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Chen Y, He J, Wang C, Li S. Utilization of intraoperative indocyanine green fluorescence imaging to identify vascular anatomy in severe pleural adhesions in uniportal video-assisted thoracoscopic surgery: a case report. Transl Cancer Res 2023; 12:2946-2951. [PMID: 37969404 PMCID: PMC10643979 DOI: 10.21037/tcr-23-729] [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: 04/26/2023] [Accepted: 09/15/2023] [Indexed: 11/17/2023]
Abstract
Background Extensive and dense pleural adhesion is a serious challenge in video-assisted thoracoscopic surgery (VATS), in which identification of vessels and their anatomical spaces is difficult. Once critical vessel is damaged while dissecting adhesion in VATS, leading to fatal hemorrhage, the surgeon will have to switch to thoracotomy. This is the first report of a case in which intraoperative indocyanine green (ICG) fluorescence imaging was used to identify critical vessels in severe pleural adhesions in uniportal VATS. Case Description The patient (67-year-old male) with an 8-year history of tuberculosis and severe mixed ventilation dysfunction underwent a standardized wedge resection due to chest computed tomography (CT) scan that revealed a 2.6-cm nodule in the right upper lung. Intraoperatively, the superior vena cava and azygos vein were successfully identified and safely dissected using ICG fluorescence imaging in the presence of extensive and dense pleural adhesions. The chest drainage tube was removed on postoperative day (POD) 3, and patient was released from hospital on POD 5. The patient recovered well and no complication was observed in the follow-up. Conclusions The ICG fluorescence imaging is used to illustrate the vessels and help to dissect them safely, which is a feasible, visualizable, and user-friendly method in severe pleural adhesions in uniportal VATS.
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Affiliation(s)
- Yongjiang Chen
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
| | - Jiaxi He
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
| | - Chudong Wang
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
| | - Shuben Li
- Department of Thoracic Surgery, Guangzhou Medical University 1st Affiliated Hospital, Guangzhou, China
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2
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Troubleshooting in thoracoscopic anatomical lung resection for lung cancer. Surg Today 2020; 51:669-677. [PMID: 32940789 DOI: 10.1007/s00595-020-02136-x] [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: 06/28/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) anatomical lung resection (ALR) has been gaining popularity in the treatment of lung cancer in line with remarkable advances in both equipment and technique. The development and refinement of its technique have allowed thoracic surgeons to perform a wide variety of challenging and complex procedures in a minimally invasive fashion. Careful and meticulous preparation may shift in the future with the increasing sophistication and capabilities of VATS ALR. Moreover, constant awareness and a structured plan of the procedure are imperative to reducing or preventing complications. Intraoperative major complications during VATS ALR are infrequent, but can have catastrophic consequences. The decision to continue with VATS should take into consideration the surgeon's skill level and ease with the approach and the relative potential benefit against the risk to the patient. We conducted this study to investigate the possible problems during VATS ALR and identify how to solve them based on the previous literature and our institutional data sampling.
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Comparison of the Video-assisted Thoracoscopic Lobectomy versus Open Thoracotomy for Primary Non-Small Cell Lung Cancer: Single Cohort Study with 269 Cases. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 54:291-296. [PMID: 33312025 PMCID: PMC7729729 DOI: 10.14744/semb.2020.60963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 11/20/2022]
Abstract
Objectives: This study aims to compare the outcomes of video-assisted thoracoscopic surgery (VATS) lobectomy with open thoracotomy lobectomy in patients with non-small cell lung cancer (NSCLC). Methods: There were 269 cases with NSCLC who underwent lobectomy between 2017-2019; these cases were retrospectively studied. VATS lobectomy (VATS Group) and open thoracotomy lobectomy (Thoracotomy Group) patients’ results were compared according to the length of hospitalizations, early postoperative complications and tumor size and stages. Results: VATS lobectomy was performed in 89 (33%) of these patients, whereas 180 (67%) patients underwent lobectomy using open thoracotomy for NSCLC. The findings showed that the average length of hospitalization was shorter in the VATS Group compared to the Thoracotomy Group (4 vs. 5.5 days) (p<0.05). It was found that the mean size of the tumour was smaller in the VATS Group when compared to the Thoracotomy Group (2.66 cm vs 3.97 cm) (p<0.001). Early postoperative complications were lower in the VATS Group (n=15, 16.8% vs n=58, 32.2%; p<0.021). Conclusion: In VATS lobectomy cases, postoperative complications are less, and the length of hospitalization is shorter. VATS lobectomy is mostly preferred smaller than 3 cm tumor size.
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Yasukawa M, Taiji R, Marugami N, Kawaguchi T, Kawai N, Sawabata N, Tojo T, Takahama J, Hamazaki N, Hirai T, Taniguchi S. Ultrasonography for Detecting Adhesions: Aspirin Continuation for Lung Resection Patients. In Vivo 2019; 33:973-978. [PMID: 31028224 PMCID: PMC6559903 DOI: 10.21873/invivo.11566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIM Aspirin reduces cardiovascular disease and/or stroke risks. However, perioperative aspirin use remains controversial. We assessed the efficacy of ultrasonography to facilitate video-assisted thoracic surgery (VATS). We analyzed the perioperative management of patients using aspirin and its association with bleeding events during lung cancer surgery. PATIENTS AND METHODS A total of 38 patients who underwent VATS after continuing or discontinuing aspirin were examined. Ultrasound was performed preoperatively to evaluate the pleural adhesions. Fisher's exact test was used to analyze correlations between the two groups. RESULTS Dense adhesions were found at VATS ports using ultrasonography (accuracy: 100%). No differences were detected in bleeding, thrombotic events, or operative times between the aspirin and non-aspirin groups. There were differences in bleeding (p=0.009) and operative times (p=0.021) between the dense adhesion and non-dense adhesion groups. CONCLUSION Preoperative detection of pleural adhesions using ultrasonography was useful in selecting pulmonary resection patients who continued aspirin perioperatively.
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Affiliation(s)
- Motoaki Yasukawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Ryosuke Taiji
- Department of Radiology, Saiseikai Chuwa Hospital, Nara, Japan
| | | | - Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Norikazu Kawai
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara, Japan
| | - Takashi Tojo
- Department of Thoracic Surgery, Saiseikai Chuwa Hospital, Nara, Japan
| | - Junko Takahama
- Department of Radiology, Saiseikai Chuwa Hospital, Nara, Japan
| | | | - Toshiko Hirai
- Department of Endoscopy and Ultrasound, Nara Medical University School of Medicine, Nara, Japan
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Nara, Japan
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Pischik VG, Kovalenko A. The role of indocyanine green fluorescence for intersegmental plane identification during video-assisted thoracoscopic surgery segmentectomies. J Thorac Dis 2018; 10:S3704-S3711. [PMID: 30505555 DOI: 10.21037/jtd.2018.04.84] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background According to recent studies, thoracoscopic segmentectomy is an acceptable alternative to lobectomy for treating different lung diseases. This approach appears to have equivalent rates of postoperative morbidity with potentially similar long-term results even in selected lung cancer patients. At the same time, surgical success is highly dependent on intraoperative interpretation of segmental anatomy. We aimed to analyze our lung segmentectomy experience and identify the role of indocyanine green (ICG)-fluorescence for intersegmental plane detection. Methods A total of 86 consecutive patients who underwent 90 thoracoscopic segmentectomies with near-infrared-indocyanine green (NIR-ICG) method between September 2015 and December 2017 were investigated. According to the preoperative 3D lung hilar model, vascular and bronchial branches of the target segment were divided. ICG was thereafter injected into the central or peripheral vein. The boundary lines between the areas with and without fluorescence was marked on the visceral pleura by electrocautery. Results The fluorescence was detected immediately after bolus ICG injection in the central vein in all patients but had a time delay of 10-25 seconds in cases of peripheral vein administration. The median duration of intensive ICG staining was 90 seconds, regardless of the injection method. Well-defined fluorescence borders were observed in 86 of 90 (95.6%) segmentectomies due to technical reasons in three cases and severe emphysema in one. Chronic obstructive pulmonary disease (COPD) in other patients did not impair the boundary line identification, but reduced the duration of intensive ICG staining. No ICG-related complications were observed. Conclusions The ICG-fluorescence technology is safe and effective for verification of anatomic segment borders for video-assisted thoracoscopic surgery (VATS). The perfusion-based ICG fluorescence technique has advantages for thoracoscopic surgeries compared to other methods. Doubling the dose of ICG allows clear detection of the intersegmental plane, even in certain suboptimal conditions.
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Affiliation(s)
- Vadim G Pischik
- Department of Thoracic Surgery, Federal Hospital #122, Saint Petersburg, Russia.,Faculty of Medicine, Saint Petersburg State University, Saint Petersburg, Russia
| | - Aleksandr Kovalenko
- Department of Thoracic Surgery, Federal Hospital #122, Saint Petersburg, Russia.,Faculty of Medicine, Saint Petersburg State University, Saint Petersburg, Russia
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Lim S, Ghosh S, Niklewski P, Roy S. Laparoscopic Suturing as a Barrier to Broader Adoption of Laparoscopic Surgery. JSLS 2018; 21:JSLS.2017.00021. [PMID: 28694682 PMCID: PMC5491803 DOI: 10.4293/jsls.2017.00021] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic surgery is increasingly replacing the open procedure because of its many patient-related benefits that are well aligned with policies and programs that seek to optimize health system performance. However, widespread adoption of laparoscopic surgery has been slow, in part, because of the complexity of laparoscopic suturing. The objective of this study was to review the clinical and economic impacts of laparoscopic suturing in key procedures and to assess its role as a barrier to the broader adoption of laparoscopic surgery. DATABASE A medical literature search of MEDLINE, EMBASE, and BIOSIS from January 2010 through June 2016 identified 47 relevant articles. CONCLUSION Laparoscopic suturing and intracorporeal knot tying may result in extended surgical time, complications, and surgeon errors, while improving patient quality of life through improved cosmesis, diet toleration, and better bowel movements. Despite advancement in surgical techniques and the availability of newer surgical tools, the complexity of laparoscopic suturing continues to be a barrier to greater adoption of MIS. The results of the study underscore the need for development of proficiency in laparoscopic suturing, which may help improve patient outcomes and reduce healthcare costs.
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Affiliation(s)
- Sangtaeck Lim
- Franchise Health Economics and Market Access, Ethicon, Inc., Somerville New Jersey, USA
| | | | - Paul Niklewski
- Endomech Clinical Research, Ethicon, Inc., Cincinnati, Ohio, USA
| | - Sanjoy Roy
- Franchise Health Economics and Market Access, Ethicon, Inc., Somerville New Jersey, USA
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Chen YY, Lin TH, Chang CC, Huang WL, Yen YT, Tseng YL. Staged bronchial closure in uniportal video-assisted thoracoscopic anatomical resection for lung cancer with calcified lymph nodes. J Vis Surg 2017; 3:149. [PMID: 29302425 DOI: 10.21037/jovs.2017.08.16] [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] [Received: 07/26/2017] [Accepted: 08/14/2017] [Indexed: 11/06/2022]
Abstract
Uniportal video-assisted thoracoscopic surgery (VATS) makes a breakthrough in these years. Even we have gained more experience and surgical skills of uniportal VATS, some elements, such as calcified perivascular lymph nodes, make the surgery challenging. In this series, we used staged bronchial closure (cut the bronchus first and then close it with stapler after dividing the pulmonary artery with calcified lymph node) as an approach for dealing with this challenging issue. Though the rate of intraoperative vessel injury is relatively high, we obtained ideal surgical outcome by using this technique in different lobes and segment of the lung.
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Affiliation(s)
- Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Hung Lin
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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8
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Lim CG, Shin KM, Lim JS, Lim JK, Kim HJ, Kim WH, Cho SH, Cha SI, Lee EB, Seock Y, Jeong SY. Predictors of conversion to thoracotomy during video-assisted thoracoscopic surgery lobectomy in lung cancer: additional predictive value of FDG-PET/CT in a tuberculosis endemic region. J Thorac Dis 2017; 9:2427-2436. [PMID: 28932548 DOI: 10.21037/jtd.2017.07.40] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To evaluate the added clinical value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans to chest CT imaging in predicting the conversion to thoracotomy during video-assisted thoracoscopic surgery (VATS) lobectomy in patients with lung cancer. METHODS This is a retrospective study of 235 consecutive patients who underwent planned VATS lobectomy for primary lung cancer between 2011 and 2015. CT images were interpreted in terms of the presence and the attenuation of peribronchial lymph nodes (PLN) and peribronchial cuffs of soft (PCS) tissue, pleural calcification, and parenchymal calcified nodule. On FDG PET/CT images, anthracofibrotic lymph node was considered present when high FDG uptake (SUVmax >3.5) was observed on PET/CT images corresponded to PLN or PCS on chest CT. RESULTS Among the 235 patients undergoing attempted VATS lobectomy, 55 (23.4%) underwent conversion to thoracotomy. Multivariate logistic regression analysis revealed that the attenuation of PLN or PCS on chest CT (OR, 2.57; 95% CI, 1.328-4.380, 0.005) was an only independent predictor of conversion. The ROC curve showed that combined FDG PET/CT and chest CT reading [areas under curve (AUC), 0.847 (95% CI, 0.795-0.891)] was significantly better than that of chest CT scans alone [AUC, 0.655 (95% CI, 0.50-0.751)] in predicting conversion (P=0.024). CONCLUSIONS The addition of FDG PET/CT scanning to chest CT imaging provides better performance for predicting conversion to thoracotomy during VATS lobectomy in lung cancer patients. Therefore, in lung cancer patients undergoing surgical resection, FDG PET/CT can provide additional reliable information in selecting the appropriate surgical approach for a lobectomy.
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Affiliation(s)
- Chun Geun Lim
- Department of Radiology, Kyungpook National University Hospital, Daegu, South Korea
| | - Kyung Min Shin
- Department of Radiology, Kyungpook National University Medical Center, Daegu, South Korea
| | - Ji Seun Lim
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea
| | - Jae Kwang Lim
- Department of Radiology, Kyungpook National University Hospital, Daegu, South Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University Medical Center, Daegu, South Korea
| | - Won Hwa Kim
- Department of Radiology, Kyungpook National University Medical Center, Daegu, South Korea
| | - Seung Hyun Cho
- Department of Radiology, Kyungpook National University Medical Center, Daegu, South Korea
| | - Seung Ick Cha
- Department of Internal Medicine, Kyungpook National University Medical Center, Daegu, South Korea
| | - Eung Bae Lee
- Department of Thoracic Surgery, Kyungpook National University Medical Center, Daegu, South Korea
| | - Yangki Seock
- Department of Thoracic Surgery, Kyungpook National University Medical Center, Daegu, South Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University Medical Center, Daegu, South Korea
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9
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Ismail M, Swierzy M, Nachira D, Rückert JC, Gonzalez-Rivas D. Uniportal video-assisted thoracic surgery for major lung resections: pitfalls, tips and tricks. J Thorac Dis 2017; 9:885-897. [PMID: 28523133 DOI: 10.21037/jtd.2017.02.04] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nearly six years since inception, uniportal video-assisted thoracic surgery (VATS) has become a growing part of major lung resections and has revolutionized the way thoracic surgeons treat pulmonary lesions. This technique is being touted for various benefits. It ensures direct visualization together with a better exposure of the lung and allows the chance of a digital palpation of the lesion through a small incision. Postoperative pain is reduced due to the involvement of only one intercostal space without rib spreading and muscle disruption. The comfort and aesthetics factors are improved significantly since the oncological principles and radicality of open surgery are restored. As the surgeons gain more experience in uniportal-VATS lobectomy, more complex cases can be managed by this technique. The objectives of this work are to set the basic steps for performing major lung resections (lobectomy, bilobectomy and pneumonectomy) by utilizing uniportal-VATS and to analyze some common pitfalls that thoracic surgeons face when practicing this technique and provide practical tips and tricks on how to avoid.
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Affiliation(s)
- Mahmoud Ismail
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Swierzy
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dania Nachira
- Department of General Thoracic Surgery, "A.Gemelli" University Hospital - Catholic University of Sacred Heart, Rome, Italy
| | - Jens C Rückert
- 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
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10
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Passera E, Rocco G. From full thoracotomy to uniportal video-assisted thoracic surgery: lessons learned. J Vis Surg 2017; 3:36. [PMID: 29078599 PMCID: PMC5637876 DOI: 10.21037/jovs.2017.01.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/10/2016] [Indexed: 11/06/2022]
Abstract
Over the last two decades, conventional video-assisted thoracic surgery (VATS) has established itself as the preferred approach for almost all thoracic surgical procedures. The procedure provides a safe and easy approach with undisputed patient benefit at a cost acceptable to the healthcare system all over the world, in large hospitals as well as underprivileged rural areas. VATS has effectively addressed the patients' right to less scarring, trauma (both of access and intrathoracic manipulation), medication, pain, hospitalization, and early return home and work. These improvements have been further stressed by the introduction of uniportal VATS (uniVATS). Single port surgery is a very exciting new modality in the field of minimal access surgery which aims at further reducing scars of standard vats and towards an hypothetical prospective of scarless surgery.
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Affiliation(s)
- Eliseo Passera
- Department of Thoracic Surgery, Humanitas Gavazzeni Institute, Bergamo, Italy
| | - Gaetano Rocco
- Department of Thoracic Surgery and Oncology, Division of Thoracic Surgery, Istituto Nazionale Tumori, IRCCS, Pascale Foundation, Naples, Italy
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11
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Fan J, Yao J, Wang Q, Chang Z. Safety and feasibility of uniportal video-assisted thoracoscopic surgery for locally advanced non-small cell lung cancer. J Thorac Dis 2016; 8:3543-3550. [PMID: 28149548 DOI: 10.21037/jtd.2016.12.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Conventional video-assisted thoracoscopic surgery (VATS) lobectomy for locally advanced non-small cell lung cancer (NSCLC) is a feasible and safe surgery in high-volume centers with significant VATS experience. Uniportal VATS lobectomy has been recently been reported to be a promising, less invasive approach. The purpose of this study is to explore the safety and feasibility of uniportal video-assisted thoracoscopic surgery (U-VATS) for the treatment of patients with locally advanced NSCLC. METHODS From January 2013 to September 2015, a total of 132 patients with locally advanced NSCLC underwent U-VATS or open thoracotomy major pulmonary resections and standard mediastinal lymph node dissection. Patients were divided into two groups: (I) locally advanced NSCLC underwent U-VATS (U-VATS); (II) locally advanced NSCLC underwent open thoracotomy (open). A descriptive and retrospective study was performed, including the operative time, operative blood loss, postoperative chest tube duration, postoperative hospital stay, lymph node dissection, postoperative complications and postoperative recovery. RESULTS A total of 132 patients with locally advanced NSCLC were included in this study: 64 (U-VATS) vs. 68 (open) patients. The patient demographic data was similar in both groups. Median operative time (157.0 vs. 160.6) and median number of lymph nodes (35.5 vs. 32.5) were similar in both groups. Chest tube duration and hospital of stay were statistically shorter in U-VATS group while rate of complications were higher in open thoracotomy group. One patient died on the 55th postoperative day because of tumor metastasis and bronchopleural fistula. A higher percentage of patients who underwent UVATS resections were able to receive adjuvant therapy timely compared to the open group. CONCLUSIONS Uniportal VATS major pulmonary resections and mediastinal lymph node dissection is a safe and feasible procedure for the treatment of locally advanced NSCLC. Particularly it is suitable for the frail patients with locally advanced NSCLC who require comprehensive treatment.
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Affiliation(s)
- Junqiang Fan
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Jie Yao
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Qi Wang
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
| | - Zhibo Chang
- Department of Thoracic Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou 310009, China
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12
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Han DP, Xiang J, Li HC, Hang JB. Uniportal video-assisted thoracic surgery right upper lobectomy with systemic lymphadenectomy. J Thorac Dis 2016; 8:2272-4. [PMID: 27621890 DOI: 10.21037/jtd.2016.05.01] [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: 11/06/2022]
Abstract
This video demonstrated a performance of uniportal video-assisted thoracoscopic surgery (VATS) right upper lobectomy with systemic lymphadenectomy. The patient had a malignant mass in his right upper lobe. The operator took a posterior to anterior approach to dissection the right upper lobe, the adjacent structures were clearly demonstrated after the entire dissection of mediastinal lymph nodes. Postoperative pathological report suggested the stage of the tumor was T1bN0M0 (stage IA).
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Affiliation(s)
- Ding-Pei Han
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jie Xiang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - He-Cheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jun-Biao Hang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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13
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Vallance A, Tcherveniakov P, Bogdan C, Chaudhuri N, Milton R, Kefaloyannis E. The evolution of intraoperative conversion in video assisted thoracoscopic lobectomy. Ann R Coll Surg Engl 2016; 99:129-133. [PMID: 27502339 DOI: 10.1308/rcsann.2016.0253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Unplanned conversion to thoracotomy remains a major concern in video assisted thoracoscopic surgery (VATS) lobectomy. This study aimed to investigate the development of a VATS lobectomy programme over a five-year period, with a focus on the causes and consequences of unplanned conversions. METHODS A single centre retrospective review was performed of patients who underwent complete anatomical lung resection initiated by VATS between January 2010 and April 2015. RESULTS In total, 1,270 patients underwent a lobectomy in the study period and 684 (53.9%) of these were commenced thoracoscopically. There were 75 cases (10.9%) with unplanned conversion. The proportion of lobectomies started as VATS was significantly higher in the second half of the study period (2010-2012: 277/713 [38.8%], 2013-2015: 407/557 [73.1%], p<0.001). The conversion rate dropped initially from 20.4% (11/54) in 2010 to 9.9% (15/151) in 2013 and then remained consistently under 10% until 2015. Conversions were most commonly secondary to vascular injury (26/75, 34.7%). Patients undergoing unplanned conversion had a longer length of stay than VATS completed patients (9 vs 6 days, p<0.001). There was a higher incidence of respiratory failure (10/75 [14.1%] vs 23/607 [3.8%], p<0.001) and 30-day mortality (7/75 [9.3%] vs 6/607 [1.0%], p=0.003) in patients with unplanned conversion than in those with completed VATS. CONCLUSIONS As our VATS lobectomy programme developed, the unplanned conversion rate dropped initially and then remained constant at approximately 10%. With increasing unit experience, it is both safe and technically possible to complete the majority of lobectomy procedures thoracoscopically.
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Affiliation(s)
| | | | - C Bogdan
- Leeds Teaching Hospitals NHS Trust , UK
| | | | - R Milton
- Leeds Teaching Hospitals NHS Trust , UK
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14
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Mei J, Liu L. [Troubleshooting Common Unexpected Situations during Thoracoscopic Anatomical
Pulmonary Resection]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 19:382-8. [PMID: 27335302 PMCID: PMC6015192 DOI: 10.3779/j.issn.1009-3419.2016.06.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The history of modern thoracoscopic pulmonary surgery could date back to the 1990s, and the related surgical technique has been matured after 20 years' development. Meanwhile, large amount of clinical data has been collected. Minimally invasive thoracic surgery represented by the thoracoscopic approach has been universally accepted as the preferred choice for the surgical treatment of early-staged non-small cell lung cancer and pulmonary benign diseases, and for the diagnosis of pulmonary diseases. With the generalization of thoracoscopic anatomical pulmonary resection, some unexpected situations during clinical practice has been reported in literatures, with issues involving anatomical variation, pathological factors, and surgical techniques. However, the systemic summary of the unexpected situations during thoracoscopic anatomical pulmonary resection is lacking until now. The present review, therefore, aims to summarize accidental issues and troubleshooting these unexpected situations on the basis of our own clinical practice and literature reports.
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Affiliation(s)
- Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Chengdu 610041, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Chengdu 610041, China
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15
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Drevet G, Ugalde Figueroa P. Uniportal video-assisted thoracoscopic surgery: safety, efficacy and learning curve during the first 250 cases in Quebec, Canada. Ann Cardiothorac Surg 2016; 5:100-6. [PMID: 27134835 DOI: 10.21037/acs.2016.03.05] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) using a single incision (uniportal) may result in better pain control, earlier mobilization and shorter hospital stays. Here, we review the safety and efficiency of our initial experience with uniportal VATS and evaluate our learning curve. METHODS We conducted a retrospective review of uniportal VATS using a prospectively maintained departmental database and analyzed patients who had undergone a lung anatomic resection separately from patients who underwent other resections. To assess the learning curve, we compared the first 10 months of the study period with the second 10 months. RESULTS From January 2014 to August 2015, 250 patients underwent intended uniportal VATS, including 180 lung anatomic resections (72%) and 70 other resections (28%). Lung anatomic resection was successfully completed using uniportal VATS in 153 patients (85%), which comprised all the anatomic segmentectomies (29 patients), 80% (4 of 5) of the pneumonectomies and 82% (120 of 146) of the lobectomies attempted. The majority of lung anatomic resections that required conversion to thoracotomy occurred in the first half of our study period. Seventy patients underwent other uniportal VATS resections. Wedge resections were the most common of these procedures (25 patients, 35.7%). Although 24 of the 70 patients (34%) required the placement of additional ports, none required conversion to thoracotomy. CONCLUSIONS Uniportal VATS was safe and feasible for both standard and complex pulmonary resections. However, when used for pulmonary anatomic resections, uniportal VATS entails a steep learning curve.
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Affiliation(s)
- Gabrielle Drevet
- Division of Thoracic Surgery, Institut Universitaire de Pneumologie et Cardiologie de Quebec, Canada
| | - Paula Ugalde Figueroa
- Division of Thoracic Surgery, Institut Universitaire de Pneumologie et Cardiologie de Quebec, Canada
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16
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Bedetti B, Scarci M, Gonzalez-Rivas D. Technical steps in single port video-assisted thoracoscopic surgery lobectomy. J Vis Surg 2016; 2:45. [PMID: 29078473 DOI: 10.21037/jovs.2016.02.18] [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] [Received: 01/27/2016] [Accepted: 02/02/2016] [Indexed: 11/06/2022]
Abstract
Video-assisted thoracoscopic surgery (VATS) has transformed the way of treating patients with lung diseases over the past two decades and this is particularly true referred to patients with lung carcinoma. The indication for surgical treatment could be extended to those patients that were functionally unable to receive a thoracotomy and overall this approach shortened the length of stay in hospital and improved the quality of life of these patients postoperatively. The best VATS technique for lobectomy has not been well defined yet. The VATS approach to lobectomy can be performed via 1-4 incisions without rib spreading with similar outcomes. Over the last few years the single port VATS approach has generated a growing interest in the scientific thoracic surgery community as less invasive for the patients and comfortable for the performing surgeon. The aim of this video-article is to show the different steps of this technique and to provide some tips and tricks to improve and facilitate the execution of the uniportal VATS lobectomy.
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Affiliation(s)
- Benedetta Bedetti
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Marco Scarci
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
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17
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Wang GS, Wang J, Rao ZP, Ding GG, Wang Z. Uniportal complete video-assisted thoracoscopic surgery lobectomy with partial pulmonary arterioplasty for lung cancer with calcified lymph node. J Thorac Dis 2016; 7:2366-70. [PMID: 26793361 DOI: 10.3978/j.issn.2072-1439.2015.12.50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Now, more and more complete video-assisted thoracoscopic surgery (cVATS) surgeons are capable of performing lobectomy by uniportal approach. However, concerns regarding the safety of uniportal procedures for complex cases such as neoadjuvant chemotherapy, bronchial sleeves or vascular reconstructions still remains. As experience with uniportal VATS has increased, its application toward more technically demanding operations has also expanded. This article describes a uniportal cVATS left upper lobectomy with partial pulmonary arterioplasty for lung cancer with calcified lymph nodes. In order to reduce the risk of bleeding, we looped the left main pulmonary artery and applied two-stage maneuvering for left upper lobe (LUL) bronchus, cut the bronchus at the distal end and close the stump using a stapler at the end, which are conducive to maximal safety.
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Affiliation(s)
- Guang-Suo Wang
- Department of Thoracic Surgery, Shenzhen People's Hospital, Second Affiliated Hospital, Medical College of Ji'nan University, Shenzhen 518020, China
| | - Jian Wang
- Department of Thoracic Surgery, Shenzhen People's Hospital, Second Affiliated Hospital, Medical College of Ji'nan University, Shenzhen 518020, China
| | - Zhan-Peng Rao
- Department of Thoracic Surgery, Shenzhen People's Hospital, Second Affiliated Hospital, Medical College of Ji'nan University, Shenzhen 518020, China
| | - Guang-Gui Ding
- Department of Thoracic Surgery, Shenzhen People's Hospital, Second Affiliated Hospital, Medical College of Ji'nan University, Shenzhen 518020, China
| | - Zheng Wang
- Department of Thoracic Surgery, Shenzhen People's Hospital, Second Affiliated Hospital, Medical College of Ji'nan University, Shenzhen 518020, China
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18
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Huang CL, Zhang W, Ni ZY, Zuo T, Zhou M, Xu J, Yang ZF, Li L, Xiao J, Zhang DY. Efficacy of video-assisted thoracoscopic surgery for 29 patients with tuberculosis-destroyed lung. Int J Clin Exp Med 2015; 8:18391-18398. [PMID: 26770443 PMCID: PMC4694343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/10/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Incompleteness of interlobar fissures and pleural adhesions, common in tuberculous destroyed lung (TDL), are among "technical contraindications" for video-assisted thoracoscopic surgery (VATS). The efficacy and safety of VATS in the treatment of TDL, has not yet been detailed in. OBJECTIVE The objective of the present study is to observe the efficacy and safety of VATS in the management of TDL. METHODS A retrospective review of anatomic lobectomy by VATS on 29 cases of TDL was performed in the Department of Thoracic Surgery of Wuhan Medical Treatment Center between October 2010 and October 2013. RESULTS All the 29 surgeries by VATS were successfully completed. No death case was reported. Operative duration of VATS was 75~400 min, with an average of 185.4 min; intraoperative amount of bleeding ranged 50 to 2300 ml, with an average of 575.6 ml; the incidence of postoperative complication was 21.4% (6/28). Postoperative complications occurred in 6 cases, among which there were 2 cases of persistent postoperative pulmonary air leak, 2 cases of pleural effusion, one case of thoracic hemorrhage and one case of arrhythmia complicated with left heart failure. There was one patient who was converted from VATS to open thoracic surgery half-way. CONCLUSION Our results have shown the efficacy, safety and a breakthrough in the "technical contraindications" of VATS in the management of TDL.
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Affiliation(s)
- Chao-Lin Huang
- Department of Thoracic Surgery, Wuhan Medical Treatment Center1 Yintan Road, Dongxihu District, Wuhan 430023, Hubei Province, People’s Republic of China
| | - Wei Zhang
- Intensive Care Unit, Wuhan Medical Treatment Center1 Yintan Road, Dongxihu District, Wuhan 430023, Hubei Province, People’s Republic of China
| | - Zheng-Yi Ni
- Department of Thoracic Surgery, Wuhan Medical Treatment Center1 Yintan Road, Dongxihu District, Wuhan 430023, Hubei Province, People’s Republic of China
| | - Tao Zuo
- Department of Thoracic Surgery, Wuhan Medical Treatment Center1 Yintan Road, Dongxihu District, Wuhan 430023, Hubei Province, People’s Republic of China
| | - Mi Zhou
- Department of Thoracic Surgery, Wuhan Medical Treatment Center1 Yintan Road, Dongxihu District, Wuhan 430023, Hubei Province, People’s Republic of China
| | - Jun Xu
- Department of Thoracic Surgery, Wuhan Medical Treatment Center1 Yintan Road, Dongxihu District, Wuhan 430023, Hubei Province, People’s Republic of China
| | - Zhi-Feng Yang
- Department of Thoracic Surgery, Wuhan Medical Treatment Center1 Yintan Road, Dongxihu District, Wuhan 430023, Hubei Province, People’s Republic of China
| | - Lei Li
- Department of Thoracic Surgery, Wuhan Medical Treatment Center1 Yintan Road, Dongxihu District, Wuhan 430023, Hubei Province, People’s Republic of China
| | - Jun Xiao
- Department of Thoracic Surgery, Wuhan Medical Treatment Center1 Yintan Road, Dongxihu District, Wuhan 430023, Hubei Province, People’s Republic of China
| | - Ding-Yu Zhang
- Intensive Care Unit, Wuhan Medical Treatment Center1 Yintan Road, Dongxihu District, Wuhan 430023, Hubei Province, People’s Republic of China
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