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Lee SH, Lee SG, Cho SH, Song JW, Kim DH. Outcomes of Single-Incision Thoracoscopic Surgery Using the Spinal Needle Anchoring Technique for Primary Spontaneous Pneumothorax. J Chest Surg 2022; 55:44-48. [PMID: 35115421 PMCID: PMC8824646 DOI: 10.5090/jcs.21.132] [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: 11/01/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Although classical multi-port video-assisted thoracic surgery has been widely performed, single-incision thoracoscopic surgery (SITS) is a popular surgical technique for the treatment of primary spontaneous pneumothorax (PSP). However, the inconvenient alignment of instruments and the limited field of view occasionally make surgeons convert from SITS to multi-port surgery or extend the incision. This study aimed to present an easy and safe SITS technique for PSP using a spinal needle. Methods In total, 139 patients underwent SITS between May 2011 and December 2017. We used a spinal needle to hook the bulla or bleb, and wedge resection was performed through a small incision. Patients' medical records were reviewed retrospectively, and a telephone survey was conducted to investigate the recurrence rate. Results The mean age of the 139 patients was 23.62±9.60 years. The mean operative time was 36.69±14.64 minutes, and multi-port conversion was not performed. The mean postoperative hospital stay was 3.00±0.78 days, and the mean indwelling chest tube duration was 1.97±0.77 days. No complications were observed. In the mean follow-up period of 86.75±23.20 months, recurrence of pneumothorax was found in 3 patients. Conclusion We suggest that SITS for PSP with the aid of a spinal needle to replace a grasper is a safe and easy technique that only requires a small incision.
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Affiliation(s)
- Seung Hyong Lee
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sun-Geun Lee
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang-Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jae Won Song
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Dae Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
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Zhang C, Zhang M, Wang H, Ma Z, Wu Y, Fu L, Zhu T, Yu G. Next-day discharge following small uniportal thoracoscopic bullectomy assisted with an anchoring suture. J Int Med Res 2020; 48:300060519896926. [PMID: 31937154 PMCID: PMC7113697 DOI: 10.1177/0300060519896926] [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
Objective Manipulating the instruments during uniportal video-assisted thoracoscopic surgery (U-VATS) bullectomy requires a relatively large incision. This study aimed to investigate the feasibility of next-day discharge following U-VATS bullectomy using an anchoring suture. Methods A stapler and a scope were inserted through a single incision in the anchoring group. The bullae were retracted by the suture, which was inserted from outside of the chest wall into the thorax, and then bullectomy was performed. For those in the control group, resection of the bullae was performed with the assistance of a grasping forceps. Results The length of the incision of the patients in the anchoring group ([13.2 ± 2.2] mm) was significantly smaller than in the control group ([26.2 ± 3.9] mm). In addition, the number of staplers used in the anchoring group was significantly less than in the control group ([1.2 ± 0.4] vs. [1.4 ± 0.5]). Furthermore, 36 (92.3%) cases in the anchoring group were uneventfully discharged within 24 hours after bullectomy. Conclusion Next-day discharge after U-VATS bullectomy through a small incision assisted with an anchoring suture is safe and feasible.
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Affiliation(s)
- Chu Zhang
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Miao Zhang
- Department of Thoracic Surgery, Xuzhou Central Hospital Affiliated to Southeast University, Xuzhou, Jiangsu, P.R. China
| | - Haiyong Wang
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Zhifeng Ma
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Yuanlin Wu
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Linhai Fu
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Ting Zhu
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
| | - Guangmao Yu
- Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, P.R. China
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Piao Z, Han SJ, Cho HJ, Kang MW. Feasibility of electromagnetic navigation bronchoscopy-guided lung resection for pulmonary ground-glass opacity nodules. J Thorac Dis 2020; 12:2467-2473. [PMID: 32642153 PMCID: PMC7330407 DOI: 10.21037/jtd.2020.03.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Recent advances in imaging modalities and recommended low-dose computed tomography screening programs have made it easier to diagnose early lung cancer. However, the diagnosis of small ground-glass nodules (GGNs) has been problematic due to inappropriate specimen procurement and failure of conventional percutaneous core needle biopsy. Thus, we aimed to evaluate the usefulness of electromagnetic navigation bronchoscopy (ENB)-guided video-assisted lung resection for not only the diagnosis but also treatment of GGNs. Methods From 2017 to 2019, 110 patients with suspicious lung cancer lesions that were not diagnosed by conventional procedure underwent ENB-guided lung resection. Among 35 cases of GGNs, 33 cases of localization were included in this study (two cup biopsy cases were excluded). We used SuperDimension™ for the ENB procedure. After general anesthesia, indigo carmine (0.3–0.5 mL) was injected, and GGNs were resected through video-assisted thoracoscopic surgery. Results Of the 33 GGNs, 16 were pure (2 adenocarcinomas in situ, 5 minimally invasive adenocarcinomas (MIAs), 3 adenocarcinomas, and 6 benign lesions) and 17 were mixed (1 MIA, 11 adenocarcinomas, and 5 benign lesions). The mean size of all lesions was 11.2±7.78 mm, mean distance to the pleura was 11.2±14.2 mm, and mean ENB procedure time was 18.8±8.88 minutes. Dye localization and surgical resection of GGN were successful in all cases. There was no procedure-related complication. Conclusions ENB is a feasible and highly accurate localization method for minimally invasive lung resection of small GGNs.
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Affiliation(s)
- Zhe Piao
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Sung Joon Han
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hyun Jin Cho
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Min-Woong Kang
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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Cho HJ, Roknuggaman M, Han WS, Kang SK, Kang MW. Electromagnetic navigation bronchoscopy-Chungnam National University Hospital experience. J Thorac Dis 2018; 10:S717-S724. [PMID: 29732192 DOI: 10.21037/jtd.2018.03.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To find small pulmonary nodules or ground grass nodules (GGNs) with video-assisted thoracoscopic surgery (VATS) is very difficult. There are several conventional methods to localize small nodules or GGNs, which require additional radiation exposure and may cause some complications such as pneumothorax or hemothorax. We aimed to evaluate the effectiveness and feasibility of electromagnetic navigational bronchoscopy-guided pulmonary localization in a minimally invasive thoracic surgery field. Methods We retrospectively reviewed the medical records from a prospectively collected database of the patients who underwent ENB procedure for biopsy and/or localization of pulmonary resection at the Chungnam National University Hospital from January 2017 to January 2018. Results A total of 37 ENB-guided dye-markings or biopsies for 37 lesions in 30 patients were performed. Thirty-two ENB-guided localizations using dye-marking for resection were performed in 25 patients. The median nodule size was 9 mm (IQR: 7-13 mm), and the median distance from the pleura was 6 mm (IQR: 3-10 mm). The failure of an ENB-guided localization was noted in 4 cases (12.5%). There was no major complication noted with the procedure, and just two patients showed mild intrabronchial bleeding stopped spontaneously. The most common lobar location was right lower lobe (11 cases, 34.4%), and all cases of localization failure were right lower lobe. A pathologic diagnosis was obtained from surgically resected specimen (not from ENB biopsy: 32 of 32 localizations, 100%), neoplastic lesions were 23 cases (72%). Of them, a primary lung cancer and metastatic lung cancer were noted in 11 cases, and in 11cases, respectively. All margins of the nodules were negative. Conclusions The ENB-guided dye localization by a well-trained thoracic surgeon enables accurate intraoperative identification of GGN or a small pulmonary nodule, with minimal complications and enables minimally invasive surgery including single port surgery.
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Affiliation(s)
- Hyun Jin Cho
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Md Roknuggaman
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Woo Sik Han
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Shin Kwang Kang
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Min-Woong Kang
- Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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Jung H, Oh TH, Cho JY, Lee DH. Mid-Term Outcomes of Single-Port versus Conventional Three-Port Video-Assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:184-189. [PMID: 28593154 PMCID: PMC5460965 DOI: 10.5090/kjtcs.2017.50.3.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/29/2016] [Accepted: 10/17/2016] [Indexed: 11/23/2022]
Abstract
Background The benefits of video-assisted thoracoscopic surgery (VATS) have been demonstrated over the past decades; as a result, VATS has become the gold-standard treatment for primary spontaneous pneumothorax (PSP). Due to improvements in surgical technique and equipment, single-port VATS (s-VATS) is emerging as an alternative approach to conventional three-port VATS (t-VATS). The aim of this study was to evaluate s-VATS as a treatment for PSP by comparing operative outcomes and recurrence rates for s-VATS versus t-VATS. Methods Between March 2013 and December 2015, VATS for PSP was performed in 146 patients in Kyungpook National University Hospital. We retrospectively reviewed the medical records of these patients. Results The mean follow-up duration was 13.4±6.5 months in the s-VATS group and 28.7±3.9 months in the t-VATS group. Operative time (p<0.001), the number of staples used for the operation (p=0.001), duration of drainage (p=0.001), and duration of the postoperative stay (p<0.001) were significantly lower in the s-VATS group than in the t-VATS group. There was no difference in the overall recurrence-free survival rate between the s-VATS and t-VATS groups. Conclusion No significant differences in operative outcomes and recurrence rates were found between s-VATS and t-VATS for PSP. Therefore, we cautiously suggest that s-VATS may be an appropriate alternative to t-VATS in the treatment of PSP.
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Affiliation(s)
- Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
| | - Tak Hyuk Oh
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
| | - Joon Yong Cho
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
| | - Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine
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