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Nii K, Igai H, Numajiri K, Ohsawa F, Kamiyoshihara M. Uniportal thoracoscopic mediastinal lymphadenectomy using appropriate surgical steps. J Thorac Dis 2024; 16:321-332. [PMID: 38410588 PMCID: PMC10894416 DOI: 10.21037/jtd-23-1350] [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] [Received: 09/01/2023] [Accepted: 11/24/2023] [Indexed: 02/28/2024]
Abstract
Background Although lymphadenectomies play an important role in the surgical treatment of patients with non-small cell lung cancer (NSCLC), the quality of lymphadenectomies via a uniportal approach has only been evaluated in a few studies. We describe the surgical steps for a mediastinal lymphadenectomy via uniportal video-assisted thoracoscopic surgery (uVATS) and compare the quality of mediastinal lymphadenectomies using uVATS versus multiportal video-assisted thoracoscopic surgery (mVATS). Methods Between April 2017 and January 2023, we analyzed data from 304 patients with NSCLC who underwent (bi-)lobectomy with nodal dissection (ND)2a-1 or greater lymphadenectomy via uVATS or mVATS. We compared patient characteristics and perioperative results, including the number of harvested lymph nodes (LNs), between the two approaches. In addition, the factors associated with N-upstage were identified. Results No significant differences in the total number of harvested LNs were detected between the two approaches. Significantly more LN#2R/4R zone LNs were harvested in the uVATS group compared with the number harvested in the mVATS group [uVATS group: 8.5, interquartile range (IQR), 5-12.3; mVATS group: 7, IQR, 5-9, P=0.0177], while no significant differences in total nodes or nodes harvested in other zones were detected. Multivariable analysis revealed that pathologic invasion size [odds ratio: 1.0200, 95% confidence interval (CI): 1.0100-1.0400, P=0.0050], but not approach (uVATS, odds ratio: 0.6240, 95% CI: 0.3160-1.2300, P=0.1750), significantly contributed to N factor upstages. Conclusions The use of appropriate surgical steps enabled us to achieve similar quality lymphadenectomies via mVATS or uVATS.
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Affiliation(s)
- Kazuhito Nii
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Kazuki Numajiri
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
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Igai H, Nii K, Kamiyoshihara M. Robotic upper division segmentectomy of the left upper lobe without turning the lung. Multimed Man Cardiothorac Surg 2024; 2024. [PMID: 38226830 DOI: 10.1510/mmcts.2023.097] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
The fissureless technique in lobectomy or the unidirectional dissection technique in segmentectomy is considered useful to avoid a postoperative prolonged air leak if a fissure is fused because it is not dissected. Another advantage of this technique is that it does not require repeated rotation of the lung to obtain a good surgical view, which may result in a shorter operating time. We believe that this technique is suitable for a robotic approach because we sometimes find it difficult to rotate the lung parenchyma in the limited rigid thoracic cavity when using the robotic approach. We demonstrate a robotic upper division segmentectomy of the left upper lobe with an explanation of the nuances of its performance. The console time was 74 minutes with minimal blood loss. The patient's postoperative course was uneventful. On the day of the operation, we removed the chest tube because we found no air leak. The patient was discharged on postoperative day (POD) 2. The final pathology report showed that a sufficient surgical margin was achieved. These good perioperative results indicate the feasibility of this technique.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery Maebashi Red Cross Hospital Maebashi 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan
| | - Kazuhito Nii
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma 371-0811, Japan
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Igai H, Nii K, Kamiyoshihara M. Two cases of lower lobe segmentectomy (left and right) using the lung-inverted approach in a robotic operation. Multimed Man Cardiothorac Surg 2024; 2024. [PMID: 38226628 DOI: 10.1510/mmcts.2023.090] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
In pulmonary segmentectomy, the dominant pulmonary arteries are conventionally divided at the fissure. However, this approach sometimes leads to accidental injury of the pulmonary artery and prolonged air leaks when the fissure is fused. To overcome these problems, we have adopted the lung-inverted approach without dissection of a fissure for segmentectomy, taking advantage of the good view provided by robotic surgery. We have successfully performed a robotic left S10 or right S6 segmentectomy using the lung-inverted approach. In addition to a good postoperative course, the console time was 72 minutes for the left S10 segmentectomy and 110 minutes for the right S6 segmentectomy; these times were considered relatively short. This approach did not require repeated rotation of the lung, which may have contributed to the short operating time. A clear understanding of the anatomy was required to properly implement this approach, because each branch of the pulmonary vessels and of the bronchi was treated at the hilum. Preoperative 3-dimensional computed tomography broncho-angiography was considered useful because it allowed us to recognize the relative positions of the dominant pulmonary vessels, bronchi and other preserved structures.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery Maebashi Red Cross Hospital Maebashi 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan
| | - Kazuhito Nii
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma 371-0811, Japan
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Igai H, Numajiri K, Ohsawa F, Nii K, Kamiyoshihara M. Comparison of the Learning Curve between Uniportal and Robotic Thoracoscopic Approaches in Pulmonary Segmentectomy during the Implementation Period Using Cumulative Sum Analysis. Cancers (Basel) 2023; 16:184. [PMID: 38201611 PMCID: PMC10778519 DOI: 10.3390/cancers16010184] [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: 11/15/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The aim of this retrospective study was to compare the learning curve and perioperative outcomes between the two approaches uVATS and RATS during their implementation periods. METHODS The uVATS group included 77 consecutive uVATS segmentectomies performed by HI between February 2019 and June 2022, while the RATS group included 30 between July 2022 and September 2023. The patient characteristics, perioperative outcomes, and learning curves were compared between the two groups. The learning curve was evaluated using operative time and cumulative sum (CUSUMOT) analysis. RESULTS Most patient characteristics and perioperative outcomes were equivalent between the two groups. In the uVATS group, after a positive slope was observed until the 14th case (initial period), a plateau was observed until the 38th case (stable period). Finally, a negative slope was observed after the 38th case (proficiency period). In the RATS group, after a positive slope was observed until the 16th case (initial period), a plateau was observed until the 22nd case (stable period). Finally, a negative slope was observed after the 22nd case (proficiency period). CONCLUSIONS In segmentectomy, a surgeon reached the proficiency period earlier in RATS than in uVATS, although the trends to the stable period were similar.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi 371-0811, Gunma, Japan
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Igai H, Nii K, Kamiyoshihara M. A robotic left S1+2c subsegmentectomy using preoperative simulation. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 38059730 DOI: 10.1510/mmcts.2023.086] [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: 12/08/2023]
Abstract
Although there are reports describing segmentectomy by a robotic approach, reports describing robotic subsegmentectomy are rare because this procedure requires more precise anatomical knowledge and exposure of subsegmental pulmonary vessels and bronchi. However, the robotic approach has several advantages, including a high-definition 3-dimensional surgical view and precise motion without tremor, which may allow us to perform the subsegmentectomy more easily. Considering these advantages of the robotic approach, we successfully performed a robotic left S1+2c segmentectomy with a short console time and a good postoperative course. We present the surgical steps of this procedure. In addition, the preoperative simulation method was useful to ensure a sufficient surgical margin. Because the robotic approach lacked tactile feedback, it was difficult to locate the target tumour intraoperatively by palpation compared with the conventional thoracoscopic approach. Finally, in this case, we obtained an adequate surgical margin using this preoperative simulation method.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery Maebashi Red Cross Hospital Maebashi 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan
| | - Kazuhito Nii
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma 371-0811, Japan
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Igai H, Matsuura N, Numajiri K, Ohsawa F, Kamiyoshihara M. Early chest drain removal on the day of uniportal thoracoscopic segmentectomy. Gen Thorac Cardiovasc Surg 2023; 71:700-707. [PMID: 37452220 DOI: 10.1007/s11748-023-01951-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Although early removal of postoperative chest drains can facilitate recovery, it can be difficult to achieve in segmentectomy due to the management of air leakage in intersegmental planes. This study prospectively examined the feasibility of drain removal on the same day of uniportal thoracoscopic segmentectomy. METHODS Twenty patients who underwent uniportal thoracoscopic segmentectomy between July 2021 and May 2022 were enrolled in this prospective study. The indications for drain removal on the day of surgery were absence of air leakage in an intraoperative sealing test, radiographic evidence of lung expansion, and continuous absence of air leakage via a drainage bottle for 4 h after the operation. The primary endpoint was rate of the patients who required re-drainage after the postoperative drainage tube was removed on the day of surgery. The secondary end points were postoperative pain evaluated using a numerical rating scale on postoperative days 1, 7, and 28; morbidity; and postoperative hospitalization period. RESULTS Fifteen patients successfully underwent drain removal on the day of surgery. None required re-drainage. The mean postoperative hospitalization period was 2.3 ± 1.7 days. Overall, 12 of the 15 (80%) patients were discharged on postoperative day 1 or 2. The mean numerical rating scale scores were 1.2 ± 1.6, 0.4 ± 0.7, and 0.4 ± 1.5 on postoperative days 1, 7, and 28, respectively. CONCLUSION In uniportal thoracoscopic segmentectomy, drain removal on the day of surgery is feasible and may reduce pain on postoperative day 1.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-Cho, Maebashi, Gunma, 371-0811, Japan.
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-Cho, Maebashi, Gunma, 371-0811, Japan
| | - Kazuki Numajiri
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-Cho, Maebashi, Gunma, 371-0811, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-Cho, Maebashi, Gunma, 371-0811, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-Cho, Maebashi, Gunma, 371-0811, Japan
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Igai H, Nii K, Kamiyoshihara M. A robotic anterior (S3) segmentectomy of the left upper lobe. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37962546 DOI: 10.1510/mmcts.2023.084] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
A robotic approach might be more suitable for pulmonary segmentectomy than the conventional thoracoscopic approach, because the high-definition 3-dimensional surgical view and precise motion without tremor allow us to dissect pulmonary vessels and bronchi to the periphery. However, among several types of segmentectomies, the anterior segmentectomy (S3) of the left upper lobe may be one of the most difficult to achieve in the robotic approach because the dissected hilar region tends to be obstructed by the lung parenchyma in the "looking-up" view. We offer two technical tips to achieve robotic left S3 segmentectomy. The first is the proper retraction of the upper lobe using straw gauze, which allows us to get a good surgical view in the dissected hilar area where pulmonary vessels and bronchi are located. Second, when the intersegmental plane is divided by robotic staplers, the lung should be moved to the dividing line because the angulation of the inserted stapler is limited. Taking these two tips into consideration, we have successfully performed a robotic left S3 segmentectomy. We show the surgical steps of this procedure.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery Maebashi Red Cross Hospital Maebashi 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan
| | - Kazuhito Nii
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma 371-0811, Japan
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Igai H, Kamiyoshihara M. A robotic fissureless left lower lobectomy. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37615197 DOI: 10.1510/mmcts.2023.059] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
The fissureless technique is considered one of several useful techniques for patients with a fused fissure to avoid postoperative prolonged air leak. When performing the fissureless technique for a lower lobectomy, we consider two important points necessary to perform this technique safely and appropriately. The first is not to injure the pulmonary artery behind the lower bronchus when encircling or dividing it. The second is to accurately identify the pulmonary artery branches to be divided. To achieve these goals, we chose a robotic approach, which yielded successful perioperative results.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery Maebashi Red Cross Hospital 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan
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Matsuura N, Igai H, Ohsawa F, Numajiri K, Kamiyoshihara M. Learning curve for uniportal thoracoscopic pulmonary segmentectomy: how many procedures are required to acquire expertise? Transl Lung Cancer Res 2023; 12:1466-1476. [PMID: 37577322 PMCID: PMC10413023 DOI: 10.21037/tlcr-23-104] [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] [Received: 02/12/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023]
Abstract
Background Minimally invasive surgeries are increasingly being performed. However, few studies have evaluated the learning curve for uniportal thoracoscopic segmentectomies. Therefore, we investigated the learning curve for uniportal thoracoscopic segmentectomy in our department. Methods We retrospectively reviewed the clinical data of consecutive patients who underwent uniportal thoracoscopic segmentectomy at our institution between February 2019 and January 2022. Two senior surgeons [Hitoshi Igai (H.I.) and Natsumi Matsuura (N.M.)] performed all of the surgeries. H.I. introduced uniportal thoracoscopic segmentectomy in our department and supervised N.M. performing this operation. Resident surgeons participated in the operations as assistants. The learning curve for uniportal thoracoscopic segmentectomy was evaluated on the basis of operative time and cumulative sum (CUSUMOT). Results The entire team, including resident surgeons, completed the learning curve by performing 60 surgeries. The learning curve consisted of three phases: initial learning (60 surgeries), accumulation of competence (16 surgeries), and acquisition of expertise (17 surgeries), respectively. The operative time, blood loss, postoperative drainage, and postoperative hospitalization time significantly improved across the phases. N.M. completed the initial learning curve faster than H.I. (16 and 29 surgeries, respectively). Conclusions Under supervision by an experienced surgeon, a team successfully completed the learning curve for uniportal thoracoscopic segmentectomy and achieved good perioperative outcomes, which indicates the importance of appropriate supervision for acquiring expertise for this surgery.
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Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Kazuki Numajiri
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
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Igai H, Kamiyoshihara M. Anterior unidirectional approach in a uniportal thoracoscopic anterior segmentectomy (S3) of the right upper lobe for a dense fissure. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37140217 DOI: 10.1510/mmcts.2023.003] [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: 05/05/2023]
Abstract
Most types of segmentectomies require dissection of a fissure to expose the pulmonary arteries, which is considered a conventional technique. Therefore, it is necessary to deal with a dense fissure in a pulmonary segmentectomy as well as in a lobectomy. Nevertheless, only a few reports describe the operative technique for managing a dense fissure in a pulmonary segmentectomy. Although a dense fissure is frequently found between the right upper and the middle lobes, only one previous report has described an anterior segmentectomy (S3) of the right upper lobe without the dissection of a dense fissure between the right upper and middle lobes. In this video tutorial, we show the appropriate surgical steps for a right S3 segmentectomy using an anterior unidirectional approach via uniportal thoracoscopy for a patient with a dense fissure.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery Maebashi Red Cross Hospital 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan
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Igai H, Kamiyoshihara M. A uniportal thoracoscopic fissureless lingual segmentectomy for a patient with a dense fissure. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37114646 DOI: 10.1510/mmcts.2023.021] [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: 04/29/2023]
Abstract
Postoperative prolonged air leak is one of the most common morbidities in general thoracic surgery, and a dense fissure is considered to be one of the main causes of prolonged air leak. In a patient with a dense fissure, the fissureless technique is considered one of the most useful options to avoid prolonged air leak, which has been reported in several previous articles after a lobectomy. However, there are few reports describing the operative technique to treat a dense fissure via a pulmonary segmentectomy, although the management of a dense fissure is necessary in a pulmonary segmentectomy as well as in a lobectomy. In this video tutorial, we show the successful results of a left lingual segmentectomy using the fissureless technique via a uniportal thoracoscopy in a patient with a dense fissure. Special emphasis was placed on how to divide the dominant pulmonary vessels and bronchus given the limited angulation of the inserted stapler.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery Maebashi Red Cross Hospital 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan
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Yazawa T, Igai H, Kamiyoshihara M, Shirabe K. Right basal bronchial fistula due to amebic infection: a case report. BMC Pulm Med 2023; 23:117. [PMID: 37060007 PMCID: PMC10103523 DOI: 10.1186/s12890-023-02412-9] [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: 08/24/2022] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Pleuropulmonary amebiasis is the second most common form of extraintestinal invasive amebiasis, but cases that include bronchopleural fistula are rare. CASE PRESENTATION A 43-year-old male was referred to our hospital for liver abscess, right pleural effusion, and body weight loss. He was diagnosed with a bronchopleural fistula caused by invasive pleuropulmonary amebiasis and human immunodeficiency virus (HIV) infection. After initial medical treatment for HIV infection and invasive amebiasis, he underwent pulmonary resection of the invaded lobe. Intraoperative inspection revealed a fistula of the right basal bronchus in the perforated lung abscess cavity, but the diaphragm was intact. The patient was discharged on postoperative day 3 and was in good condition at the 1-year follow-up. CONCLUSIONS Clinicians should be aware that pleuropulmonary amebiasis can cause a bronchopleural fistula although it is very rare.
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Affiliation(s)
- Tomohiro Yazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22, Showa-Machi, Maebashi, 371-8511, Gunma, Japan.
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Ken Shirabe
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22, Showa-Machi, Maebashi, 371-8511, Gunma, Japan
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Igai H, Matsuura N, Numajiri K, Ohsawa F, Kamiyoshihara M. Supervision by an experienced surgeon can reduce the learning curve of uniportal thoracoscopic lobectomy. Transl Lung Cancer Res 2023; 12:207-218. [PMID: 36895919 PMCID: PMC9989800 DOI: 10.21037/tlcr-22-739] [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: 10/12/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
Background This retrospective study was performed to investigate the learning curve of uniportal thoracoscopic lobectomy with ND2a-1 or greater lymphadenectomy for two senior surgeons, and to evaluate how supervision affected the learning curve. Methods Between February 2019 and January 2022, 140 patients with primary lung cancer underwent uniportal thoracoscopic lobectomy with ND2a-1 or greater lymphadenectomy in our department. Two senior surgeons (HI and NM) performed most of the operations, with junior surgeons performing the rest. HI initiated this surgical method in our department and supervised all operations performed by other surgeons. Patient characteristics and perioperative outcomes were reviewed, and the learning curve was evaluated based on operative time and the cumulative sum method (CUSUMOT). Results No significant differences were observed in patient characteristics or perioperative outcomes between groups. Three distinct learning curve phases were identified for each senior surgeon: HI, cases 1-21, cases 22-40, cases 41-71; NM cases 1-16, cases 17-30, cases 31-49. For HI, the rate of conversion to thoracotomy was significantly higher in the initial phase (14.3%, P=0.04) although other perioperative outcomes were equivalent between phases. For NM, while the duration of postoperative drainage was significantly shorter in phase 2 and phase 3 (P=0.026), other perioperative outcomes, including conversion rate (5.3-7.1%), were equivalent between phases. Conclusions Supervision by an experienced surgeon was important for avoiding conversion to thoracotomy during the initial period, and facilitated the surgeon rapidly gaining proficiency with the surgical method.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kazuki Numajiri
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
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Igai H, Numajiri K, Ohsawa F, Kamiyoshihara M. Standardization of intra- and peri-operative management to reduce postoperative drainage time after major thoracoscopic pulmonary resections. J Thorac Dis 2023; 15:568-578. [PMID: 36910069 PMCID: PMC9992609 DOI: 10.21037/jtd-22-1377] [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: 10/03/2022] [Accepted: 01/13/2023] [Indexed: 02/25/2023]
Abstract
Background It is important to reduce the postoperative drainage time after thoracic surgery to relieve postoperative pain and facilitate patient mobilization. We standardized intra- and peri-operative management of major, thoracoscopic pulmonary resections in February 2019. In this study, we investigated whether this standardization reduced the postoperative drainage time. Moreover, we examined how such management affected re-admission within 30 days after operation (because of pleural complications). Methods Between May 2012 and February 2022, 815 patients with malignant or benign disease underwent major thoracoscopic pulmonary resections in our department. The patients were classified into two groups: those who received standardized management (n=352) and those who did not (n=463). After propensity score-matching, we compared characteristics and perioperative results between the two groups (n=234 in each group) by univariate analysis. The factors affecting postoperative drainage time and re-admission within 30 days after operation (because of pleural complications) were evaluated via multivariate analysis. Standardized management was as follows: (I) intraoperatively, any dense fissures were left untreated to avoid postoperative air leakage. A fissureless or unidirectional dissection technique served as an alternative; pulmonary vessels and bronchi were divided at the hilum in patients with dense fissures. (II) The chest drain was removed when air leakage ceased, regardless of the fluid volume or surgeon's preference. Results The standardized management group evidenced superior results in terms of operative time (P<0.0001) and postoperative drainage time (P<0.0001). There were no significant differences in the remaining perioperative parameters. Moreover, standardized management significantly reduced postoperative drainage time, as revealed by multivariate analysis [estimated regression coefficient: -0.47; 95% confidence interval (CI): -0.78 to -0.16; P=0.003]. Moreover, standardized management did not significantly increase re-admission (because of pleural complications) [odds ratio (OR) =1.76; 95% CI: 0.557 to 5.58; P=0.34]. Conclusions Standardized intra- and peri-operative management significantly reduced the postoperative drainage time after major thoracoscopic pulmonary resections, without increasing re-admissions within 30 days among patients with pleural complications caused by insufficient drainage. Surgeons must master a fissureless or a unidirectional dissection technique, avoid dissection of fused fissures, and apply standardized perioperative drainage management.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kazuki Numajiri
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
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15
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Igai H, Kamiyoshihara M. Thoracoscopic transareolar approach for primary spontaneous pneumothorax in young male patients. Video-assist Thorac Surg 2023. [DOI: 10.21037/vats-22-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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16
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Igai H, Matsuura N, Numajiri K, Ohsawa F, Kamiyoshihara M. A dense fissure is not a contra-indication for uniportal thoracoscopic lobectomy. J Thorac Dis 2022; 14:4650-4659. [PMID: 36647473 PMCID: PMC9840050 DOI: 10.21037/jtd-22-1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022]
Abstract
Background A dense fissure is a main cause of a postoperative prolonged air leak (PAL). Such a fissure, if exposed, sometimes incidentally injures the pulmonary artery. We investigated whether uniportal thoracoscopic lobectomy which is considered technically more difficult than the conventional multiportal approach was appropriate for patients with dense fissures. Methods From February 2019 to January 2022, 140 patients with primary lung cancer underwent uniportal thoracoscopic lobectomy with ≥ ND2a-1 lymphadenectomy. Patients were divided into those with dense (n=22) and separated (n=118) fissures. All dense fissures were treated using a fissureless technique without exposure of the pulmonary artery. We compared the characteristics and perioperative results of the two groups. We used multivariate analysis to identify factors predictive of PAL. Results Although dense fissures were significantly associated with right upper lobectomies, the other patient characteristics and perioperative results were similar between the two groups. No significant pulmonary artery injuries occurred in the fissureless group. In subgroup analyses of right upper lobectomy patients, we found no other significant between-group differences in patient characteristics or perioperative results. In multivariate analyses, right upper lobectomy [odds ratio (OR): 0.047, 95% confidence interval (CI): 0.0044-0.49, P=0.011] or smoking index (OR: 1.03, 95% CI: 1-1.07, P=0.048) was the factor predictive of PAL. Conclusions A dense fissure is not a contraindication for uniportal thoracoscopic lobectomy using the fissureless technique, which is thus safe.
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17
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Igai H, Kamiyoshihara M, Numajiri K, Ohsawa F. Procedures to avoid postoperative prolonged air leak in thoracic surgery. J Thorac Dis 2022; 14:4220-4222. [DOI: 10.21037/jtd-22-1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
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18
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Igai H, Kamiyoshihara M. Infrared thoracoscopic extended lobectomy (right upper lobe and S6) with intravenous indocyanine green administration using preoperative simulation to ensure safe surgical margin. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36227277 DOI: 10.1510/mmcts.2022.038] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Although it is crucial to ensure a sufficient surgical margin for a malignant neoplasm, we sometimes struggle to achieve this goal using a minimally invasive approach because it is difficult to palpate the tumor adequately via the small skin incision. To overcome this issue, we adopted a preoperative simulation method for a patient undergoing a right upper lobe and a posterior segmentectomy of the lower lobe (extended lobectomy) and obtained successful results. The discrepancy between the virtual and the actual surgical margins was 5 mm.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery Maebashi Red Cross Hospital 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan
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19
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Kamiyoshihara M, Igai H, Matsuura N, Ohsawa F, Numajiri K. [Multidisciplinary Treatment for Postoperative Recurrent Patients-Report of a Long-Term Survivor]. Gan To Kagaku Ryoho 2022; 49:1117-1119. [PMID: 36281606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We present a long-term survivor who received multidisciplinary treatment for a postoperative recurrence. A 52-year-old female who had been clinically diagnosed with primary lung cancer underwent a right lower lobectomy, middle lobe wedge resection, and lymph node dissection(ND2a-1), and was pathologically diagnosed with primary pulmonary papillary adenocarcinoma( pT3N0M0, Stage ⅡB)positive for a sensitizing EGFR mutation(L858R). The patient was given UFT as postoperative adjuvant chemotherapy for 2 years. During the follow-up, multiple pulmonary metastases occurred in postoperative month 44. Gefitinib was administered as the first-line treatment, which resulted in a complete response for 30 months. Then, stereotactic radiotherapy was administered for 3 brain metastases, and multiple pulmonary metastases were treated with cisplatin plus pemetrexed and carboplatin plus pemetrexed for PD, but an adverse event occurred. Therefore, pemetrexed monotherapy was administered as a fourth-line treatment for 5 months. Then, afatinib, nivolumab, docetaxel, osimertinib, S-1, pembrolizumab, and atezolizumab(11th-line treatment)were administered with each PD or new lesion. Finally, the best supportive care was administered and she died on postoperative month 134, which was post-recurrent month 90.
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20
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Matsuura N, Igai H, Kamiyoshihara M. Uniportal thoracoscopic lateral and posterior basal segmentectomy using intersegmental tunneling: Comparison with multiportal approach. Asian J Endosc Surg 2022; 15:863-866. [PMID: 35620902 DOI: 10.1111/ases.13084] [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: 04/12/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
Thoracoscopic lateral and posterior basal (S9 + 10) segmentectomy (or S10 segmentectomy) is one of the most technically challenging anatomical segmentectomies. We have used "intersegmental tunneling" in the multiportal approach, and we now apply this with a little ingenuity in the uniportal approach. However, because of interference between instruments and the limited insertion angles in the uniportal approach, complex segmentectomies such as S9 + 10 or S10 become even more difficult. The perioperative outcomes were compared between uniportal and multiportal thoracoscopic lateral and posterior basal segmentecomy using intersegmental tunneling. There were no significant differences between the groups in patient characteristics and perioperative outcomes other than operation time, which was significantly shorter in the uniportal group than in the multiportal group (169 ± 21 vs 216 ± 34 min, P = .011). Thoracoscopic S9 + 10 (S10) segmentectomy can be safely performed through the uniportal approach without any difficulties using an intersegmental tunneling method and adding a little ingenuity.
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Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan
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21
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Miki Y, Yoshimura S, Sasaki T, Takizawa R, Kimura K, Haraguchi Y, Sasaki W, Kishi S, Nakatani Y, Kaseno K, Goto K, Take Y, Nakamura K, Niwamae N, Kamiyoshihara M, Naito S. Bilateral Cardiac Sympathetic Denervation for Treatment-Resistant Ventricular Arrhythmias in Heart Failure Patients with a Reduced Ejection Fraction. Int Heart J 2022; 63:692-699. [PMID: 35908853 DOI: 10.1536/ihj.21-601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 12/13/2022]
Abstract
The sympathetic nervous system plays an important role in life-threatening ventricular arrhythmias (VAs). Bilateral cardiac sympathetic denervation (BCSD) is performed for refractory VAs. We sought to assess our institutional experience with BCSD in managing treatment-resistant monomorphic ventricular tachycardia (MMVT) in heart failure patients with a reduced ejection fraction (HFrEF).Four patients with HFrEF (EF 30.0 ± 8.2%, New York Heart Association [NYHA] class IV 1) underwent BCSD for MMVT (VT storm 3, repetitive VT requiring implantable cardioverter defibrillator [ICD] therapy 1) refractory to antiarrhythmic drugs, catheter ablation and ICD therapy. BCSD was effective for suppressing VT in 3 patients for whom deep sedation was effective for suppressing VT. One patient remained alive after 14 months of follow-up without episodes of VT. One patient died of acute myocardial infarction before discharge and 1 patient died from unknown cause at 3 days post-discharge. In contrast, BCSD was completely ineffective for suppressing VT in a patient with NYHA class IV for whom deep sedation and stellate ganglion block were ineffective. This patient died on the 10th post-CSD day, despite left ventricular assist device implantation. In all cases, BCSD was successfully performed without procedure-related complications.Despite the limited number of cases, our results showed that BCSD in patients with HFrEF suppressed refractory MMVT in acute-phase except for a patient with NYHA class IV; however, the prognoses were not good. BCSD may be a treatment option at an earlier stage of NYHA and a bridge to orthotopic heart transplantation, even if BCSD is effective for suppressing VAs.
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Affiliation(s)
- Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | | | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Ryoya Takizawa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kohki Kimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | | | - Wataru Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shohei Kishi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Nogiku Niwamae
- Department of Cardiovascular Medicine, Japanese Red Cross Maebashi Hospital
| | | | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
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22
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Igai H, Matsuura N, Kamiyoshihara M. Uniportal thoracoscopic left posterior basal segmentectomy using a posterior approach. Thorac Cancer 2022; 13:2401-2403. [PMID: 35815411 PMCID: PMC9376154 DOI: 10.1111/1759-7714.14572] [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] [Received: 06/06/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/27/2022] Open
Abstract
Posterior basal (S10) segmentectomy is one of the most challenging (and uncommon) types of pulmonary segmentectomy. Here, we present two key tips for facilitating a uniportal operation. The first is a full understanding of the relative locations of the pulmonary vessels and bronchi (as revealed by preoperative three‐dimensional computed tomography/broncho‐angiography), and the other is the use of “suction‐guided stapling” to dissect and divide the peripheral pulmonary vessels and bronchi. We describe the successful postoperative course of a patient who was so treated.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
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23
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Igai H, Matsuura N, Kamiyoshihara M. Invited commentary on: The usefulness of the nomogram to predict tumor spread through air spaces (STAS) in patients with clinical stage I non-small cell lung cancer preoperatively. Eur J Cardiothorac Surg 2022; 62:6585338. [PMID: 35553658 DOI: 10.1093/ejcts/ezac309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery,, Japanese Red Cross Maebashi Hospital
| | - Natsumi Matsuura
- Department of General Thoracic Surgery,, Japanese Red Cross Maebashi Hospital
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24
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Igai H, Matsuura N, Kamiyoshihara M. En bloc resection of the left upper lobe and the anterior basal segment of the lower lobe via a uniportal thoracoscopic approach for a dense fissure. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 35377974 DOI: 10.1510/mmcts.2022.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Unidirectional dissection including a fissureless technique is a reasonable procedure for performing uniportal thoracoscopic major pulmonary resections because the angulation of the inserted surgical instruments or a thoracoscope via a single small incision is extremely limited. This type of procedure is considered useful for many types of anatomical pulmonary resections via a uniportal approach. In this video tutorial, which illustrates a more complicated case, we show en bloc resection of a left upper lobe and anterior basal segment (S8) using unidirectional dissection via a uniportal thoracoscopic approach for a patient with a dense fissure.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery Maebashi Red Cross Hospital 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital
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25
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Igai H, Matsuura N, Kamiyoshihara M. Preoperative Simulation of Thoracoscopic Segmentectomy. Ann Thorac Surg 2022; 114:e295-e297. [PMID: 35122721 DOI: 10.1016/j.athoracsur.2021.12.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/08/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022]
Abstract
When performing thoracoscopic pulmonary segmentectomy, we sometimes encounter a non-palpable malignant tumor located near the intersegmental plane that we had planned to divide. In such a situation it can be difficult to ensure a sufficient surgical margin. To overcome this problem, we now perform preoperative simulation using the Ziostation2 (Ziosoft, Tokyo, Japan) to calculate the surgical margin. This yields margins of at least 20 mm; the discrepancy between the virtual and actual surgical margins is always less than 5 mm.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital.
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital
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26
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Yazawa T, Igai H, Numajiri K, Ohsawa F, Matsuura N, Kamiyoshihara M. Comparison of stapler and electrocautery for division of the intersegmental plane in lung segmentectomy. J Thorac Dis 2022; 13:6331-6342. [PMID: 34992813 PMCID: PMC8662472 DOI: 10.21037/jtd-21-1397] [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] [Received: 08/23/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
Background We retrospectively compared the use of a stapler and electrocautery for division of the intersegmental plane during pulmonary segmentectomy. Methods We enrolled 156 patients who underwent pulmonary segmentectomy in our department between March 2006 and August 2020. The patients were divided into electrocautery (n=62) and stapler (n=94) groups based on the device used to divide the intersegmental plane. Patient characteristics, perioperative outcomes, and ratios of actual (calculated using software) to predicted (calculated by counting the resected segments) lung volumes were compared between the two groups. Additionally, we used multivariate analysis to identify the factors that contributed to the incidence of postoperative air leakage after cut-off value was set by receiver operating characteristic (ROC) curve analysis. Moreover, a subset analysis was performed based on the type of segmentectomy (common or uncommon). Common segmentectomies included resection of the basilar or superior segment of the lower lobe, or lingular or upper division of the left upper lobe; all other segmentectomies were classified as uncommon. Results Compared to the electrocautery group, the stapler group had shorter operative times (P=0.0027), duration of postoperative drainage (P=0.00037), and duration of postoperative hospitalization (P=0.0021). Moreover, incidence of postoperative ≥3 days drainage was significantly reduced in the stapler group (P=0.003). There were no significant differences between the stapler and electrocautery groups in the actual:predicted lung volumes at 6 months (1.01 and 1.04, respectively; P=0.28) or 12 months (1.06 and 1.07, respectively; P=0.68) after surgery. Preoperative lung volume was significantly correlated with preoperative vital capacity (VC) (γ=0.69; P<0.001) and forced expiratory volume in 1 second (FEV1) (γ=0.48; P<0.001). The multivariate analysis indicated that the use of stapler for division of intersegmental plane was the only factor that contributed to reducing the incidence of postoperative ≥3 days drainage (P=0.0027, odds ratio: 0.23, 95% CI: 0.086–0.597). In a subset analysis of uncommon segmentectomy, there were no significant differences among the groups in most perioperative results. Conclusions Compared to electrocautery, the use of a stapler for division of the intersegmental plane was associated with better perioperative outcomes, especially reduction of postoperative drainage time, and similar postoperative remnant lung volumes and function.
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Affiliation(s)
- Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kazuki Numajiri
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
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27
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Matsuura N, Igai H, Ohsawa F, Yazawa T, Kamiyoshihara M. Differentiation between staple line granuloma and recurrence after sublobar resection for primary lung cancer. J Thorac Dis 2022; 14:26-35. [PMID: 35242365 PMCID: PMC8828522 DOI: 10.21037/jtd-21-1626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022]
Abstract
Background The use of sublobar resection for early-stage lung cancer or frail cases that cannot tolerate radical surgery for primary lung cancer has been increasing. This study aimed to identify the frequency, shape, and course of staple line thickening and granuloma formation after sublobar resection for primary lung cancer, and to identify factors that help distinguish them from recurrent cancer cases. Methods The medical records of 64 patients who underwent sublobar resection for primary lung cancer from January 2012 to December 2017 at our institution were retrospectively reviewed. Computed tomography (CT) images taken every 6 months for at least 3 years after surgery were reviewed, and the postoperative course was examined. Results Staple line thickening at the time of the first CT scan after surgery was observed in 43 cases (67.2%). Of them, linear thickening was seen in 31 cases (72.1%), and nodular thickening was seen in 12 cases (27.9%). Of these 43 cases, 25 cases were decreased, 8 cases were unchanged and 10 cases showed a tendency to progress during the follow-up period. Of the 64 cases, 7 (10.9%) had staple line recurrence. Staple line recurrence was significantly correlated with vascular invasion (P=0.015), surgical margin (P=0.013), nodular thickening (P<0.001) and a tendency to show progressive thickening (P<0.001). Conclusions Staple line thickening was observed in many cases of sublobar resection, and most of them were linear thickening. Staple line recurrence should be suspected if nodular thickening appears and shows a tendency to progress.
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Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
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28
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Kamiyoshihara M, Igai H, Matsuura N, Ohsawa F, Numajiri K. [Recurrent Postoperative Lung Cancer with Tumor Shrinkage after Discontinuation of Pembrolizumab-A Case Report]. Gan To Kagaku Ryoho 2022; 49:67-69. [PMID: 35046365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Our patient was a 41-year-old man with non-small cell lung cancer of grade cT3N2M0 and clinical Stage ⅢA. After induction chemoradiotherapy(weekly CBDCA plus PTX[5 courses]and concurrent radiation of 50 Gy, left upper lobectomy with lymph node dissection(ND2a-1)was performed. The postoperative pathological findings were large cell carcinoma, ypT2aN2M0, Stage ⅢA, with complete resection; the PD-L1 tumor proportion score was 50 to 74%. Consolidation chemotherapy( triweekly CBDCA plus PTX, 1 course)followed. Twelve months after surgery, he developed mediastinal lymph node recurrence(#4L), and pembrolizumab was administered every 3 weeks as a first-line treatment. Complete response was evident after 3 courses; thus, we continued this monotherapy. After 35 courses(24 months)of pembrolizumab, we discontinued the regimen. Twenty-two months later, the disease has not progressed. The patient is being followed-up in our outpatient department. We report a case of recurrent postoperative lung cancer with continuous tumor shrinkage after discontinuation of pembrolizumab.
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Numajiri K, Matsuura N, Igai H, Ohsawa F, Kamiyoshihara M. Uniportal thoracoscopic pulmonary segmentectomy provides good perioperative results and early postoperative recovery. J Thorac Dis 2022; 14:2908-2916. [PMID: 36071752 PMCID: PMC9442541 DOI: 10.21037/jtd-22-555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/17/2022] [Indexed: 11/06/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Kazuki Numajiri
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan
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30
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Matsuura N, Igai H, Ohsawa F, Numajiri K, Kamiyoshihara M. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6541454. [PMID: 35237828 PMCID: PMC9297503 DOI: 10.1093/icvts/ivac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/13/2022] [Accepted: 02/19/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
- Corresponding author. Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura, Maebashi, Gunma 371-0811, Japan. Tel: +81-27-265-3333; fax: +81-27-225-5250; e-mail: (N. Matsuura)
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kazuki Numajiri
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
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31
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Igai H, Matsuura N, Kamiyoshihara M. Infrared thoracoscopic pulmonary segmentectomy with intravenous indocyanine green administration using preoperative simulation. Eur J Cardiothorac Surg 2021; 61:1443-1445. [PMID: 34966936 DOI: 10.1093/ejcts/ezab563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/10/2021] [Revised: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 11/14/2022] Open
Abstract
Infrared thoracoscopy with intravenous indocyanine green administration is one of the useful methods to identify an appropriate intersegmental line during thoracoscopic pulmonary segmentectomy. In this procedure, we have introduced preoperative simulation to calculate the distance between the target tumour and intersegmental plane using Ziostation2 (Ziosoft, Tokyo, Japan) to ensure sufficient surgical margin without palpation. By using this preoperative simulation, we obtained sufficient surgical margin in a patient with a 16-mm part-solid nodular shadow undergoing infrared thoracoscopic upper division (S1-3) segmentectomy of left upper lobe with intravenous indocyanine green administration. The discrepancy between the virtual and the actual surgical margin was <10 mm. This preoperative simulation can help us obtain sufficient surgical margin without palpation of the tumour in infrared thoracoscopic segmentectomy.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma, Japan
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Matsuura N, Igai H, Kamiyoshihara M. Carinal resection and reconstruction: now and in the future. Transl Lung Cancer Res 2021; 10:4039-4042. [PMID: 34858792 PMCID: PMC8577976 DOI: 10.21037/tlcr-21-731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/18/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
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Igai H, Matsuura N, Kamiyoshihara M. Uniportal thoracoscopic lateral and posterior (S9+10) segmentectomy using a modified intersegmental tunneling procedure. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34662001 DOI: 10.1510/mmcts.2021.053] [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: 11/06/2022]
Abstract
The lateral and posterior basal (S9+10) segmentectomy is one of the most challenging operations because it requires exposure and recognition of pulmonary vessel branches and bronchi that are located deep in the lung parenchyma. To perform this difficult operation appropriately, even via a uniportal approach, we adopted a modified version of the intersegmental tunneling procedure. Intersegmental tunneling followed by division of the intersegmental plane between S6 and S9-10 was performed before the division of the A9+10 in the modified version. In addition to the clear recognition of the dominant vessels and bronchi permitted by the tunneling procedure, we were able to divide them smoothly using a stapler in the modified version, although the tip of the inserted stapler stuck to the lung parenchyma in the previous version. This method might be universally preferable, even for less experienced surgeons, when they perform this challenging operation.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery Maebashi Red Cross Hospital 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital
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Matsuura N, Igai H, Kamiyoshihara M. Uniportal thoracoscopic anterior and lingular (S3+4+5) segmentectomy of the left upper lobe using intravenous indocyanine green. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34559961 DOI: 10.1510/mmcts.2021.052] [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: 11/06/2022]
Abstract
Although an anterior and lingular (S3+4+5) segmentectomy of the left upper lobe is rarely performed, this type of segmentectomy is very useful to ensure a sufficient margin when the tumor is located at the border between the anterior segment (S3) and the superior lingular segment (S4). However, it might be technically difficult to perform this unusual segmentectomy via a uniportal approach because of the limited angulation and exposure of the peripheral vessels/bronchi. We present the successful results of a patient undergoing uniportal thoracoscopic S3+4+5 segmentectomy of the left upper lobe and describe some technical details.
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Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital
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Igai H, Kamiyoshihara M, Matsuura N. Uniportal thoracoscopic apical (S1) segmentectomy of the right upper lobe via an anterior approach. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34559963 DOI: 10.1510/mmcts.2021.051] [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: 11/06/2022]
Abstract
An apical (S1) segmentectomy of the right upper lobe is considered one of the most challenging procedures among the uncommon pulmonary segmentectomies. However, we consider that the uniportal thoracoscopic approach, for which the single port access is located at the 4th intercostal space of the anterior axillary line, makes this challenging operation easier because we can recognize any intrathoracic vessels and bronchi that should be divided just under the incision. Moreover, it is easy to insert a stapler to divide an intersegmental plane between S1 and the other segments because of the good surgical view provided by this approach. In this video tutorial, we describe the successful results of a patient undergoing uniportal thoracoscopic S1 segmentectomy of the right lower lobe and explain the nuances of performing it.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital
| | | | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital
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Ohtaki Y, Kaira K, Yajima T, Erkhem-Ochir B, Kawashima O, Kamiyoshihara M, Igai H, Onozato R, Ibe T, Kosaka T, Nakazawa S, Nagashima T, Oyama T, Shirabe K. Comprehensive expressional analysis of chemosensitivity-related markers in large cell neuroendocrine carcinoma of the lung. Thorac Cancer 2021; 12:2666-2679. [PMID: 34453496 PMCID: PMC8520808 DOI: 10.1111/1759-7714.14102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/29/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives Various drug‐sensitivity markers have been reported to be associated with tumor progression and chemotherapy resistance. Detailed expression profiles of sensitivity markers for cytotoxic chemotherapy in pulmonary large cell neuroendocrine carcinoma (LCNEC) remain unclear. Herein, we aimed to clarify the correlation between the expression of drug‐sensitivity markers and clinicopathological features, prognostic impact, and status of tumor immunity in patients with LCNEC. Methods We retrospectively analyzed the correlation between clinicopathological features and the expression of drug‐sensitivity‐related markers, including vascular endothelial growth factor 2 (VEGFR2), thymidylate synthase (TS), tubulin beta 3 class III (TUBB3), topoisomerase I (Topo‐I), and Topo‐II in 92 surgically resected LCNEC samples. Furthermore, we examined the prognostic significance of expression of these and their correlation with the immune cell status. Results Overall, high expression of TS, TUBB3, VEGFR2, Topo‐I, and Topo‐II was detected in 50 (54%), 31 (34%), 23 (25%), 65 (71%), and 36 (39%) samples, respectively. Univariate and multivariate analyses revealed that advanced pathological T and N factors, positive lymphatic permeation, and Topo‐II expression were independent unfavorable prognosticators for recurrence‐free survival, and advanced pathological T and N factors, Topo‐II positive expression, and TS positive expression were independent unfavorable prognosticators for overall survival. In terms of correlation with immune cell status, higher expression of VEGFR2 was closely linked to negative PD‐L1 expression. Conclusions These findings suggest that elevated Topo‐II and TS expression may contribute to poor outcomes through protumoral biology in patients with LCNEC, and elevated VEGFR2 expression might negatively impact tumor immune reactions in LCNEC.
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Affiliation(s)
- Yoichi Ohtaki
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Toshiki Yajima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Bilguun Erkhem-Ochir
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Osamu Kawashima
- Department of General Thoracic Surgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | | | - Hitoshi Igai
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Ryoichi Onozato
- Department of General Thoracic Surgery, Gunma Prefectural Cancer Center, Ota, Japan
| | - Takashi Ibe
- Department of General Thoracic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Takayuki Kosaka
- Department of General Thoracic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshiteru Nagashima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of General Thoracic Surgery, Gunma Prefectural Cancer Center, Ota, Japan
| | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ken Shirabe
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
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Igai H, Kamiyoshihara M, Furusawa S, Ohsawa F, Yazawa T, Matsuura N. The learning curve of thoracoscopic surgery in a single surgeon and successful implementation of uniportal approach. J Thorac Dis 2021; 13:4063-4071. [PMID: 34422336 PMCID: PMC8339743 DOI: 10.21037/jtd-21-500] [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] [Received: 03/21/2021] [Accepted: 05/27/2021] [Indexed: 11/11/2022]
Abstract
Background In some institutions, a recently introduced uniportal approach has replaced the multiportal approach for thoracoscopic major pulmonary resection. This study investigated the effect of this change on the surgical learning curve by examining the perioperative results of a single surgeon. Methods Between April 2012 and August 2020, 376 patients with primary lung cancer underwent thoracoscopic lobectomy with ND2a-1/2 lymphadenectomy in the authors’ hospital. Surgery was performed by one of the authors in 189 of these patients, who were thus enrolled in this retrospective study. The surgeries were classified chronologically into five phases and the operative time, rate of intraoperative massive bleeding, and rate of postoperative prolonged air leak (PAL) were then compared. The learning curve (i.e., operative time) was assessed by Spearman’s rank correlation test. The perioperative results achieved with the uniportal and multiportal approaches were also compared before and after the patients were matched for their characteristics based on the propensity score. Results The five phases differed significantly with respect to the operative time and rate of postoperative PAL (P<0.0001, P=0.0061). The correlation between operative time and number of consecutive cases was also significant (r=−0.579, P<0.0001). Superior results in terms of operative time (P<0.0001), duration of postoperative drainage (P<0.0001), and rate of postoperative PAL (P=0.0034) were obtained using a uniportal rather than multiportal approach. Conclusions The transition from a multiportal to a uniportal approach did not cause a decline in the learning curve of thoracoscopic lobectomy with ND2a-1/2 lymphadenectomy.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Shinya Furusawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
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Kamiyoshihara M, Igai H, Matsuura N, Yazawa T, Ohsawa F. [Alectinib for an Octogenarian Patient with Poor Performance Status and ALK Fusion Gene-Positive Lung Cancer-A Case Report]. Gan To Kagaku Ryoho 2021; 48:1053-1055. [PMID: 34404075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
An 89-year-old female who had been clinically diagnosed with primary lung cancer underwent right upper lobectomy and lymph node dissection(ND2a-2). Postoperative pathological staging revealed a stage ⅡA(pT1bN1M0)adenocarcinoma that was negative for an EGFR mutation. Nineteen months after surgery, the patient developed a mediastinal lymph node metastasis, and radiotherapy was prescribed. Thirty-eight months later, she developed new mediastinal/hilar lymph node metastases and was prescribed pemetrexed(500 mg on day 1 of each of 3 weeks)as the first-line therapy. A complete response was evident after 10 courses. However, she developed grade 3 nausea, and pemetrexed was discontinued. During 10 months of follow-up, no new lesion appeared; therefore, follow-up was discontinued. Ninety-three months after surgery, she was referred to our hospital because an abnormal shadow was apparent on chest roentgenography. A thorough examination revealed pleural dissemination, pulmonary metastases, mediastinal/hilar lymph node metastases, an adrenal metastasis, and bone metastases. Although her performance status(PS)was poor(grade 4), as the diagnosis was ALK fusion gene-positive adenocarcinoma, alectinib(600 mg once daily)was commenced as the second-line therapy. Complete response was achieved 14 months later(ie, 108 months after surgery and 89 months after postoperative recurrence). Thus, an octogenarian patient with poor PS and ALK fusion gene-positive adenocarcinoma exhibited a complete response after treatment with alectinib.
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Kamiyoshihara M, Igai H, Matsuura N, Ohsawa F, Numajiri K, Yazawa T, Yajima T, Shirabe K. [Video-assisted Thoracoscopic Total Pleural Adhesiolysis:Tips and Pitfalls]. Kyobu Geka 2021; 74:504-508. [PMID: 34193784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSES Here, we present the tips and pitfalls of video-assisted thoracoscopic( VATS) total pleural adhesiolysis( TPA), determined on an empirical basis. PATIENTS AND METHODS From 2012 to 2020, VATS-TPA was performed in 33 patients undergoing pulmonary anatomic lung resection at our institute. The basic procedure was as follows:after peeling off the area of pleural adhesion surrounding the surgical ports using the fingers, the thoracoscope was inserted into the thorax and the adhesions in other areas were peeled off under thoracoscopic guidance. RESULTS The adhesiolysis group had a longer operating time, greater blood loss, and higher rate of conversion to thoracotomy compared to the non-adhesiolysis group. However, the results were acceptable considering the extra manipulation for adhesiolysis. CONCLUSIONS VATS-TPA is a necessary component of the standard surgical procedure for general thoracic surgeons in cases of total pleural adhesion.
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Affiliation(s)
- Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
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Igai H, Kamiyoshihara M, Furusawa S, Ohsawa F, Yazawa T, Matsuura N. A prospective comparative study of thoracoscopic transareolar and uniportal approaches for young male patients with primary spontaneous pneumothorax. Gen Thorac Cardiovasc Surg 2021; 69:1414-1420. [PMID: 34145507 DOI: 10.1007/s11748-021-01647-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/11/2020] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In this study, we introduce a novel approach, thoracoscopic transareolar bullectomy, for treating young male patients with primary spontaneous pneumothorax (PSP). This approach might be less invasive and cosmetically superior to existing methods. We also prospectively compared transareolar and uniportal approaches. METHODS Between April 2018 and July 2019, 40 patients were prospectively assigned to transareolar (n = 21) and uniportal (n = 19) groups. We compared patient characteristics and perioperative results. Approximately 1 week or 1 year after the operation, postoperative pain was evaluated using a numerical rating scale (NRS), and cosmetic satisfaction was graded on a four-point scale. RESULTS We found no significant between-group differences in patient characteristics or perioperative results. NRS scores did not differ on postoperative day (POD) 7 (transareolar, 1.8 ± 0.9 vs. uniportal, 1.6 ± 0.9; p = 0.62) or in postoperative month (POM) 12 (transareolar, 1.3 ± 0.5 vs. uniportal, 1.1 ± 0.5; p = 0.18). In terms of cosmetic satisfaction, the transareolar group was more satisfied on POD 7 (transareolar, 3.5 ± 0.6 vs. uniportal, 2.9 ± 0.9; p = 0.02) and in POM 12 (transareolar, 3.8 ± 0.5 vs. uniportal, 3.3 ± 0.9; p = 0.0065). CONCLUSION Although the perioperative results of the transareolar and uniportal approaches were similar, the former approach afforded a little better cosmetic satisfaction and might be useful option for young males with PSP.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan.
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan
| | - Shinya Furusawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, 389-1 Asakura-cho, Maebashi, Gunma, 371-0811, Japan
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Igai H, Kamiyoshihara M. The tips of uniportal thoracoscopic lateral and posterior basal (S9+10) segmentectomy. Video-assist Thorac Surg 2021. [DOI: 10.21037/vats-2019-uvs-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ohsawa F, Igai H, Yazawa T, Matsuura N, Kamiyoshihara M. [Lung Cancer Cases with Spontaneous Regression]. Kyobu Geka 2021; 74:429-433. [PMID: 34059585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Case 1 was a 79-year-old man. Computed tomography (CT) showed a nodule in the left upper lobe. Surgery was planned, but the regression of the nodule was noted and the surgery was postponed. Six months later, the nodule shadow increased again, and was surgically resected. Pathological diagnosis was adenocarcinoma. Case 2 was an 82-year-old man. CT showed a nodule in the right lower lobe and surgery was planned, but the nodule regressed. Three months later, it increased and was resected. It was pathological diagnosed as squamous cell carcinoma. Although spontaneous regression of lung cancer is rare, careful follow up of the regressed nodules shadow is required because of possible regrowth after the regression.
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Affiliation(s)
- Fumi Ohsawa
- Department of Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
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Kamiyoshihara M, Yazawa T, Igai H, Matsuura N, Ohsawa F, Furusawa S. [Erlotinib plus Bevacizumab Therapy for Postoperative Recurrence of Adenosquamous Cell Carcinoma Harboring EGFR Mutation-A Case Report]. Gan To Kagaku Ryoho 2021; 48:841-843. [PMID: 34139736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 59-year-old man clinically diagnosed with primary lung cancer underwent left lower lobectomy and lymph node dissection( ND2a-2). The postoperative pathological stage was ⅠB(pT2aN0M0), and the lesion was positive for epidermal growth factor receptor(EGFR)exon 21 L858R mutation. Thirty months after surgery, the patient developed pleural dissemination and effusion in the left pleural cavity. Carboplatin(AUC=6, day 1, every 3 weeks)and nab-paclitaxel(100 mg/m2, day 1 and day 8, every 3 weeks)were administered as first-line therapy. Progressive disease was evident 10 months after 4 courses of first-line therapy. Pembrolizumab(200 mg, day 1, every 3 weeks)was then administered as second-line therapy. After 7 months(9 courses of therapy), the lung cancer had metastasized to the left third intercostal muscle, and the pleural nodules regrew. The former lesion was treated with radiotherapy owing to the development of pain in the chest. Erlotinib (150 mg once daily)and bevacizumab(15 mg/kg, day 1, every 3 weeks)were initiated as third-line therapy, resulting in complete response at 14 months(67 months after surgery, 37 months after postoperative recurrence). The prognosis of patients with EGFR-positive pulmonary adenosquamous carcinoma and undergoing treatment with EGFR-tyrosine kinase inhibitors(TKI)is reportedly poor. Herein, we report a rare case of adenosquamous carcinoma with EGFR mutation presenting complete response following treatment with EGFR-TKI.
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Kamiyoshihara M, Igai H, Matsuura N, Yazawa T, Ohsawa F, Furusawa S. [Postoperative Recurrence of ROS1‒Positive Pulmonary Adenocarcinoma after 19 Years]. Gan To Kagaku Ryoho 2021; 48:685-687. [PMID: 34006714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 73‒year‒old woman underwent right lower lobectomy for Stage ⅠA(pathological Stage T1N0M0)pulmonary adenocarcinoma. After 19 years, she complained of dyspnea on exertion. Computed tomography revealed metastatic lesions in the bilateral supraclavicular, mediastinal, and hilar lymph nodes. Thoracoscopic lymph node biopsy showed recurrence of the adenocarcinoma, and immunohistochemical staining confirmed that the metastases were ROS1‒positive. The patient responded well to crizotinib therapy. The prognosis of non‒small‒cell lung cancer is considered favorable when it does not recur within 5 years, postoperation. However, few studies have reported the recurrence of ROS1‒positive pulmonary adenocarcinoma after a long disease‒free interval. Long‒term postoperative follow‒up is essential for patients with ROS1‒positive pulmonary adenocarcinomas.
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Abstract
Background In recent years, opportunities to conduct anatomical segmentectomies for early stage lung cancer, metastatic lung tumor, and so on have been increasing. Generally, uniportal video-assisted thoracoscopic surgery (U-VATS) uncommon segmentectomy is technically more complicated because of limited angulation compared to multiportal VATS (M-VATS) and the need to treat peripheral vessels/bronchi compared to common segmentectomy. This study aimed to determine the safety and feasibility of U-VATS uncommon segmentectomy compared with U-VATS common segmentectomy and M-VATS uncommon segmentectomy. Methods We retrospectively reviewed the medical records of 76 patients in the M-VATS group and 45 patients in the U-VATS group who underwent VATS segmentectomy from January 2015 to December 2020. During that period, the perioperative results of U-VATS uncommon (n=22) segmentectomy were compared with those of U-VATS common (n=23) and M-VATS uncommon (n=37) segmentectomy. Uncommon segmentectomy was defined as any segmentectomy other than segmentectomies of the lingual, basilar, or superior segment of the lower lobe (S6), and upper division of the left upper lobe. All patients in our department underwent preoperative three-dimensional computed tomography (3D-CT) angiography and bronchography to image bronchovascular structures and determine the resection line. Results Patients characteristics were similar between the U-VATS uncommon segmentectomy group and the U-VATS common segmentectomy group or the M-VATS uncommon segmentectomy group. In U-VATS, there were no significant differences between common and uncommon segmentectomy in operation time, postoperative drainage, postoperative hospitalization, and postoperative complications. Comparing M-VATS and U-VATS uncommon segmentectomies, operation time (145±35 vs. 185±44 min, P<0.001) and postoperative hospitalization (3.1±1.6 vs. 4.2±1.8 days, P=0.02) were significantly shorter in the U-VATS group than in the M-VATS group. There were no significant differences in blood loss, intraoperative bleeding, duration of postoperative drainage and postoperative complications. Conclusions In U-VATS, both types of segmentectomies can be achieved with similar results. Moreover, U-VATS shortened operation time and postoperative hospitalization in uncommon segmentectomy compared with conventional M-VATS. U-VATS is a useful approach for uncommon segmentectomy.
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Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
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Igai H, Matsuura N, Kamiyoshihara M. Uniportal thoracoscopic right anterior basal (S8) segmentectomy using unidirectional dissection. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 33901348 DOI: 10.1510/mmcts.2021.021] [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: 11/06/2022]
Abstract
Anterior basal (S8) segmentectomy is one of the most challenging procedures among the uncommon pulmonary segmentectomies because the surgeon has to identify dominant pulmonary vein branches located deep in the lung parenchyma. Moreover, with the uniportal thoracoscopic approach, the angulation of inserted surgical instruments via a single small incision is extremely limited, which causes technical difficulties. However, adoption of a suitable procedure such as unidirectional dissection enables us to perform this type of minimally invasive surgical procedure. We describe the successful results of a patient undergoing uniportal thoracoscopic S8 segmentectomy of the right lower lobe and explain the nuances of performing it.
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Affiliation(s)
- Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital
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Matsuura N, Igai H, Yazawa T, Ohsawa F, Yoshikawa R, Kamiyoshihara M. [Uniportal versus Multiportal Video-assisted Thoracic Surgery for Primary Lung Cancer]. Kyobu Geka 2021; 74:167-171. [PMID: 33831867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aimed to consider the safety and feasibility of uniportal video-assisted thoracic surgery( VATS)[ u-VATS] compared with multiportal VATS( m-VATS). METHODS Sixty-two patients underwent anatomical lung resection for primary lung cancer via u-VATS between February 2019 and May 2020 at our institution. We performed propensity score matching of these cases versus anatomical lung resection cases under m-VATS performed from January 2017 to December 2019, and compared the perioperative results. RESULTS In the u-VATS group, operation time( 142 minutes vs. 178 minutes, p<0.01) and postoperative drainage days( 1.6 days vs. 2.4 days, p=0.01) were significantly shorter. There were no differences in intraoperative blood loss, vascular damage, conversion rate, number of lymph nodes dissected, postoperative complications, and postoperative hospital stay. The number of pain complaints and the number of analgesics (non-steroidal anti-inflammatory drugs:NSAIDs) prescribed at the first outpatient clinic after discharge were significantly lower in the u-VATS group( 10 vs. 22, p=0.03). CONCLUSIONS U-VATS shortened the operation time and postoperative drainage period compared with conventional m-VATS, and significantly reduced the use of analgesics. U-VATS is considered to be safe and less invasive surgical procedure based on the present study.
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Affiliation(s)
- Natsumi Matsuura
- Department of Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
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Kamiyoshihara M, Yazawa T, Igai H, Matsuura N, Ohsawa F, Iwashita H. [Docetaxel and Ramucirumab Combination Chemotherapy after Nivolumab Treatment for Pretreated Pulmonary Squamous Cell Carcinoma-A Successful Case]. Gan To Kagaku Ryoho 2021; 48:211-213. [PMID: 33597361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
For immune checkpoint inhibitor(ICI)-pretreated patients, docetaxel and ramucirumab(DTX plus RAM)combination therapy can be more effective than no treatment. Herein, we present the case of a patient who had been treated with ICIs and was thereafter successfully treated with DTX plus RAM. A 62-year-old man with primary pulmonary squamous cell carcinoma( PDL-1 tumor proportion score<1%)at clinical stage ⅠA2(cT1bN0M0)was treated as follows: 1)right upper lobectomy ND2a-2(pT1bN0M0, stage ⅠA2); 2)surgery for a solitary pleural metastasis 20 months later; 3)cisplatin plus vinorelbine for multiple pleural metastases as a first-line treatment 24 months after the initial surgery; and 4)nivolumab as a second-line treatment. However, progressive disease and an adverse event occurred after 5 courses of nivolumab, and DTX plus RAM were introduced as a third-line treatment. A complete response to 12 courses of combination therapy(41 months after surgery/29 months after recurrence)was determined. Unfortunately, the DTX plus RAM regimen had to be withdrawn because the patient developed drug-induced acute pneumonitis. The patient has been in remission since drug discontinuation and is receiving steroid and home-oxygen therapy.
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Yoshikawa R, Matsuura N, Igai H, Yazawa T, Ohsawa F, Kamiyoshihara M. Uniportal approach as an alternative to the three-portal approach to video-assisted thoracic surgery for primary spontaneous pneumothorax. J Thorac Dis 2021; 13:927-934. [PMID: 33717565 PMCID: PMC7947474 DOI: 10.21037/jtd-20-2928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/28/2022]
Abstract
Background In recent years, uniportal video-assisted thoracic surgery (U-VATS) has been used for primary spontaneous pneumothorax (PSP). This study compared the perioperative outcomes of U-VATS and three-port VATS (3P-VATS) and sought to determine the risk factors for postoperative recurrence. Methods From October 2010 to February 2017, 232 patients with PSP undergoing surgical treatment were enrolled in this study. The patients were divided into two groups: U-VATS (n=161) and 3P-VATS (n=71) depending on the period of surgery. Retrospective analysis of the perioperative results and the risk factors for recurrence was performed. Results Both the operation time and duration of postoperative drainage were initially longer in the U-VATS group, but the difference gradually decreased such that ultimately there was no significant difference compared to the 3P-VATS group (P=0.10 and P=0.12, respectively). The duration of postoperative hospital stay and postoperative recurrence rate were not different between the two groups (P=0.084 and P=0.44, respectively). By multivariate analysis, the age (HR, 0.42, 95% CI: 0.24−0.72, P<0.01) and number of bullae (single vs. multiple: HR, 0.03, 95% CI: 0.002−0.54, P=0.02) were risk factors for recurrence. Conclusions The perioperative results and recurrence rate did not differ between the U-VATS and 3P-VATS groups, thereby demonstrating the non-inferiority of U-VATS. Postoperative risk factors for PSP recurrence were patient age and the number of bullae. Additional treatment may be needed to reduce recurrence in young patients with multiple bullae. Clinical registration number: The Institutional Review Board of Maebashi Red Cross Hospital (no. 2019-21).
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Affiliation(s)
- Ryohei Yoshikawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
| | - Natsumi Matsuura
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 389-1 Asakura-cho, Maebashi, Gunma 371-0811, Japan
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Matsuura N, Igai H, Ohsawa F, Yazawa T, Kamiyoshihara M. Uniport vs. multiport video-assisted thoracoscopic surgery for anatomical lung resection-which is less invasive? J Thorac Dis 2021; 13:244-251. [PMID: 33569204 PMCID: PMC7867835 DOI: 10.21037/jtd-20-2759] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/24/2022]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) has been recognized as a standard procedure, but whether uniport VATS (U-VATS) is a more effective and minimally invasive approach compared with multiport VATS (M-VATS) is controversial. Methods The medical records of 184 patients in the M-VATS group and 69 patients in the U-VATS group who underwent anatomical lung resection from April 2017 to July 2020 at our institution were retrospectively reviewed. Postoperative outcomes were compared among U-VATS and M-VATS. Multivariate analysis was performed to identify factors that reduce postoperative pain. Results The mean operation time was significantly shorter in U-VATS than in M-VATS (172±43 min in M-VATS vs. 143±43 min in U-VATS, P<0.0001). Duration of postoperative drainage (2.2±1.2 days in M-VATS vs. 1.6±1.0 days in U-VATS, P=0.0002) and hospitalization (4.0±1.6 days in M-VATS vs. 3.1±1.6 days in U-VATS, P=0.0003) were significantly shorter in U-VATS than in M-VATS. The rate of postoperative complications was not significantly different between the groups (P=0.732). The number of analgesic prescriptions over 10 days postoperatively was significantly less in U-VATS than in M-VATS [68 (37.0%) in M-VATS vs. 8 (11.6%) in U-VATS, P<0.0001]. A multivariate logistic regression model showed that U-VATS was the only significant predictor for reduction of postoperative pain (odds ratio =0.204, P=0.0001). Conclusions U-VATS shortened the operation time, postoperative drainage duration, and hospitalization compared with conventional M-VATS, and it significantly reduced the use of analgesics. There were no differences in perioperative results such as blood loss and the postoperative complication rate. U-VATS can be said to be a safe and minimally invasive surgical procedure.
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Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
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