Objective To explore clinical application values of thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure for esophageal cancer. Methods Clinical data of 196 patients with esophageal cancer （EC） who underwent thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure in West China Hospital of Sichuan University from February 2008 to August 2012 were analyzed retrospectively. There were 145 male and 51 female patients with their age of 40-76 （58.8±6.6） years. There were 43 patients with EC in the upper segment of the esophagus, 115 patients with EC in the middle segment of the esophagus and 38 patients with EC in the lower segment of the esophagus.Results Total operation time was 215-780 （305.0±40.7） minutes，including thoracoscopic operation time of 50-580 （105.0±38.4） minutes and laparoscopic operation time of 28-105 （54.0±8.6） minutes. Intraoperative blood loss was 20-440 （285.4±38.5） ml. The number of dissected lymph nodes was 6-39 （20.4±1.6） for each patient. Postoperative hospital stay was 7-93 （12.8±5.2） days. Sixty patients （30.6%） had postoperative complications，including 28 patients （14.3%） with pulmonary comp-lications，5 patients （2.5%） with chylothorax，5 patients （2.5%） with arrhythmias，15 patients （7.6%） with anastomotic fistula，10 patients （5.0%） with recurrent laryngeal nerve injury，and other complications in 2 patients. Conclusion Thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure is a safe and feasible operation for esophageal cancer.
ObjectiveTo summarize the experience of totally thoracoscopic cardiac surgery (TTCS) for atrial septal defect.MethodsClinical data of 442 patients undergoing TTCS for atrial septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively. There were 149 male and 293 female patients, aged 3-74 (29.1±14.3) years. Surgical procedures were performed through 3 ports at the right chest wall.ResultsAll the operations were completed successfully. Mean operative time was 1.5-4.6 (2.2±0.3) h. The mean extracorporeal circulation and aortic cross-clamp time was 28-118 (55.9±13.3) min and 8-78 (21.5±10.2) min, respectively. Mechanical ventilation and intensive care unit stay time was 3.5-122.0 (8.1±7.4) h and 13-141 (20.7±10.2) h, respectively. Postoperation drainage volume was 70-1 280 (251.8±131.5) mL. The hospital stay was 4-16 (7.1±1.4) d. Intraoperative and postoperative complications occurred in 15 patients (3.3%). The mean follow-up time was 1-128 (67.6±33.3) months, and during the period, there were 25 patients of atrial fibrillation, 25 patients of mild-moderate tricuspid valve incompetence, 1 patient of moderate tricuspid valve incompetence. There was no reoperation or residual shunt during the period of follow-up. And the heart function was improved.ConclusionTTCS is a feasible, safe and minimal invasive approach for patients with atrial septal defect and has good short to medium-term outcomes.
Abstract: Objective To investigate the feasibility of videoassisted thoracoscopic surgery (VATS) ronchial sleeve lobectomy for lung cancer, and to describe this treatment method. Methods Between December 2010 and April 2011, three patients in our hospital underwent VATS bronchial sleeve lobectomy as treatment for right upper lobe nonsmall cell lung cancer. The patients were one female and two males, aged 61, 65, and 62 years. Surgical incisions were the same as for singledirection VATS right upper lobectomy. The right superior pulmonary vein was firstly transected, followed by the first branch of the pulmonary artery. Then, the lung fissure was transected and the mediastinal lymph nodes, including the subcarinal nodes, were also dissected to achieve sufficient exposure of the right main bronchus. The bronchus was transected via the utility incision, and the anastomosis was accomplished by continuous suture with 30 Prolene stitches. Another 0.5 cm port in the 7th intercostal space at the posterior axillary line was added in the third operation for handling of a pair of forceps to help hold the needle during anastomosis. A sealing test was performed to confirm that there was no leakage after completion of the anastomosis, and the stoma was covered with biological material. Bronchoscopy was performed to clear airway secretions and to confirm that there was no stenosis on postoperative day (POD) 1. Results The lobectomy and lymph node dissection was finished in 5158 minutes (averaging 54.7), and the time needed foranastomosis was 4055 minutes (averaging 45.7). Total blood loss was 55230 ml (averaging 155.0 ml). Number of dissected lymph nodes was 1821 (averaging 19.3). One patient was diagnosed with adenocarcinoma of the right upper lobe with metastatic hilar lymph node invasive to the right upper lobar bronchus. The other two patients were both diagnosed with centrally located squamous cell carcinoma of the right upper lobe, and all the patients achieved microscopically negative margins. There was no stenosis of the anastomosis stoma, and the postoperative course was uneventful. These patients were discharged on POD 810 (averaging 8.7 days), and they recovered well during the followup period, which lasted 2 to 6 months. [WTHZ]Conclusion [WTBZ]For experienced skillful thoracoscopic surgeons, VATS bronchial sleeve lobectomy is safe and feasible. Making the incisions of a singledirection VATS lobectomy with an additional miniport may be an ideal approach for this procedure.
Objective To examine the effect and safety of thoracoscopic surgery for left atrium myxoma excision. Method Sixty-nine left atrial myxoma patients underwent excision of left atrial myxoma in our hospital between January 2012 and August 2014 year. The patients were divided into two groups according to the procedure. Thirty patients under-went thoracoscopic surgery, as a thoracoscopic group, with 8 males and 22 females, aged 47.36±13.02 years. Thirty-nine patients received median sternotomy surgery, as a median sternotomy group, with 10 males and 29 females, aged 49.17±13.09 years. The effect and safety between the two groups were compared. Results All patients survived after surgery without death and other serious complications. Compared with the median sternotomy surgery group, longer cardiopul- monary bypass and aortic cross clamp time, shorter ICU stay, ventilator support, and postoperative drainage time, shorter hospital stay time, less postoperative drainage, lower cost, and more higher rate of returning to work in 1 month after surgery were found in the thoracoscopic group with P value less than 0.05. There was no complication of stroke and other neurological complication in the two groups. All patients were followed up for 11 months to 4 years and 7 months, average age of 38.5±12.7 months. There was no recurrence in both groups. Conclusions The thoracoscopic left atrial myxoma excision cardiopulmonary is effective and safe. It can be used as a surgical treatment of left atrial myxoma preferred.
ObjectiveTo investigate the occurrence of indwelling urinary catheter in patients receiving thoracoscopic lobectomy and relevant risk factors.MethodsWe retrospectively reviewed the clinical data of the 737 patients who received thoracoscopic lobectomy in our hospital and analyzed the risk factors of indwelling urinary catheter during postoperative hospitalization using univariate analysis and multiple-variate logistic regression analysis between December 2018 and May 2019. There were 253 males and 484 females at median age of 57 (50, 64) years.ResultsA percentage of 14.4% (106/737) of the patients adopted postoperative indwelling urinary catheter. Univariate regression analysis showed that gender and postoperative bedridden time were risk factors for indwelling urinary catheter in the patients after thoracoscopic lobectomy (P<0.05). Multiple-variate logistic regression analysis showed that male gender (OR=2.018, 95% CI 1.316-3.096, P<0.001) and postoperative bedridden time >18 hours (OR=2.298, 95%CI 1.502-3.516, P<0.001) were the independent risk factors for indwelling urinary catheter.ConclusionMale gender and those with longer postoperative bedridden time are high-risk population to indwell urinary catheter. Positive measures should be taken to reduce the chance of indwelling urinary catheter.
ObjectiveTo compare postoperative efficacy of thoracoscopic partial pneumonectomy with or without thoracic drainage tube postoperatively.MethodsThe PubMed, Wanfang database, CNKI and Web of Science from January 2000 to August 2020 were searched by computer to collect randomized controlled studies (RCT), cohort studies and case-control studies on the efficacy of chest drainage tube placement versus no placement after thoracoscopic partial pneumonectomy. Two reviewers independently screened articles and extracted data to evaluate the risk of literature bias. Meta-analysis was performed with RevMan software.ResultsA total of 15 articles were included, including 1 RCT and 14 cohort studies. A total of 1 524 patients were enrolled, including 819 patients in the test group (no postoperative chest drainage tube group) and 705 patients in the control group (postoperative chest drainage tube group). Compared with the control group, the length of hospital stay in the test group was shorter (MD=–1.3, 95%CI –1.23 to –0.17, P<0.000 01) and the incidence of postoperative pneumothorax was higher (RD=0.06, 95%CI 0.01 to 0.10, P=0.01). There was no significant difference between the two groups in operation time (MD=–2.37, 95%CI –7.04 to 2.30, P=0.32), the incidence of postoperative complications (RR=2.43, 95%CI 0.79 to 1.80, P=0.39), the reintervention rate of postoperative complications (RD=0.02, 95%CI=–0.00 to 0.04, P=0.05), postoperative subcutaneous emphysema (RD=0.02, 95%CI –0.01 to 0.06, P=0.20) and the incidence of postoperative pleural effusion (RD=0.04, 95%CI –0.00 to 0.09, P=0.10) .ConclusionCompared with the patients with chest drainage tube placement after thoracoscopic partial pneumonectomy (the control group), the test group can shorten the hospital stay. Although the incidence of postoperative pneumothorax is higher than that of the control group, the operation time, incidence of postoperative subcutaneous emphysema and in-hospital complications, and reintervention rate of in-hospital complications are not statistically significant between the two groups. Therefore no chest drainage tube may be placed after partial pneumonectomy.
ObjectiveTo systematically review the clinical effects and safety of thoracoscopy operation and thoracotomy for spontaneous pneumothorax. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 10, 2013), Web of Knowledge, CNKI, CBM, WanFang Data and VIP up to October 2013. Randomized controlled trials involving treatment outcomes of spontaneous pneumothorax using thoracoscopy compared with thoracotomy were included. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then RevMan 5.2 software was used for meta-analysis. ResultsA total of 7 studies involving 481 patients were included. The results of meta-analysis showed that the operative time in the thoracoscopy goup was significantly longer than that in the thoracotomy group (MD=13.57, 95%CI 3.58 to 23.56, P=0.008). But there was no significant difference in recurrence rates (RR=3.16, 95%CI 0.84 to 11.94, P=0.09), total postoperative complications (RR=1.33, 95%CI 0.46 to 3.88, P=0.46), postoperative chest drainage time (MD=-0.00, 95%CI-0.64 to-0.63, P=0.99), and hospitalization time (MD=0.09, 95%CI-0.21 to 0.40, P=0.55). ConclusionCompared with thoracotomy, thoracoscopy does not increase recurrence rates, postoperative complications, chest drainage time or hospitalization time, but it could prolong operation time in a certain extent.
Cardiac surgery has a gradual change from traditional median sternotomy to minimally invasive surgery due to the appearance and application of peripheral extracorporeal circulation. There are great differences in the clinical practice of two different surgical methods in mitral valve operation. Minimally invasive thoracic surgery has the advantages of less trauma, less bleeding, faster recovery, beauty and so on. However, such surgery also has its weaknesses, such as longer learning curve, narrow operation space and high requirements of equipment. To compare the differences of early and long-term results in mitral valve operation between traditional median sternotomy and minimally invasive thoracic surgery is to better summarize and operate minimally invasive thoracic surgery for mitral valve surgery.
ObjectiveTo compare solitary pulmonary nodule resection via thoracoscopic 3D mode or 2D mode and to further evaluate the clinical application value of thoracoscopic 3D mode. MethodsWe retrospectively analyzed the clinical data of 120 patients with solitary pulmonary nodule between March 2013 and March 2014 in the First Hospital Affiliated to Xiamen University. The patients were allocated into two groups including a 3D-VATS group (50 patients) and a 2D-VATS group (70 patients). Pulmonary partial resection was performed firstly. Pulmonary lobectomy would be conducted or not on the basis of intra operative rapid pathological results. ResultsTwenty three patients were performed 3D-VATS in the 3D-VATS group. Twenty-nine patients were diagnosed as pathological malignancy underwent lobectomy plus partial dissection. There were statistical differences between the 3D-VATS group and the 2D-VATS group in operative time (t=1.967, P<0.05), intra operative blood loss (t=7.85, P<0.05), drainage volume 24 h after operation (t=6.18, P<0.05), postoperative chest tube retention time (t=7.1, P<0.05), and postoperative hospital stay (t=2.35, P<0.05). Following-up time in the 3D-VATS group was 6.3 (2-12) months. Complications occurred in 3 patients, including 2 patients with postoperative pneumonia and 1 patient with paroxysmal atrial fibrillation in the 3D-VATS group. The following-up time in the 2D-VATS group was 8.2 (2-15) months. Complications occurred in 4 patients, including 1 patient with chylous hydrothorax, 2 patients with pneumothorax, 1 patient with delayed pulling up the chest closed drainage in the 2D-VATS group. The patients in both groups with complications were cured by appropriate treatment. Conclusion3D-VAST for SPN is a new operation mode choice. It is safe and feasible with low incidence of postoperative complications. Surgery vision, stereo feeling, the operation of adaptation, and postoperative recovery have certain advantages. It is worthy popularizing.
ObjectiveTo explore the effectiveness of thoracoscopic surgery for treating late-presenting congenital diaphragmatic hernias and summarize the experience. MethodsBetween October 2012 and February 2015, 21 children with late-presenting congenital diaphragmatic hernias underwent thoracoscopic surgery. Of the 21 cases, 12 were girls and 9 were boys with a median age of 1 year and 3 months (range, 2 months to 8 years). Eight patients had obvious symptom in the initial stage:shortness of breath and dyspnea; 13 cases were found occasionally through chest radiography. Of 21 cases, 17 had left diaphragmatic hernias and 4 had right diaphragmatic hernias. The emergency surgery was performed in 5 cases because oppressed obviously and selective operation in 16 cases. Hernial sac existed in 5 cases; there were 19 cases of Bochdalek's hernia and 2 cases of Morgagni's hernia. The size of diaphragmatic defect ranged from 3 cm×2 cm to 5 cm×5 cm. ResultsThe operation time was 35-80 minutes (mean, 50 minutes), and intraoperative blood loss was 3-5 mL (mean, 3.8 mL). Primary healing of incision was obtained. Postoperative abdominal distension and pneumothorax occurred in 12 and 2 cases respectively. The follow-up time was 1-3 years (mean, 20 months). All the cases had a good recovery and satisfactory appearance of the thoracic incision. The symptoms and signs of shortness of breath and dyspnea disappeared. There was no recurrence and chest infection. ConclusionUnder the conditions of mastering operative indications strictly, thoracoscopic repair for late-presenting congenital diaphragmatic hernia is safe and feasible. It can facilitate the procedure and decrease the recurrence rate relying on intraoperative application of hernia repair needle, knot pusher-assistant, and reasonable processing defect periphery.