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Wang B, Wang J, Sun T, Ding Y, Li S, Lu H. Innovative Techniques in Video-Assisted Thoracoscopic Surgery: Lu's Approach. Lung Cancer (Auckl) 2024; 15:9-17. [PMID: 38328758 PMCID: PMC10848822 DOI: 10.2147/lctt.s446418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
Purpose Lu's approach for video-assisted thoracoscopic surgery (LVATS), which derives from Uniportal Video-Assisted Thoracoscopic Surgery(UVATS), is a novel surgical approach for VATS and carries out micro-innovation for lung cancer resection. The objective of this study is to elucidate the safety, feasibility, and efficacy of this novel surgical approach. Patients and Methods The clinical data of patients with non-small cell lung cancer (NSCLC) who underwent a curative thoracoscopic lobectomy between Mar. 2021 and Mar. 2022, were retrospectively collected and analyzed. Patients were divided into the LVATS group and the UVATS group. Propensity score matching (PSM) was used to reduce selection bias and create two comparable groups. Perioperative variables were compared, and a p-value < 0.05 was deemed statistically significant. Results A total of 182 patients were identified, among whom 86 patients underwent LVATS and 96 UVATS. Propensity matching produced 62 pairs in this retrospective study. There were no deaths during perioperative period. Patients in the LVATS group experienced a shorter operation time (88 (75, 106) VS 122 (97, 144) min, P <0.001), less intraoperative blood loss (20 (20, 30) VS 25 (20, 50) mL, P = 0.021), shorten incision length (2.50 (2.50, 2.50) VS 3.00 (3.00, 3.50) cm, P <0.001), and more drainage volume (460 (310, 660) VS 345 (225, 600) mL, P = 0.041) than patients in the UVATS group. There was not significant difference in the lymph node stations dissected (5 (4, 5) VS 5 (4, 5), P = 0.436), drainage duration (3 (3, 4) VS 3 (3, 4) days, P =0.743), length of postoperative hospital stay (4 (4, 5) VS 4 (4, 6) days, P = 0.608), VAS on the POD1 (4 (4, 4) VS 4 (4, 4), P=0.058) and POD3 (3 (3, 4) VS 4 (3, 4), P=0.219), and incidence of postoperative complications (P=0.521) between the two groups. Conclusion Lu's approach for video-assisted thoracoscopic lobectomy is safe and feasible, potentially reducing surgery time, incision length, and intraoperative blood loss.
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Affiliation(s)
- Baofeng Wang
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, People’s Republic of China
- Department of Thoracic Surgery, Weifang People’s Hospital, Weifang, Shandong, People’s Republic of China
| | - Jiang Wang
- Department of Thoracic Surgery, Weifang People’s Hospital, Weifang, Shandong, People’s Republic of China
| | - Tongyu Sun
- Department of Thoracic Surgery, Weifang People’s Hospital, Weifang, Shandong, People’s Republic of China
| | - Yilin Ding
- Department of Thoracic Surgery, Weifang People’s Hospital, Weifang, Shandong, People’s Republic of China
| | - Shasha Li
- Clinic, Weifang People’s Hospital, Weifang, Shandong, People’s Republic of China
| | - Hengxiao Lu
- Department of Thoracic Surgery, Weifang People’s Hospital, Weifang, Shandong, People’s Republic of China
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Xu Y, Luo J, Ge Q, Cong Z, Jiang Z, Diao Y, Huang H, Wei W, Shen Y. Safety and feasibility of a novel chest tube placement in uniportal video-assisted thoracoscopic surgery for non-small cell lung cancer. Thorac Cancer 2023; 14:2648-2656. [PMID: 37491972 PMCID: PMC10493483 DOI: 10.1111/1759-7714.15049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The type and placement of chest tube for patients undergoing uniportal video-assisted thoracoscopic lobectomy remains controversial. The aim of this study was to assess the efficacy and safety of a novel technique in which a pigtail catheter was used alone as the chest tube and placed near the incision for chest drainage after uniportal video-assisted thoracoscopic lobectomy and extended lymphadenectomy. METHODS A total of 217 patients undergoing uniportal video-assisted thoracoscopic lobectomy were retrospectively reviewed and divided into two groups. In group A, a 12-Fr pigtail catheter with several side ports was placed next to the uniportal wound. In group B, a conventional 20-Fr chest tube was placed through the uniportal wound itself. Postoperative complications related to chest tube placement and patients' subjective satisfaction were compared between the two groups. Postoperative pain management effect and other clinical outcomes such as duration of chest drainage and postoperative stay were also compared. RESULTS There were 112 patients in group A and 105 patients in group B. A significantly lower incidence of wound complications was found in group A postoperatively (p = 0.034). The pain score on coughing in group A was significantly lower than that in group B on postoperative day two (POD2) (p = 0.021). There was no significant difference of other clinical outcomes such as duration of chest drainage and postoperative stay as well as major complications between the two groups. CONCLUSION Placing a 12-Fr pigtail catheter alone next to the uniportal wound for chest drainage might be effective and safe after uniportal video-assisted thoracoscopic lobectomy and extended lymphadenectomy.
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Affiliation(s)
- Yang Xu
- Department of Cardiothoracic Surgery, Jingling Hospital, Jingling School of Clinical MedicineNanjing Medical UniversityNanjingChina
| | - Jing Luo
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
| | - Qi‐Yue Ge
- Department of Cardiothoracic Surgery, Jingling Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Zhuang‐Zhuang Cong
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
| | - Zhi‐Sheng Jiang
- Department of Cardiothoracic Surgery, Jingling HospitalBengbu Medical CollegeNanjingChina
| | - Yi‐Fei Diao
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
- Department of Cardiothoracic Surgery, Jingling Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Hai‐Rong Huang
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
| | - Wei Wei
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
- Department of Cardiothoracic Surgery, Jingling HospitalBengbu Medical CollegeNanjingChina
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jingling Hospital, Jingling School of Clinical MedicineNanjing Medical UniversityNanjingChina
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
- Department of Cardiothoracic Surgery, Jingling Hospital, School of MedicineSoutheast UniversityNanjingChina
- Department of Cardiothoracic Surgery, Jingling HospitalBengbu Medical CollegeNanjingChina
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Abu Ajamia S, Albandak M, Ayyad M, Abu Asbeh Y. A Large Pleural Solitary Fibrous Tumor Successfully Resected Using Uniportal Video-Assisted Thoracoscopic Surgery. Cureus 2023; 15:e42628. [PMID: 37641746 PMCID: PMC10460637 DOI: 10.7759/cureus.42628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Solitary fibrous tumors (SFTs) are rare neoplasms arising from submesothelial connective tissue. Typically affecting elderly individuals, SFTs can exhibit malignant characteristics despite most cases being benign. Diagnosis often occurs incidentally on routine chest radiographs, and patients are usually asymptomatic unless the tumor causes compression of adjacent structures. While imaging studies aid in identification, confirmation of the diagnosis requires bronchoscopy with tissue sampling and immunohistochemistry. Surgical excision remains the primary treatment for SFTs, with complete resection being associated with a better prognosis. Our case highlights the successful management of a massive SFT using uniportal video-assisted thoracoscopic surgery (VATS). Regular chest computed tomography (CT) follow-up is important for monitoring SFTs and ensuring timely intervention when necessary. We present the case of a 54-year-old female with a massive SFT presenting as a pleural tumor in the right lower lobe. The patient was initially asymptomatic, and the diagnosis was made incidentally during routine chest CT follow-up. Uniportal VATS was successfully performed for the excision of the tumor measuring 10x9x6 cm. Our case highlights the successful application of uniportal VATS for the thoracoscopic removal of a huge pleural solitary fibrous tumor.
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Affiliation(s)
| | | | | | - Yousef Abu Asbeh
- General Surgery, Al-Quds University, Jerusalem, PSE
- Thoracic Surgery Unit, Al-Ahli Hospital, Hebron, PSE
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Wang L, Ge L, Ren Y. Case report: Combined cervical incision with an intercostal uniportal video-assisted thoracoscopic surgery approach for mediastinal brachial plexus schwannoma. Front Oncol 2023; 13:1168963. [PMID: 37377912 PMCID: PMC10291177 DOI: 10.3389/fonc.2023.1168963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Mediastinal neurogenic tumors primarily originate from the intercostal and sympathetic nerves, whereas schwannomas originating from the brachial plexus are rare. Surgical intervention for such tumors is complex and associated with the risk of postoperative upper limb dysfunction due to their unique anatomical location. In this report, we present the case of a 21-year-old female diagnosed with a mediastinal schwannoma, who underwent a novel surgical approach combining cervical incision and intercostal uniportal video-assisted thoracoscopic surgery (VATS). Our study reviewed the patient's clinical presentation, treatment approach, pathology, and prognosis. The findings of this study demonstrate that the cervical approach, combined with intercostal uniportal VATS, is a feasible surgical method for the removal of mediastinal schwannomas originating from the brachial plexus.
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Affiliation(s)
- Linlin Wang
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, Liaoning, China
| | - Lihui Ge
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, Liaoning, China
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Yang F, Wang X, Xu H, Aramini B, Zhu Y, Jiang G, Fan J. A novel drainage strategy using chest tube plus pleural catheter in uniportal upper lobectomy: A randomized controlled trial. Thorac Cancer 2022; 14:399-406. [PMID: 36562112 PMCID: PMC9891854 DOI: 10.1111/1759-7714.14759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In this study we explored whether one pleural catheter plus single chest tube drainage could achieve a noninferior drainage effect when compared with the traditional two chest tubes in uniportal video-assisted thoracoscopic surgery (VATS) for an upper pulmonary lobectomy. METHODS Patients that underwent an upper pulmonary lobectomy from January to November 2020 were enrolled in this single-center, randomized, open-label, noninferiority trial. Prior to closure, patients were randomized to an intervention group who received an improved drainage strategy involving one pleural catheter with one chest tube (24 Fr), while traditional double chest tube drainage was applied for the control group. RESULTS A total of 390 patients entered the study, although 190 were excluded for changing nonuniportal surgical approaches or opting for nonlobectomy resections. Finally, 200 patients were randomized (100 in the intervention group and 100 in the control group). The baseline demographic and clinical characteristics were comparable between the groups. The incidence of pneumothorax in the intervention and control groups was similar on postoperative Day 1 (noninferiority, 10% vs. 13%, p = 0.658). In addition, there were no significant differences in secondary outcomes such as incidence of pneumothorax by Day 30, postoperative chest tube/pleural catheter removal time, amount of drainage on Day 1, total amount of drainage after operation, or postoperative hospitalization. A significantly lower pain score was observed in the intervention group (3.33 ± 0.68 vs. 3.68 ± 0.94, p = 0.003). CONCLUSIONS The new strategy is noninferior to double chest tube drainage after an upper pulmonary lobectomy offers superior pain control, and is recommended for an upper lobectomy by uniportal VATS.
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Affiliation(s)
- Fu Yang
- Department of Thoracic SurgeryShanghai Jiao Tong University First People's HospitalShanghaiChina
| | - Xing Wang
- Department of Thoracic SurgeryShanghai Jiao Tong University First People's HospitalShanghaiChina,Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Honglei Xu
- Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Beatrice Aramini
- Division of Thoracic SurgeryG.B. Morgagni‐L. Pierantoni Hospital, University of BolognaForliItaly
| | - Yuming Zhu
- Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Gening Jiang
- Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
| | - Jiang Fan
- Department of Thoracic SurgeryShanghai Jiao Tong University First People's HospitalShanghaiChina,Department of Thoracic SurgeryShanghai Tongji University Affiliated Shanghai Pulmonary HospitalShanghaiChina
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Zhai R, Liu H, Wang J, Shan L, Luo M, Yao F. Extensive open lobectomy experience is not a prerequisite for learning uniportal video-assisted thoracic surgery lobectomy. J Surg Oncol 2022; 126:1104-1113. [PMID: 35830284 DOI: 10.1002/jso.27013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/25/2022] [Accepted: 07/05/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Uniportal video-assisted thoracoscopic surgery (U-VATS) lobectomy has been increasingly adopted to manage early stage lung cancer. However, little information is available on whether this technique can be taught to surgeons inexperienced in open lobectomy. This study aimed to investigate the learning curve for U-VATS lobectomy performed by a single surgeon with limited open lobectomy experience. METHODS From July 2018 to September 2020, 103 patients received U-VATS lobectomy for lung cancer by a single surgeon. The learning curve was assessed using three statistical methods: the moving average analysis, cumulative sum (CUSUM) analysis, and risk-adjusted CUSUM (RA-CUSUM) analysis. RESULTS The moving average analysis showed a continuous decrease in operative time throughout the study period. The CUSUM analysis demonstrated three well-differentiated learning phases: Phase 1 (the initial 34 cases) representing the initial learning, Phase 2 (the middle 33 cases) representing the improvement of competence, and Phase 3 (the final 36 cases) representing technical proficiency. RA-CUSUM analysis revealed that the maximized cumulative surgical failure, defined as the maximum cumulative difference between the observed and predicted surgical failures, was found in the 61st case. CONCLUSIONS U-VATS lobectomy is feasible for surgeons with limited open lobectomy experience. Multidimensional statistical analyses suggested that 61-67 cases were required to gain technical proficiency and ensure acceptable surgical outcomes.
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Affiliation(s)
- Rong Zhai
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - He Liu
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian Wang
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Limei Shan
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ming Luo
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fei Yao
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Kara HV, Sarbay İ, Batur Ş, Turna A. An intrapericardial thymoma resected by uniportal video-assisted thoracoscopic surgery. Turk Gogus Kalp Damar Cerrahisi Derg 2022; 30:458-461. [PMID: 36303684 PMCID: PMC9580282 DOI: 10.5606/tgkdc.dergisi.2022.20700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/02/2020] [Indexed: 06/16/2023]
Abstract
Thymomas are usually located in the normal location of the thymus in the anterior mediastinum. It is very rare for thymomas to arise primarily intrapericardially. A 76-year-old male patient with a known human immunodeficiency virus positivity and has been under close follow-up for five years was admitted to our clinic. Thoracic computed tomography revealed an intrapericardial mass. Uniportal video-assisted thoracoscopic surgery was performed for the resection of the intrapericardial mass. Pathological examination revealed a type AB thymoma with a 3x3x2.5-cm dimensions (Stage 1). He underwent adjuvant irradiation. He has been doing well without any recurrence for 41 months. In conclusion, resection of intrapericardial masses is feasible and safe. This is the first case with a purely intrapericardial thymoma that was resected via uniportal videoassisted thoracoscopic surgery in the literature.
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Affiliation(s)
- Hasan Volkan Kara
- Department of Thoracic Surgery, Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
| | - İsmail Sarbay
- Department of Thoracic Surgery, Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
| | - Şebnem Batur
- Department of Pathology, Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
| | - Akif Turna
- Department of Thoracic Surgery, Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
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Chen X, Yang J, Xia M, Wu H, Wang S, Zhang W. Single-Injection Midpoint Transverse Process-to- Pleura Block Versus Thoracic Paravertebral Block for Postoperative Analgesia After Uniportal Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2022; 36:2432-2438. [PMID: 35115225 DOI: 10.1053/j.jvca.2021.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The effect of midpoint transverse process-to-pleura block (MTPB) is unclear. The authors compared the analgesic characteristics of MTPB with those of thoracic paravertebral nerve block (TPVB) in patients undergoing uniportal video-assisted thoracoscopic surgery (uVATS) and examined the 2 types of blocks for noninferiority. DESIGN A randomized, controlled trial. SETTING A single-institution, university hospital. PARTICIPANTS The study comprised 82 patients between 18 and 75 years of age. Eighty-one patients were included for final analysis. INTERVENTIONS Patients were randomly allocated to either the MTPB group (Group M) or the TPVB group (Group P). MEASUREMENTS AND MAIN RESULTS The primary outcome was the mean difference in the postoperative visual analog scale (VAS) score between Group M and Group P at rest and at 12 hours. The secondary outcomes included VAS scores during rest and coughing, nerve block performance, intraoperative consumption of anesthetics and vasoactive medication, time at first use of patient-controlled intravenous analgesia (PCIA), number of uses of PCIA, consumption of sufentanil in PCIA, and side effects. The mean difference in VAS score in the MTPB and TPVB group at rest and 12 hours postoperatively was 0.5 (95% confidence interval, -0.26 to 0.36). There was no significant difference in the time at first use of PCIA, which was 12 (10, 12) hours and 11 (10, 12) hours in Group M and Group P, respectively. The depth of puncture was shallower, and the time to perform block was shorter in Group M compared with Group P (p < 0.001). CONCLUSIONS The analgesic effect of single-level-injection MTPB is noninferior to that of TPVB in patients undergoing uVATS. The target point of the needle in MTPB is shallower and farther away from the pleura compared with TPVB. For these reasons, it is quicker and safer and, thus, may be preferable.
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Affiliation(s)
- Xu Chen
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Jinjing Yang
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Min Xia
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Hao Wu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Sheng Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Wei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China.
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Kang MK, Kang DK, Heo W, Hwang YH. The Learning Curves of Uniportal Video-Assisted Thoracoscopic Surgery Lobectomy: A Single Center Experience. J Laparoendosc Adv Surg Tech A 2021; 32:606-611. [PMID: 34714148 DOI: 10.1089/lap.2021.0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Backgrounds: The aim of our study is to describe the learning curve for uniportal video-assisted thoracoscopic surgery (VATS) lobectomy from our single center's experience for adopting it because uniportal VATS is generally considered a technically difficult procedure. Methods: A retrospective review of all 164 consecutive patients who underwent uniportal VATS lobectomy between June 2015 and February 2020 was done. A cumulative summation (CUSUM) method was applied to evaluate the learning curves of the operation time. Results: Among the 164 patients, the CUSUM value inflected at the 31st case. Ninety-five consecutive patients underwent uniportal VATS upper lobectomy. The other 69 consecutive patients underwent uniportal VATS lower lobectomy. The operation time CUSUM learning curve analysis revealed that the curves descended from the 21st case in upper lobectomy group and the 12th case in lower lobectomy group. Conclusion: Operators are required to experience at least 21 cases for upper lobectomy and 12 cases for lower lobectomy until the operation time is stabilized.
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Affiliation(s)
- Min Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Do Kyun Kang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Woon Heo
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Youn-Ho Hwang
- Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Kang DK, Kang MK, Heo W, Hwang YH. Successful Repair of Bronchoesophageal Fistula Through Uniportal Video-Assisted Thoracoscopic Surgery. J Investig Med High Impact Case Rep 2021; 9:23247096211028385. [PMID: 34176303 PMCID: PMC8236769 DOI: 10.1177/23247096211028385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This report describes a case of successful repair of bronchoesophageal fistula through uniportal video-assisted thoracoscopic surgery. A 79-year-old female patient presented with persistent cough and aspiration pneumonia. Chest computed tomography and esophagography showed a bronchoesophageal fistula at right side wall of mid to lower esophagus. Esophagogastroduodenoscopy confirmed a fistula in the esophageal diverticulum. Surgical treatment was planned. The operation was performed through uniportal video-assisted thoracoscopic surgery. The patient was discharged 6 days postoperatively without any complication. No recurrence has been observed during 3 months follow-up in the outpatient clinic to date.
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Affiliation(s)
- Do Kyun Kang
- Haeundae Paik Hospital, Busan, Korea.,Inje University, Busan, Korea
| | - Min Kyun Kang
- Haeundae Paik Hospital, Busan, Korea.,Inje University, Busan, Korea
| | - Woon Heo
- Haeundae Paik Hospital, Busan, Korea.,Inje University, Busan, Korea
| | - Youn-Ho Hwang
- Haeundae Paik Hospital, Busan, Korea.,Inje University, Busan, Korea
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Mizukami Y, Takahashi Y, Adachi H. Single-Port vs Conventional Three-Port Video-Assisted Thoracoscopic Pulmonary Wedge Resection: Comparison of Postoperative Pain and Surgical Costs. Ann Thorac Cardiovasc Surg 2020; 27:91-96. [PMID: 32999140 PMCID: PMC8058539 DOI: 10.5761/atcs.oa.20-00142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Single-port video-assisted thoracoscopic (VATS) pulmonary wedge resection was reported in 2004. We started using single-port VATS (SPVATS) pulmonary wedge resection in 2017 and compared results between conventional three-port VATS (VATS group) and SPVATS (SPVATS group). METHODS We identified 145 consecutive patients with VATS group and SPVATS group. Perioperative characteristics including pain and the number of stapler cartridges used were examined as the surgical outcomes, retrospectively. RESULTS In all, 66 cases of SPVATS group and 79 cases of VATS group pulmonary wedge resection were compared. The rate of epidural anesthesia (p <0.0001) was significantly higher and operative time (p <0.0001) was significantly longer with VATS group than with SPVATS group. The number of stapler cartridges used, duration of drain insertion, and rate of postoperative complications did not differ significantly between groups. Average numerical rating scale (NRS) score on postoperative day 1 and postoperative day 7 (p <0.0001 each), maximum NRS score on postoperative day 7 (p = 0.0082) and amount of 25 mg tramadol (p = 0.0062) were significantly lower in SPVAS group than in VATS group. CONCLUSION Our results suggest that SPVATS pulmonary wedge resection offers better pain control and cost-effectiveness than three-port VATS pulmonary wedge resection. These findings should contribute to the body of evidence for SPVATS.
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Affiliation(s)
- Yasushi Mizukami
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Hokkaido
| | - Yuki Takahashi
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Hokkaido
| | - Hirofumi Adachi
- Department of Thoracic Surgery, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Hokkaido
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Menna C, Poggi C, Andreetti C, Maurizi G, Ciccone AM, D'Andrilli A, Vanni C, Vestri AR, Fiorelli A, Santini M, Venuta F, Rendina EA, Ibrahim M. Does the length of uniportal video-assisted thoracoscopic lobectomy affect postoperative pain? Results of a randomized controlled trial. Thorac Cancer 2020; 11:1765-1772. [PMID: 32379396 PMCID: PMC7327668 DOI: 10.1111/1759-7714.13291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy has become a common approach for the treatment of early stage lung cancer. Here, we aimed to establish whether the length of uniportal incision could affect postoperative pain and surgical outcomes in consecutive patients undergoing uniportal VATS lobectomy for early stage lung cancer. METHODS This was a unicenter Randomized Control Trial (NCT03218098). Consecutive patients undergoing uniportal VATS lobectomy for Stage I lung cancer were randomly assigned to a Small Incision group or Long Incision group in 1:1 ratio based on whether patients received a 4 cm or 8 cm incision. The endpoints were to compare the intergroup difference regarding (i) postoperative pain measured by brief pain inventory (BPI) questionnaire (first endpoint); (ii) operative time; (iii) length of chest drainage; (iv) length of hospital stay; (v) postoperative complications; and (vi) pulmonary functional status (secondary endpoints). RESULTS A total of 48 patients were eligible for the study. Four patients were excluded; the study population included 44 patients: 23 within the Small Incision group, and 21 within the Long Incision group. The 11 BPI scores between the two groups showed no significant difference. Small Incision group presented higher operative time than Long Incision group (138.69 vs. 112.14 minutes; P = 0.0001) while no significant differences were found regarding length of hospital stay (P = 0.95); respiratory complications (P = 0.92); FEV1% (P = 0.63), and 6-Minute Walking Test (P = 0.77). CONCLUSIONS A larger incision for uniportal VATS lobectomy significantly reduced the operative time due to better exposure of the anatomical structures without increasing postoperative pain or affecting the surgical outcome. KEY POINTS A larger incision for uniportal VATS lobectomy significantly reduced the operative time due to better exposure of the anatomical structures without increasing postoperative pain or affecting the surgical outcome. To perform a larger incision could be a valuable strategy, particularly in nonexpert hands or when the patient's anatomy or tumor size make exposure of anatomic structures through smaller incisions difficult.
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Affiliation(s)
- Cecilia Menna
- Division of Thoracic Surgery, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Camilla Poggi
- Division of Thoracic Surgery, Policlinico Umberto I, University of Rome "Sapienza", Rome, Italy
| | - Claudio Andreetti
- Division of Thoracic Surgery, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Giulio Maurizi
- Division of Thoracic Surgery, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Anna Maria Ciccone
- Division of Thoracic Surgery, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Antonio D'Andrilli
- Division of Thoracic Surgery, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Camilla Vanni
- Division of Thoracic Surgery, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Anna Rita Vestri
- Department of Public Health and Infectious Disease, University of Rome "Sapienza", Rome, Italy
| | - Alfonso Fiorelli
- Thoracic surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Santini
- Thoracic surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Federico Venuta
- Division of Thoracic Surgery, Policlinico Umberto I, University of Rome "Sapienza", Rome, Italy.,Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy.,Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
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Huang H, Ma H, Chen S. Enhanced recovery after surgery using uniportal video-assisted thoracic surgery for lung cancer: A preliminary study. Thorac Cancer 2017; 9:83-87. [PMID: 29087621 PMCID: PMC5754309 DOI: 10.1111/1759-7714.12541] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/15/2017] [Accepted: 09/15/2017] [Indexed: 01/05/2023] Open
Abstract
Background This study investigated the clinical efficiency of enhanced recovery after surgery (ERAS) using uniportal video‐assisted thoracoscopic surgery for lung cancer. Methods The clinical data of 83 patients with early‐stage non‐small cell lung cancer (NSCLC) at the First Affiliated Hospital of Soochow University from January 2016 to February 2017 were retrospectively analyzed. ERAS was applied to 38 patients (ERAS group), while 45 patients received conventional surgical treatment (control group). The operative duration, number of lymph nodes retrieved, blood loss, visual analogue scale (VAS), postoperative duration of chest tube placement, length of hospital stay, and postoperative complications were compared between the groups. Results Surgeries were conducted successfully in all patients, and no mortality occurred during the perioperative period. The ERAS group had better VAS on the third postoperative day, shorter chest tube duration, and shorter length of hospital stay (P < 0.05). No differences between the groups in terms of operative duration, number of lymph nodes retrieved, blood loss, VAS on the first postoperative day, or complication rate were found (P > 0.05). Conclusions ERAS using uniportal video‐assisted thoracoscopic surgery for NSCLC patients is safe and practicable, and could also reduce the length of hospital stay.
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Affiliation(s)
- Haitao Huang
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haitao Ma
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shaomu Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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