drugs, and the major lung resections can be performed through this approach.
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Affiliation(s)
- József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Department of Anesthesiology, University of Szeged, Szeged, Hungary
| | - Tamás Tánczos
- Department of Anesthesiology, University of Szeged, Szeged, Hungary
| | - Attila Paszt
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Anna Rieth
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Tibor Németh
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Balázs Pécsy
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Aurél Ottlakán
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Ferenc Rárosi
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Zsolt Molnár
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
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15
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Chen PH, Hung WT, Chen JS. Nonintubated Video-Assisted Thoracic Surgery for the Management of Primary and Secondary Spontaneous Pneumothorax. Thorac Surg Clin 2020; 30:15-24. [PMID: 31761280 DOI: 10.1016/j.thorsurg.2019.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Nonintubated video-assisted thoracoscopic surgery for the treatment of primary and secondary pneumothorax was first reported in 1997 by Nezu. However, studies on this technique are few. Research in the past 20 years has focused on the perioperative outcomes, including the surgical duration, length of hospital stay, and postoperative morbidity and respiratory complication rates, which appear to be better than those of surgery under intubated general anesthesia. This study provides information pertaining to the physiologic, surgical, and anesthetic aspects and describes the potential benefits of nonintubated thoracoscopic surgery for the management of primary and secondary spontaneous pneumothorax.
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Affiliation(s)
- Pei-Hsing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, No. 579, Sec. 2, Yun-Lin Road, Douliu City, Yun-Lin County 64041, Taiwan
| | - Wan-Ting Hung
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan.
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16
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Abstract
Hemothorax is a collection of blood in the pleural cavity usually from traumatic injury. Chest X-ray has historically been the imaging modality of choice upon arrival to the hospital. The sensitivity and specificity of point-of-care ultrasound, specifically through the Extended Focal Assessment with Sonography in Trauma (eFAST) protocol has been significant enough to warrant inclusion in most Level 1 trauma centers as an adjunct to radiographs.1,2 If the size or severity of a hemothorax warrants intervention, tube thoracostomy has been and still remains the treatment of choice. Most cases of hemothorax will resolve with tube thoracostomy. If residual blood remains within the pleural cavity after tube thoracostomy, it is then considered to be a retained hemothorax, with significant risks for developing late complications such as empyema and fibrothorax. Once late complications occur, morbidity and mortality increase dramatically and the only definitive treatment is surgery. In order to avoid surgery, research has been focused on removing a retained hemothorax before it progresses pathologically. The most promising therapy consists of fibrinolytics which are infused into the pleural space, disrupting the hemothorax, allowing for further drainage. While significant progress has been made, additional trials are needed to further define the dosing and pharmacokinetics of fibrinolytics in this setting. If medical therapy and early procedures fail to resolve the retained hemothorax, surgery is usually indicated. Surgery historically consisted solely of thoracotomy, but has been largely replaced in non-emergent situations by video-assisted thoracoscopy (VATS), a minimally invasive technique that shows considerable improvement in the patients' recovery and pain post-operatively. Should all prior attempts to resolve the hemothorax fail, then open thoracotomy may be indicated.
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17
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Comparison of Diagnostic Yield and Safety between Semirigid Pleuroscopic Cryobiopsy and Forceps Biopsy for Undiagnosed Pleural Effusion. Can Respir J 2019; 2019:5490896. [PMID: 31929846 PMCID: PMC6939421 DOI: 10.1155/2019/5490896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 01/09/2023] Open
Abstract
For undiagnosed pleural effusion, diagnostic yields and safety were similar between pleuroscopic cryobiopsy and forceps biopsy, but cryobiopsy obtained a larger pleural tissue sample than forceps biopsy.
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18
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Yeung C, Dawson J, Gilbert S. Uniportal video-assisted thoracoscopy approach to the management of non-pulmonary diseases of the chest. J Thorac Dis 2019; 11:S2062-S2068. [PMID: 31637039 DOI: 10.21037/jtd.2019.03.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of uniportal video-assisted thoracoscopy (u-VATS) is becoming a commonly used surgical technique and can be an effective approach for the surgical treatment of many pulmonary and non-pulmonary conditions. This review article summarizes current medical evidence informing the practice of u-VATS for treating non-pulmonary conditions including hyperhidrosis, hemothorax, pleural effusion, and thymic disease.
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Affiliation(s)
- Ching Yeung
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada.,Faculty of Medicine, Department of Surgery, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
| | - Jennifer Dawson
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
| | - Sebastien Gilbert
- The Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada.,Faculty of Medicine, Department of Surgery, University of Ottawa, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
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19
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Li X, Wang X, Zhang H, Cheng H, Cao Q. Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae. J Cardiothorac Surg 2019; 14:71. [PMID: 30971282 PMCID: PMC6458681 DOI: 10.1186/s13019-019-0894-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/01/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Rapid rehabilitation surgery has become a widely accepted approach. Thoracic surgeons have attempted in many ways to make surgery less invasive. We combined tubeless technology, single-port technology and mediastinum approach for the treatment of simultaneous bilateral primary spontaneous pneumothorax(PSP)or pulmonary bullae. And we evaluated its therapeutic effect. This study aimed to investigate if tubeless single-port video-assisted thoracic surgery (Tubeless-SPVATS) via anterior mediastinum can be used as an alternative surgical treatment for bilateral lung diseases, especially for concurrent or contralateral recurrence PSP. METHODS From November 2014 to December 2016, 18 patients with simultaneous bilateral PSP or pulmonary bullae were treated with tubeless -SPVATS via anterior mediastinum. They were 13 males and 5 females with an average age of 20.2 ± 2.3 years (17 to 24 years). They all had preoperative chest CT and were diagnosed with simultaneous bilateral PSP or pulmonary bullae. RESULTS Fifteen patients underwent bilateral bullae resection with Tubeless-SPVATS via anterior mediastinum. Three patients underwent bilateral single-port video-assisted thoracic surgery. No thoracotomy was performed. No death and grade 3-4 mobidity were found. All the patients started eating 6 hours after surgery. The average operation time was 44.56±17.8min. The patients were discharged 3. 5±1.0 days postoperatively. CONCLUSIONS Tubeless-SPVATS via anterior mediastinum is a safe and feasible treatment for patients with simultaneous bilateral PSP or pulmonary bullae. However,contralateral thoracic is not explored fully enough. And when contralateral lung bullae are located near the hilum, endoscopic linear stapler cannot be easily used to conduct suture. Thus, the recurrence rate after performing Tubeless-SPVATS may be increased compared to performing thoracotomy. However, compared to bilateral thoracic surgery, this method reduced postoperative pain. And it took significantly less time than bilateral thoracic surgery. Thus, this method has some clinic value.
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Affiliation(s)
- Xiaojian Li
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China
| | - Xiaojin Wang
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China
| | - Huayong Zhang
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China
| | - Hua Cheng
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China
| | - Qingdong Cao
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, Guangdong, China.
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20
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Mao Y, Yu Y, Han Y. Influence of thoracic drainage fluid on proliferation, migration, apoptosis, and drug resistance in lung cancer cell lines. Cancer Manag Res 2019; 11:2253-2259. [PMID: 30962714 PMCID: PMC6433100 DOI: 10.2147/cmar.s187019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to clarify the effect of thoracic drainage fluid (DF) on lung cancer cells in vitro. Methods We assessed the influence of DF on the proliferation and migration of lung cancer cells (LTEP-a-2 and A549) using the MTT cell proliferation assay and scratch wound assay. Cell apoptosis was determined by flow cytometric analysis. We also investigated the effect of DF on drug chemosensitivity, assessing viability of LTEP-a-2 and A549 cells. Results The proliferative rates of cancer cells in the DF-treated group were significantly higher than those of the control group. Similar results were obtained for cell migration of lung cancer cells. Cells in the DF-treated groups showed a lower percentage of apoptosis than those of the control groups. Chemosensitivity of lung cancer cells to doxycycline and cisplatin (DDP) was lowered by DF. Conclusion These findings suggest that DF affects lung cancer cells by promoting proliferation and migration, inhibiting apoptosis, and increasing drug resistance.
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Affiliation(s)
- Yuqiang Mao
- Department of Thoracic Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China,
| | - Ying Yu
- Liaoning Medical Device Test Institute, Shenyang 110179, China
| | - Yun Han
- Department of Thoracic Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China,
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21
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Fernandez-Pineda I, Seims AD, VanHouwelingen L, Abdelhafeez H, Wu H, Wu J, Murphy AJ, Davidoff AM. Modified Uniportal Video-Assisted Thoracic Surgery Versus Three-Port Approach for Lung Nodule Biopsy in Pediatric Cancer Patients. J Laparoendosc Adv Surg Tech A 2019; 29:409-414. [DOI: 10.1089/lap.2018.0120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Aaron D. Seims
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Lisa VanHouwelingen
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Hafeez Abdelhafeez
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Huiyun Wu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jianrong Wu
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew J. Murphy
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew M. Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
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22
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Migliore M. Uniportal video-assisted thoracic surgery: twentieth anniversary. J Thorac Dis 2019; 10:6442-6445. [PMID: 30746185 DOI: 10.21037/jtd.2018.12.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marcello Migliore
- Thoracic Surgery, Policlinico University Hospital, University of Catania, Catania, Italy
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23
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Abstract
The role of anatomic segmentectomy as an acceptable, lung parenchymal sparing alternative to pulmonary lobectomy for the small peripheral stage I lung cancer is under great scrutiny today. This is not a new consideration, particularly for the patient with impaired cardiopulmonary reserve where preservation of lung function may be a critical issue in deciding on surgical resection for local/regional control of their cancer. In this review, we discuss the oncologic issues along with past and present evidence supporting "anatomic" lung preservational surgery in the management of lung cancer.
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Affiliation(s)
- Rodney J Landreneau
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Matthew J Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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24
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Hiebinger A, Bodner J. Video-assisted thoracic surgery double sleeve resections: the next step. J Thorac Dis 2018; 10:5659-5660. [PMID: 30505472 DOI: 10.21037/jtd.2018.09.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andreas Hiebinger
- Department of Thoracic Surgery, Klinikum Bogenhausen, Munich, Germany
| | - Johannes Bodner
- Department of Thoracic Surgery, Klinikum Bogenhausen, Munich, Germany
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25
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Nachira D, Meacci E, Petracca Ciavarella L, Chiappetta M, De Santis G, Ferretti GM, Mastromarino MG, Porziella V, Vita ML, Congedo MT, Cesario A, Ismail M, Gonzalez-Rivas D, Margaritora S. Uniportal video-assisted thoracic surgery Roman experience-a report of the first 16-month Roman experience. J Thorac Dis 2018; 10:S3678-S3685. [PMID: 30505552 DOI: 10.21037/jtd.2018.03.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The acceptance of uniportal video-assisted thoracic surgery (U-VATS) for thoracic procedures has been growing worldwide. This study reports one of the widest Italian U-VATS experiences. Methods The prospectively collected data of 237 patients underwent a U-VATS procedure, between May 2016 and September 2017, were retrospectively reviewed. A wide range of procedures, like major and minor lung resections, esophageal surgery, pleural and mediastinal one, was performed. The main aim of the study was evaluating general outcomes in terms of safety and effectiveness, and analyzing short-term results of U-VATS approach. Results The mean age of population was 59.93±16.03 years. In 208 cases (85.3%) a U-VATS lung resection was performed, in 10 cases (4.1%) an esophagectomy or an esophageal diverticulectomy, in 15 (6.1%) a mediastinal procedure and in 11 (4.5%) a toilette for pleural empyema or removal of pleural lesions. The chest tube duration was 4.24±3.73 days and the postoperative hospital stay was 4.62±4.59 days. The intraoperative and thirty-day mortality were null. Mean level of pain in I postoperative day was 2.30±1.26 on VAS scale and the mean duration was of 1.54±1.21 days. In 93% of cases there was a resolution of pain after chest tube removal. Furthermore, the average level of cosmetic satisfaction was 2.73±0.49 (measured on a 0-3 scale). Conclusions According to our experience, U-VATS seems to be a safe and practicable mini-invasive technique, above all for surgeons who already have thoracoscopy experience or made proper training attending multilevel courses, hands-on conferences and wet-labs.
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Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Leonardo Petracca Ciavarella
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Marco Chiappetta
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Giulia De Santis
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Gian Maria Ferretti
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Maria Giovanna Mastromarino
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Venanzio Porziella
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Alfredo Cesario
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
| | - Mahmoud Ismail
- Competence Center of Thoracic Surgery, Department of Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.,Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A.Gemelli", Rome, Italy
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26
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Lirio F, Galvez C, Bolufer S, Corcoles JM, Gonzalez-Rivas D. Tubeless major pulmonary resections. J Thorac Dis 2018; 10:S2664-S2670. [PMID: 30345103 DOI: 10.21037/jtd.2018.06.48] [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: 11/06/2022]
Abstract
From its inception, cutting edge minimally invasive thoracic surgery has pursued to barely produce patient perturbation. Although state of the art techniques such as uniportal approach have achieved a remarkable reduction in postoperative morbidity, there is still a way to go in patient comfort. A new 'tubeless' concept has surfaced as an alternative to double-lumen intubation with general anaesthesia combining non-intubated spontaneous breathing video-assisted thoracic surgery (VATS) surgery under loco-regional blockade with the avoidance of central line, epidural or urinary catheter and chest tube in selected patients. Those procedures combine the most evolved and less invasive techniques in anaesthesia, video-assisted surgery and perioperative care to cause the least trauma and allow for faster recovery. Non-intubated thoracic surgery used to rise some concerns regarding spontaneous breathing collapse, oxygenation, cough reflex triggering and mediastinal shift. Today, experienced teams in high-volume centers have proven non-intubated major lung resections are feasible and safe once those drawbacks have been overcome with the proper techniques and extensive previous expertise in VATS. Tubeless thoracic surgery is currently evolving, challenging former exclusion criteria and expanding indications to major lung resections or even tracheal and carinal resections to provide better intraoperative status and promote minimal need for recovery.
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Affiliation(s)
- Francisco Lirio
- Department of Thoracic Surgery, Marina Salud Hospital, Denia, Spain
| | - Carlos Galvez
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Sergio Bolufer
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | | | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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27
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Dailey WA, Frey GT, McKinney JM, Paz-Fumagalli R, Sella DM, Toskich BB, Thomas M. Percutaneous Computed Tomography-Guided Radiotracer-Assisted Localization of Difficult Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:1451-1457. [PMID: 29979620 DOI: 10.1089/lap.2018.0248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To report our institutional experience with radiotracer-assisted localization of lung nodules (RALN) in combination with uniportal video-assisted thoracoscopic surgery (UVATS). Methods: We retrospectively reviewed electronic medical records and radiology images of 27 consecutive adult patients who underwent planned UVATS lung resections combined with RALN from January 2014 to May 2017. Based on preoperative imaging, 29 nondescript nodules were marked with technetium 99 m macroaggregated albumin under computed tomography guidance before resection. Perioperative outcomes were analyzed. Results: All 29 nodules were successfully marked and resected with negative margins by UVATS; 12 (41.5%) were pure ground-glass opacities. Three patients had prior ipsilateral lung resections. There were no conversions to multiport VATS or thoracotomy. The majority (86.5%) of the nodules were malignant. The median nodule size was 8 mm (range: 3-20 mm) and depth, 56 mm (range: 22-150 mm). The majority (21/27; 77.8%) of patients underwent wedge resections alone, while 6 patients had anatomical resections. Median times were as follows: radiotracer injection to surgery, 219 minutes (range: 139-487 minutes); operative time, 85.5 minutes (32-236 minutes); chest tube removal, 1 day (range: 1-2 days); and length of stay, 2 days (range: 1-4 days). Four patients (14.8%) had a pigtail catheter placed for pneumothorax after radiotracer injection. One patient was readmitted 1 week after discharge for a spontaneous pneumothorax. There were no other morbidities or any 90-day mortality. Conclusion: RALN can be combined with UVATS to effectively resect small, deep, or low-density lung lesions that are difficult to visualize or palpate by thoracoscopy.
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Affiliation(s)
| | - Gregory T Frey
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - J Mark McKinney
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | | | - David M Sella
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Beau B Toskich
- 2 Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Mathew Thomas
- 3 Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
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Abstract
Background No prospective randomised studies or international guidelines exist for conduct of pulmonary metastasectomy. The aim of this study was to generate general recommendations for the practice of pulmonary metastasectomy through a cross sectional survey of thoracic surgeons. Methods A panel of international experts who participated in a consensus statement formation on video-assisted thoracoscopic surgery (VATS) lobectomy were approached to participate in the survey. The Delphi methodology consisting of two rounds of voting was used to establish recommendations. Clinical practice was deemed 'recommended' if 50-74% of the experts reached agreement and 'highly recommended' if 75% or more of the experts reached agreement following the second round of voting. Results Twenty-two experts from 8 countries completed both rounds of standardised questionnaires. Recommendations were reached on all of the 18 questions concerning the role, indications, contraindications, preoperative evaluation, operative strategy, follow-up and alternative treatment strategies for pulmonary metastasectomy. Conclusions The results of this survey represent a collective agreement among international thoracic surgery experts and establishes general recommendations for the practice of pulmonary metastasectomy.
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Affiliation(s)
- James M Caristo
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - David H Tian
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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Guido-Guerrero W, Bolaños-Cubillo A, González-Rivas D. Single-port video-assisted thoracic surgery (VATS)-advanced procedures & update. J Thorac Dis 2018; 10:S1652-S1661. [PMID: 30034831 DOI: 10.21037/jtd.2018.05.43] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The uniportal approach for major pulmonary resections began in 2010, with the first case being reported by D González-Rivas and colleagues in La Coruña, Spain. Since then, in different countries, thoracic surgeons had been performing hundreds of cases, with more advanced and complex procedures. Nowadays, there are reports of uniportal tracheal resection and reconstruction, carinal resection, bronchoplastic procedures, lobectomies with en bloc chest wall excision, and vascular reconstruction with optimal outcomes. The development of technologies and the potential benefits of a direct view, anatomic instrumentation, better cosmesis, and, potentially, less postoperative pain have led uniportal video-assisted thoracic surgery to grow exponentially worldwide.
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Affiliation(s)
- William Guido-Guerrero
- Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica
| | - Albert Bolaños-Cubillo
- Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica
| | - Diego González-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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30
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Palleschi A, Mendogni P, Mariolo AV, Nosotti M, Rosso L. An alternative chest tube placement after uniportal video-assisted thoracic surgery. J Thorac Dis 2018; 10:3078-3080. [PMID: 29997976 DOI: 10.21037/jtd.2018.04.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alessandro Palleschi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Vincenzo Mariolo
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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31
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Migliore M, Fornito M, Palazzolo M, Criscione A, Gangemi M, Borrata F, Vigneri P, Nardini M, Dunning J. Ground glass opacities management in the lung cancer screening era. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:90. [PMID: 29666813 DOI: 10.21037/atm.2017.07.28] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary ground glass opacity (GGO) is becoming an important clinical dilemma in oncology as its diagnosis in clinical practice is increasing due to the introduction of low dose computed tomography (CT) scan and screening. The incidence of cancer in GGO has been reported as high as 63%. The purpose of this manuscript is to review best available evidence papers on management of GGO in lung cancer to address the following questions: (I) how to correlate CT findings with malignancy; (II) when and who operate? (III) how to perform intraoperative detection of intrapulmonary GGO? (IV) wedge, segmentectomy or lobectomy? Taking a cue from a clinical scenario, a review on PubMed was conducted. The words search included: "Lung ground glass opacity". The research was limited to human and adults. We considered all published articles from 1990 to April 2017, which reported on at least sufficient data, to be eligible. The literature search was limited to articles in English. A total of 1,211 articles have been found. Interestingly, while in 1991, only one paper was published on low-dose high-resolution CT, in 2016, 126 papers have been published. Most cited and recent papers have been chosen for discussion. Many recent papers have been published from Asian groups. It is clearly not possible to conclude from these data what is the best strategy for GGO in the lung cancer screening era. Certainly, when there is uncertainty, personal opinion and experience should not influence decision making, on the contrary decision should be taken by a multidisciplinary team.
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of Surgery and Medical Specialities, Policlinico University Hospital, University of Catania, Catania, Italy
| | - Mariaconcetta Fornito
- CT/PET Center, Nuclear Medicine Department, A.R.N.A.S. GARIBALDI-Nesima, Catania, Italy
| | - Manuela Palazzolo
- Section of Thoracic Surgery, Department of Surgery and Medical Specialities, Policlinico University Hospital, University of Catania, Catania, Italy
| | - Alessandra Criscione
- Section of Thoracic Surgery, Department of Surgery and Medical Specialities, Policlinico University Hospital, University of Catania, Catania, Italy
| | - Mariapia Gangemi
- Section of Thoracic Surgery, Department of Surgery and Medical Specialities, Policlinico University Hospital, University of Catania, Catania, Italy
| | - Francesco Borrata
- Section of Thoracic Surgery, Department of Surgery and Medical Specialities, Policlinico University Hospital, University of Catania, Catania, Italy
| | - Paolo Vigneri
- Department of Oncology, University of Catania, Catania, Italy
| | - Marco Nardini
- Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Joel Dunning
- Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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32
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Affiliation(s)
- Alan D L Sihoe
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.,Division of Thoracic Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen 518054, China
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33
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Abouarab AA, Rahouma M, Kamel M, Ghaly G, Mohamed A. Single Versus Multi-Incisional Video-Assisted Thoracic Surgery: A Systematic Review and Meta-analysis. J Laparoendosc Adv Surg Tech A 2018; 28:174-185. [DOI: 10.1089/lap.2017.0446] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ahmed A. Abouarab
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mohamed Rahouma
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Kamel
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Galal Ghaly
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Abdelrahman Mohamed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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34
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Mineo TC, Ambrogi V. A glance at the history of uniportal video-assisted thoracic surgery. J Vis Surg 2017; 3:157. [PMID: 29302433 DOI: 10.21037/jovs.2017.10.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/03/2017] [Indexed: 01/26/2023]
Abstract
In the history of thoracic surgery, the advent of video-assisted thoracic surgery (VATS) had on effect equivalent to that provoked by a true revolution. VATS successfully allowed minor, major and complex procedures for various lung and mediastinal pathologies with small incision instead of the traditional accesses. These small incisions abolished ugly scars, generated less acute and chronic pain, reduced hospital stay and costs, allowed faster return to normal day life activities. Conventional VATS was initially performed through 3-4 ports and rapidly evolved to uniportal or single portal access [uniportal video-assisted thoracic surgery (uniVATS)]. First uniportal procedures were published in 2000. In 2010, uniportal technique for lobectomy was described. Focused experimental courses, live surgery events, the internet media favored the rapid diffusion of this technique over the world. Major and complex uniVATS lung resections involving segmentectomy, pneumonectomy, bronchoplasty and vascular reconstruction, redo VATS, en bloc chest wall resections have been accomplished with satisfactory outcomes. Interestingly, different uniportal approaches and techniques are emerging from a number of VATS centers particularly experienced in the mini-invasive thoracic surgery. As confidence grew, in 2014, the first uniVATS left upper lobectomy via the subxiphoid approach was reported. This novel technique is quite challenging but appropriate patient selection as well as availability of dedicated instruments allowed to perform procedures safely. The diffusion of uniVATS paralleled with the development of nonintubated awake anesthesia technique. In 2007 the first nonintubated lobectomy was described. In 2014 the first single port VATS lobectomy in a nonintubated patient with lung cancer of the right middle lobe was accomplished. The nonintubated uniVATS represents an intriguing technique, so that very experienced thoracoscopic surgeons may enroll to surgery elderly and high risk patients. Decreased postoperative pain and hospitalization, faster access to the radio-chemotherapy and diminished inflammatory response are important benefits of the modern approach to the thoracic pathologies. The history of uniVATS documented a constant and irresistible progress. This technique may further provide unthinkable surprises in next future.
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Affiliation(s)
- Tommaso Claudio Mineo
- Department of Surgery and Experimental Medicine, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy.,Thoracic Surgery, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy
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35
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Affiliation(s)
- Andrea Zuin
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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36
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Galvez C, Navarro-Martinez J, Bolufer S, Lirio F, Sesma J, Corcoles JM. Nonintubated uniportal VATS pulmonary anatomical resections. J Vis Surg 2017; 3:120. [PMID: 29078680 DOI: 10.21037/jovs.2017.08.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 11/06/2022]
Abstract
Nonintubated procedures have widely developed during the last years, thus nowadays major anatomical resections are performed in spontaneously breathing patients in some centers. In an attempt for combining less invasive surgical approaches with less aggressive anesthesia, nonintubated uniportal video-assisted thoracic surgery (VATS) lobectomies and segmentectomies have been proved feasible and safe, but there are no comparative trials and the evidence is still poor. A program in nonintubated uniportal major surgery should be started in highly experienced units, overcoming first a learning period performing minor procedures and a training program for the management of potential crisis situations when operating on these patients. A multidisciplinary approach including all the professionals in the operating room (OR), emergency protocols and a comprehensive knowledge of the special physiology of nonintubated surgery are mandatory. Some concerns about regional analgesia, vagal block for cough reflex control and oxygenation techniques, combined with some specific surgical tips can make safer these procedures. Specialists must remember an essential global concept: all the efforts are aimed at decreasing the invasiveness of the whole procedure in order to benefit patients' intraoperative status and postoperative recovery.
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Affiliation(s)
- Carlos Galvez
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Jose Navarro-Martinez
- Department of Anesthesiology and Surgical Critical Care, University General Hospital, Alicante, Spain
| | - Sergio Bolufer
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Francisco Lirio
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Julio Sesma
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Juan Manuel Corcoles
- Department of Thoracic Surgery, University Hospital of Vinalopo, Alicante, Spain
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37
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Sanna S, Bertolaccini L, Brandolini J, Argnani D, Mengozzi M, Pardolesi A, Solli P. Uniportal video-assisted thoracoscopic surgery in hemothorax. J Vis Surg 2017; 3:126. [PMID: 29078686 DOI: 10.21037/jovs.2017.08.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/04/2017] [Indexed: 11/06/2022]
Abstract
The management of hemothorax (spontaneous or, more often, due to thoracic trauma lesions), follows basic tenets well-respected by cardiothoracic surgeons. In most, a non-operative approach is adequate and safe, with a defined group of patients requiring only tube thoracostomy. Only a minority of patients need a surgical intervention due to retained hemothorax, persistent bleeding or incoming complications, as pleural empyema or entrapped lung. In the early 1990s, the rapid technological developments determined an increase of diagnostic and therapeutical indications for multiport video-assisted thoracoscopic surgery (VATS) as the gold standard therapy for retained and persistent hemothorax, allowing an earlier diagnosis, total clots removal and better tubes placement with less morbidity, reduced post-operative pain and shorter hospital stay. There is no consensus in the literature regarding the timing for draining hemothorax, but best results are obtained when the drainage is performed within the first 5 days after the onset. The traditional multi-port approach has evolved in the last years into an uniportal approach that mimics open surgical vantage points utilizing a non-rib-spreading single small incision. Currently, in experienced hands, this technique is used for diagnostic and therapeutic interventions as hemothorax evacuation as like as the more complex procedures, such as lobectomies or bronchial sleeve and vascular reconstructions.
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Affiliation(s)
- Stefano Sanna
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy
| | - Luca Bertolaccini
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy
| | - Jury Brandolini
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy
| | - Desideria Argnani
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy
| | - Marta Mengozzi
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy
| | | | - Piergiorgio Solli
- Department of Thoracic Surgery, AUSL Romagna Teaching Hospital, Forlì, Italy
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38
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Matilla González JM. Lung Cancer Surgery in the xxi Century. Arch Bronconeumol 2017; 54:177-178. [PMID: 28807583 DOI: 10.1016/j.arbres.2017.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 11/17/2022]
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Barba-Pacheco J, Navarro G, Gonzalez-Rivas D, Polit F, Wong P, Nieto F, Romero M, Carrera J, Villacis J, Zambrano MJ, Bravo K, Velastegui R, Rodríguez F, Reyes M, Cullacay S, Cercado R, Salvatierra S. First uniportal video assisted thoracic surgery masterclass in Ecuador. J Vis Surg 2017; 3:77. [PMID: 29078640 DOI: 10.21037/jovs.2017.05.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/10/2017] [Indexed: 11/06/2022]
Abstract
Currently video-assisted thoracic surgery (VATS) and the evolution Uniportal VATS have a worldwide acceptance and Ecuador is not exception when we decided invited to Dr. Diego Gonzalez-Rivas pioneer surgeon in the world of single-port video-assisted thoracoscopic procedures, with the aim to provide a faster recovery of the patients compared to those who received a conventional thoracotomy. We thanks the opportunity to present a report to the first Masterclass in Uniportal VATS with live surgery, performed on February 23rd to 24th of 2017 at the Luis Vernaza Hospital in Guayaquil-Ecuador. In addition to demonstrate the efficacy and safety of the uniportal VATS technique we presented a video of uniportal VATS left lower lobectomy performed by Dr. Diego Gonzalez-Rivas during the first uniportal masterclass in Guayaquil, Ecuador.
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Affiliation(s)
- John Barba-Pacheco
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Gutenberg Navarro
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.,Director of Uniportal VATS training program at Shanghai Pulmonary Hospital, Shanghai 200433, China
| | - Fernando Polit
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Pamela Wong
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Fabrizio Nieto
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Manuel Romero
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Jaime Carrera
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Jonathan Villacis
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Martha J Zambrano
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Karina Bravo
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Renee Velastegui
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Freddy Rodríguez
- Cardiothoracic Surgery Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Manuel Reyes
- Anesthesiology Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Silvia Cullacay
- Imagenology Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Ramiex Cercado
- Imagenology Department, Luis Vernaza Hospital, Guayaquil, Ecuador
| | - Sara Salvatierra
- Thoracic Surgery Department, National Police Hospital, Guayaquil, Ecuador
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Cai Y, Han Y, Zhang N, Fu S, Deng Y, Fu X. Modular Uniportal Video-Assisted Thoracoscopic Lobectomy and Lymphadenectomy: A Novel Pattern of Endoscopic Lung Cancer Resection. J Laparoendosc Adv Surg Tech A 2017; 27:1230-1235. [PMID: 28562171 DOI: 10.1089/lap.2017.0063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Since the development of the uniportal video-assisted thoracoscopic surgery (VATS) technique, the use of uniportal VATS has become increasingly popular for the surgical resection of non-small cell lung cancer (NSCLC). The objective of this study is to introduce a novel modularly designed surgical pattern for uniportal VATS for lung cancer resection and to investigate the safety, feasibility, and efficacy of this novel method. MATERIALS AND METHODS The clinical data of NSCLC patients who underwent a curative uniportal VATS lobectomy between March 2015 and April 2016, including via the modular pattern (MP) and the conventional pattern (CP), were retrospectively collected and analyzed. Perioperative and postoperative parameters, including the operation duration, estimated intraoperative blood loss, rate of conversion to thoracotomy, lymph node dissection number, and postoperative complications, were compared between the two groups. RESULTS A total of 321 patients were identified, among whom 221 underwent MP uniportal VATS lobectomy and 100 were treated via CP uniportal VATS lobectomy. Patients in the MP group experienced a shorter operation duration (135.58 ± 47.16 minutes versus 148.86 ± 42.53 minutes, P = .017) and less estimated intraoperative blood loss (75.20 ± 37.99 mL versus 89.50 ± 41.11 mL, P = .003) than patients in the CP group. No significant difference was observed in the intraoperative conversion rate (2.7% versus 5.0%, P = .477), total number of lymph nodes dissected (24.67 ± 7.73 versus 25.34 ± 7.62, P = .471), postoperative drainage duration (4.86 ± 1.96 days versus 4.78 ± 2.10 days, P = .755), length of stay (9.60 ± 2.93 days versus 9.97 ± 2.80 days, P = .286), or incidence of postoperative complications between the two groups. No postoperative deaths occurred. CONCLUSIONS MP uniportal VATS lobectomy combined with mediastinal lymphadenectomy appears to be a safe and feasible technique for the treatment of NSCLC. The use of this technique can reduce the operation duration and intraoperative blood loss.
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Affiliation(s)
- Yixin Cai
- 1 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Ying Han
- 2 Department of Infection Control, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Ni Zhang
- 1 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Shengling Fu
- 1 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Yu Deng
- 1 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
| | - Xiangning Fu
- 1 Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
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Guerrero WG, González-Rivas D. Multiportal video-assisted thoracic surgery, uniportal video-assisted thoracic surgery and minimally invasive open chest surgery-selection criteria. J Vis Surg 2017; 3:56. [PMID: 29078619 DOI: 10.21037/jovs.2017.03.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/06/2017] [Indexed: 11/06/2022]
Abstract
Thoracic surgery started the path to minimally invasive surgery over a hundred years ago, with the first thoracoscopic procedure performed by Jacobeus in 1910. Interestingly, these first procedures were performed using a single port approach and were used for diagnostic and minor procedures only. For a long period of time, the progress for minimally invasive thoracic surgery was considerably slow until the early 90s, when video assisted thoracic surgery started to be used for major pulmonary resections. Since then, video-assisted thoracic surgery (VATS) had a widespread use around the world and an ongoing search for a less invasive procedures evolved into uniportal VATS. Now, thoracic surgeons have a variety of choices for minimally invasive thoracic surgery and must be trained in these approaches to keep up with the evolution of the specialty and be up to date with the recommended treatments for diseases needing surgical intervention. The approach chosen by each surgeon is a matter of preference, while keeping in mind certain characteristics specific to the pathology and patient to be treated, the level of training of the surgeon, and the healthcare resources available. As more evidence is collected, the choice for video-assisted procedures, which have currently been proven safe, effective, less invasive and, in general, show good results, will prevail.
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Affiliation(s)
- William Guido Guerrero
- Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica
| | - Diego González-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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42
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Céspedes-Meneses E, Echavarri-Arana JM, Tort-Martínez A, Guzmán-de Alba E, das Neves-Pereira JC, González-Rivas D. Uniportal video-assisted thoracic surgery course in Mexico-first experience. J Vis Surg 2016; 2:142. [PMID: 29078529 PMCID: PMC5638613 DOI: 10.21037/jovs.2016.07.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 07/27/2016] [Indexed: 11/06/2022]
Abstract
"The First Minimally Invasive Thoracic Surgery Uniportal Course" in Mexico was held from July 13th to 15th in Mexico City, at the National Institute of Respiratory Diseases (INER). Thoracic surgeons from around Mexico assisted the course. The special guests were the Spanish doctor Diego González-Rivas and the Brasilian doctor Joao Carlos das Neves-Pereira. The course included live surgery and wet lab. Demonstration of the uniportal video-assisted thoracic surgery (VATS) technique was done. The course was a success and Mexican thoracic surgeons were ready to adopt this technique.
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Affiliation(s)
- Erick Céspedes-Meneses
- Department of Thoracic Surgery, General Hospital “October the 1st”, Institute of Security and Social Services for State Workers (ISSSTE), Mexico City, Mexico
| | - José Manuel Echavarri-Arana
- Head, Division of Surgery, General Hospital “October the 1st”, Institute of Security and Social Services for State Workers (ISSSTE), Mexico City, Mexico
| | - Alejandro Tort-Martínez
- Head, Department of General Surgery, General Hospital “October the 1st”, Institute of Security and Social Services for State Workers (ISSSTE), Mexico City, Mexico
| | - Enrique Guzmán-de Alba
- Division of Thoracic Surgery, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | | | - Diego González-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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Clavero JM. Single port training in Latin-America-first uniportal video-assisted thoracoscopic surgery masterclass in Santiago, Chile. J Vis Surg 2016; 2:140. [PMID: 29078527 DOI: 10.21037/jovs.2016.08.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 11/06/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) surgery has become the standard technique in Thoracic Surgery since its introduction 20 years ago. Single port VATS appeared as the next step in its evolution, with rapid development since the first uniportal video-assisted thoracoscopic surgery lobectomy (VATS lobectomy) by Dr. Diego Gonzalez-Rivas. During the last 5 years, the approach has been simplified, standardized and taught in many countries, courses, live surgery and dedicated programs, with reproducible results. Hands-on courses represent the best way to learn a new surgical technique, as it shortens learning curves and decreases complications. We present the first training course in single port VATS in our country, which became the first hands course in Thoracic Surgery in Chile.
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Aamodt H. Transition from thoracotomy to uniportal video-assisted thoracic surgery in non-small cell lung cancer-the Oslo experience. J Vis Surg 2016; 2:111. [PMID: 29399497 DOI: 10.21037/jovs.2016.06.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 11/06/2022]
Abstract
Thoracoscopic surgery has been applied in medicine for more than 100 years. Still it is only within the last decade that it has gained momentum as a method in non-small cell lung cancer (NSCLC) surgery. Several approaches have been published, one of the more resent being uniportal video-assisted thoracic surgery (VATS). In this article we describe the transition from thoracotomy to uniportal VATS in our institution, the last step to uniportal VATS exemplified with two cases performed during our masterclass held in May 2016.
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Affiliation(s)
- Henrik Aamodt
- Department of Cardiothoracic Surgery, Oslo University Hospital, Ullevål, Norway
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Deng Y, Hao Z, Fu X. [Development, Application Details, and Prospects of Uni-VATS on Lung Cancer Radical Operation under the Concept of "Precise Medical Treatment"]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:371-6. [PMID: 27335300 PMCID: PMC6015189 DOI: 10.3779/j.issn.1009-3419.2016.06.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
单孔电视胸腔镜手术(uni-portal uideo-assisted thoracic surgery, Uni-VATS)的推广,是近年微创胸外科最重大的进展之一。随着腔镜下成像设备、切割缝合器械及电分离器械的改进,单孔VATS的应用范围已从最初的肺组织活检术逐渐扩大到解剖性肺叶/段切除、全肺切除、支气管/血管袖式吻合。多中心大量报道已证实:单孔VATS行肺叶切除安全、可行,清扫纵隔淋巴结的组数及总数均不低于传统多孔VATS,在疼痛、创伤及术后恢复方面也有积极的结果。虽然暂未得到多中心、大样本的临床数据如5年生存率,但有序地逐步开展单孔VATS仍是微创胸外科未来发展的重要方向。本文将围绕单孔VATS的原理及具体操作细节,结合肺癌根治术的基本操作理念进行讨论及综述,以期为单孔VATS的有序、规范化开展提出思考和探索。
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Affiliation(s)
- Yu Deng
- Department of Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhipeng Hao
- 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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