ObjectiveTo investigate the feasibility of video-assisted thoracoscopic surgery (VATS) lung resection in the treatment of tuberculosis.MethodsWe retrospectively analyzed the clinical data of 164 tuberculosis patients who underwent lung resection in Xi'an Chest Hospital from 2013 to 2017. Patients were divided into two groups according to the surgical procedure: a VATS group (85 patients, 56 males and29 females) and a thoracotomy group (79 patients, 52 males and 27 females). The clinical effect of the two groups was compared.Results Compared to the thoracotomy group, the VATS group had less operation time (151.59±76.75 min vs. 233.48±93.89 min, P<0.001), amount of intraoperative blood loss (200.00 ml vs. 600.00 ml, P<0.001), the postoperative drainage (575.00 ml vs. 1 110.00 ml, P=0.001), extubation time (4 d vs. 6 d, P<0.001) and hospital stay (13.00 d vs. 17.00 d, P<0.001). There was no statistical difference in postoperative complications (10 patients vs.17 patients, P=0.092) between the two groups. A total of 97 patients underwent lobectomy, including 36 of the VATS group and 61 of the thoracotomy group. The operation time (211.39±70.88 min vs. 258.20±87.16 min, P=0.008), the intraoperative blood loss (400.00 ml vs. 700 ml, P<0.010), the postoperative drainage (800.00 ml vs. 1 250.00 ml, P=0.001), extubation time (5.00 d vs. 8.00 d, P=0.002) and hospital stay (13.11±4.45 d vs. 19.46±7.74 d, P<0.010) in the VATS group were significantly better than those in the thoracotomy group. There was no statistical difference in postoperative complication rate (4 patients vs. 14 patients, P=0.147) between the two[1], groups.ConclusionCompared with conventional thoracotomy, VATS lung resection has obvious advantages in treatment of tuberculosis, which may be the preferred technique.
A 54-year-old asymptomatic man underwent a video-assisted thoracoscopic left pneumonectomy for squamous-cell carcinoma. During the surgery, a complete left pericardial defect was unexpectedly discovered, but no special intervention was made. The preoperative chest CT was reciewed, which showed the heart extended unusually to the left, but the left pericardial defect was not evident. The operation time was 204 min and the patient was discharged from hospital upon recovery 9 days after the surgery. The pathological result indicated moderately differentiated squamous-cell carcinoma (T2N1M0, stage ⅡB), and metastasis was found in the parabronchial lymph nodes (3/5). The patient did not receive chemotherapy after the surgery, and there was no signs of recurrence 6 months after the surgery. Complete pericardial defects usually do not endanger the lives of patients, and if the patient is asymptomatic, pneumonectomy is feasible.
ObjectiveTo investigate the efficacy of total thoracoscopy (VATS) lobectomy and the thoracotomy for the treatment of benign lung disease. MethodsWe retrospectively analyzed the clinical data of 70 patients with benign lung diseases in the First People's Hospital of Qujing between January 2012 and September 2013. According to the surgical way, the patients were divided into two groups including a total VATS group involved in 35 patients with 25 males and 10 females, aged 18 to 71 years, mean age of 41.3±6.4 years and a thoracotomy group involved in 35 patients with 26 males and 9 females, aged 19 to 72 years, mean age of 42.4±5.6 years. Then we compared the efficacy of the two groups. ResultsThere was no statistical difference (P > 0.05) in operative time and postoperative survival rate comparison. While in the total VATS group, the total thoracoscopic incision length, bleeding volume or pain time, postoperative day time of analgesia, thoracic drainage volume, postoperative drainage tube pulling time and hospitalization time were all lower than those in the thoracotomy group with statistical differeces (P < 0.05). ConclusionThe thoracoscopic lobectomy for treatment of benign pulmonary lesions is superior to the conventional thoracotomy with much less bleeding and pain, more faster postoperative recovery and less impact on the patient's body. It's suitable for clinical application in normal hospital.
Objective To investigate the risk factors of postoperative urinary retention of non-small cell lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy without indwelling urinary catheterization. Methods In this prospective trial, we recruited 148 patients who were scheduled for lung cancer lobectomy under general anesthesia by VATS in Department of Thoracic Surgery in West China Hospital from July through December 2015. These patients were divided into two groups including a trial group and a control group. There was no indwelled urethral catheter in the trial group. And the patients in the control group were indwelled urethral catheter routinely. Postoperative urinary retention, urinary tract infection, the postoperative hospitalization duration and the clinical data were recorded. Results There was no significant difference between the trial group and the control group in postoperative urinary retention (9.46% vs. 6.76%, P=0.087). However, the ratios of the male patients and the patients with history of abdomen operation, and international prostate symptom score (IPSS) of the urinary retention patients (83.33%, 33.33%, 26.55±7.00) were statistically higher than those of the patients without urinary retention (56.62%, 0.00%, 15.31±8.31, P=0.017, P=0.000, P=0.031). Postoperative urinary tract infection rates in the trial group and the patients with urinary retention (4.05%，25%) were statistically higher than those in the control group and the patients without urinary retention (1.35%, 0.74%, P=0.049, P=0.048). Conclusion The risk factors of postoperative urinary retention patients with non-small cell lung cancer undergoing VATS lobectomy are male patients, history of abdomen operation, and moderate to severe hyperplasia of prostate.
ObjectiveTo investigate the feasibility,safety and short-term clinical outcomes of complete videoassisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage lung cancer (LC). MethodsClinical data of 138 consecutive patients with early-stage LC who underwent lobectomy in the First People's Hospital of Jining from January 2012 to May 2013 were retrospectively analyzed. There were 71 patients undergoing complete VATS lobectomy including 39 male and 32 female patients with their age of 57.9±10.6 years (VATS group) and 67 patients undergoing lobectomy via traditional thoracotomy including 36 male and 31 female patients with their age of 60.3±8.2 years (thoracotomy group). Operation time,intraoperative blood loss, groups and number of lymph node dissection,thoracic drainage duration, postoperative hospital stay,vision analogue scores (VAS) on the 1st,3rd and 30th postoperative day, and postoperative morbidity were compared between the 2 groups. ResultsAll the patients in both groups success fully received their operation. Intraoperative blood loss (147±113 ml vs. 146±91 ml) number of lymph node dissection (9.9±3.6 vs. 10.0±3.6) group of lymph node dissection (3.1±1.3 vs. 3.4±1.3) and VAS on the 1st and 3rd postoperative day of VATS group were not statistically different from those of the thoracotomy group (P>0.05). Operation time (119±27 minutes vs. 135±29 minutes) thoracic drainage duration (3.0±0.9 days vs. 3.8±1.2 days) postoperative hospital stay (8.0±2.1 days vs. 10.2±5.4 days) VAS on the 30th postoperative day (2.6±0.7 vs. 3.2±1.1) and postoperative morbidity (8.5% vs. 19.4%) of VATS group were significantly shorter or lower than those of the thoracotomy group (P<0.05). Fifty-nine patients in VATS group and 58 patients in the thoracotomy group were followed up for 2-18 months after disc harge. During follow-up,there was no death in either group. There was 1 patient with brain metastasis,1 patient with liver metastasis,and 2 patients with bone metastasis. ConclusionComplete VATS lobectomy is safe and feasible for the treatment of early LC with the advantages of minimal invasiveness,less morbidity,better postoperative recovery and less chronic incision pain. Complete VATS lobectomy can also achieve similar standardization of lymph node dissection as routine thoracotomy.
ObjectiveTo analyze clinical experience and outcomes of video-assisted thoracoscopic surgery (VATS)for bioprosthetic mitral valve replacement (MVR). MethodsWe retrospectively analyzed 32 patients who underwent VATS bioprosthetic MVR in the Department of Cardiovascular Surgery of Guangdong General Hospital from March to December 2013. There were 14 males and 18 females with a mean age of 55.6±17.3 years (range, 19 to 80 years), mean body weight of 55.7±9.7 kg (range, 37 to 78 kg) and mean body surface area of 1.67±0.16 m2 (range, 1.30 to 1.95 m2). Five patients had atrial fibrillation. There were 20 patients in New York Heart Association (NYHA)functional class Ⅱ, 11 patients in class Ⅲ, and 1 patient in class Ⅳ. There were 16 patients with rheumatic mitral valve disease, 11 patients with degenerative mitral valve disease, 4 patients with infective endocarditis and 1 patient with associated congenital heart disease. ResultsVATS bioprosthetic MVR was successfully performed for all the patients, including 27 patients with Medtronic Hancock Ⅱ Bioprosthesis and 5 patients with Medtronic Mosaic Bioprosthesis. Concomitantly, tricuspid valvuloplasty was performed for 13 patients and atrial septal defect repair was performed for 1 patient. There was no in-hospital death, low cardiac output syndrome or left ventricular rupture. Postoperative echocardiography showed good bioprosthetic function in all the patients without paravalvular leakage. Postoperative cardiac function significantly improved compared with preoperative cardiac function. There were 9 patients in NYHA functional class Ⅰ, 17 patients in class Ⅱ, and 6 patients in class Ⅲ. Left atrial diameter and left ventricular end-diastolic diameter examined postoperatively and 3 months after surgery were significantly smaller than preoperative values. Left ventricular ejection fraction (LVEF)examined postoperatively and 3 months after surgery was significantly lower than preoperative LVEF. ConclusionsVATS bioprosthetic MVR is a minimally invasive, safe and feasible procedure with a low postoperative morbidity. Incision size can be significantly reduced with a special type of bioprosthesis.
Abstract： Objective To evaluate the safety, feasibility, and clinical outcome of complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage non-small cell lung cancer （NSCLC）. Methods We retrospectively analyzed the clinical data of 160 consecutive patients（the VATS group, 83 males and 77 females with average age at 60.8 years）with early-stage NSCLC who underwent complete VATS lobectomy between January 2005 andDecember 2008 in Zhongshan Hospital of Fudan University，and compared them with 357 patients（the thoracotomy group, 222 males and 135 females with average age at 59.5 years）who underwent open thoracotomy in the same period. Results The conversion rate of the VATS group was 5.0%（8/160）. The operation time of the VATS group was significantly shorter than that of the thoracotomy group（113.0 min vs.125.0 min, P=0.039）. Length of postoperative hospital stay was not statistically different between the two groups（10.3±4.3 d vs.9.1±4.6 d，P=0.425）. The postoperative morbidity of the VATS lobectomy group and the thoracotomy group was 9.4%（15/160）and 10.1% （36/357） respectively，and the postoperative mortality of the two groups was 0.6%（1/160）and 2.0%（7/357）respectively. There was no statistical difference in the mean group of lymph node dissection （2.4±1.5 groups vs.2.4±1.7 groups，P=0.743） and the mean number of lymph node dissection （9.8±6.3 vs.10.1±6.4，P=0.626） between the two groups. The overall 5-year survival rate of the VATS group was significantly higher than that of the thoracotomy group （81.5% vs.67.8%, P=0.001）. Subgroup analysis showed that the 5-year survival rate of pⅠa stage, pⅠb stage, and pⅢa stage was 86.0%, 84.5%, and 58.8% respectively in the VATS group, and 92.9%, 76.4%, and 25.3% respectively in the thoracotomy group. Conclusion Complete VATS lobectomy is technically safe and feasible for patients with early-stage NSCLC. The lymph node dissection extension of complete VATS lobectomy is similar to that of open thoracotomy, and long-term outcome of complete VATS lobectomy is superior to that of open thoracotomy. Randomized controlled trials of large sample size are further needed to demonstrate superiority.
Objective To investigate the application and techni ques of endoscop ic linear stapling device in complete video-assisted thoracoscopic lobectomy, a n d to improve the safety and quality of the operation. Methods From September 2006 to January 2008,sixty consecutive complete video-assisted thoracoscopic lo b ectomies were performed. The patients include 30 men and 30 women with average a ge of 59.8 years old. Eight patients suffered from benign lung lesions, and 52 p atients suffered from primary lung cancers or other pulmonary malignancy. The op erations were performed under general anesthesia with doublelumen intubation a nd complete thoracoscopy.The procedures include 12 right upper lobectomies, 10 right middle lobectomies, 14 right lower lobectomies, 8 left upper lobectomies a nd 16 left lower lobectomies. All arteries, veins, bronchus involved were manag ed with endoscopic linear stapling devices. Results All the pr ocedures were successful with one conversion case（1.67%） due to tense lymph no des adhesion, no severe complications, as active bleeding, continuous air leak, foreign body reac tion or operation related death occured. Endoscopic linear stapling devices were used for stapling in 381 different procedures with average of 6.35 per case, am ong which 124 (2.06 per case)were for pulmonary arteries, 66(1.10 per case) for pulmonary veins, 60 for lobar bronchus and 131 for interlobar fissures.A period of 11.3 months (2-18 months) follow-up of all patients shows no dela yed bleeding, bronchialpleural fistula, pyothorax or pneumonia. Concl usion The application of endoscopic linear stapling device is one of th e major difficulty in complete video-assisted thoracoscopic lobectomy. Careful manipulation under some specific principles is the key for the security of the operation.
ObjectiveTo explore the surgical procedures for primary spontaneous pneumothorax without bullae. MethodsWe retrospectively analyzed the clinical data of 52 patients with primary spontaneous pneumothorax without bullae, who underwent surgical treatment in Second Affiliated Hospital of Kunming Medical University between January 2008 and January 2013. There were 46 males and 6 females, with mean average age of 23.2±4.3 years (ranged from 16 to 34 years). According to the different methods of intraoperative surgery, all patients were divided into three groups. The patients in a group Ⅰ (n=20) underwent video-assisted thoracoscope (VATS) selective apex of low energy electric coagulation treatment. The patients in a group Ⅱ (n=21) underwent VATS lung tip part of lung resection. The patients in a group Ⅲ (n=11) received VATS resection of the pleura. The clinical effectiveness among the three groups was compared. ResultsCompared with other two kinds of operation schemes,the leak duration(2.61±1.89 d vs. 4.90±3.20 d vs. 5.36±2.57 d, P=0.012), postoperative chest tube drainage time (3.67±2.13 d vs. 6.00±3.73 d vs. 7.03±2.58 d, P=0.003), postoperative length of hospital stay (4.95±2.16 d vs. 7.35±3.03 d vs. 8.61±2.67 d, P=0.002) and the recurrence rate (0.0% vs. 23.1% vs. 12.5%, P=0.021) of the patients with lung tip part resection of lung tissue by VATS were significantly lower. There were no statistically significant differences in the indicators of the patients with selective apex of low energy electric coagulation by VATS and those with pleural resection by VATS (P>0.05). ConclusionLung tip part of the lung tissue resection by VATS for primary spontaneous pneumothorax without bullae is better than VATS selective apical low energy coagulation treatment and VATS resection of the pleura both in the short and long-term efficacy.
Abstract： Objective To compare clinical outcomes of complete video-assisted thoracoscopic surgery （cVATS） lobectomy with routine thoracotomy lobectomy for the treatment of bronchiectasis, and evaluate the feasibility, safety and specific considerations of cVATS lobectomy for the treatment of bronchiectasis. Methods We retrospectively analyzed the clinical data of 115 patients who underwent lobectomy for the treatment of bronchiectasis in Beijing Chaoyang Hospital from May 2009 to January 2012. According to the way of operation, these patients were divided into two groups （cVATS group and thoracotomy group）. In the thoracotomy group, there were 62 patients （28 males and 34 females with an age of 46.2±11.9 years） who underwent routine thoracotomy lobectomy. In the cVATS group, there were 53 patients （19 males and 34 females with an age of 45.7±12.2 years） who underwent cVATS lobectomy. Operation time, intra-operative blood loss, postoperative thoracic drainage, complications and hospitalization, and cost of hospitalization were compared between the two groups. Results There was no perioperative death in all patients. There was no statistical difference in operation time between the two groups. Intra-operative blood loss of thoracotomy group patients was significantly higher than that of cVATS group patients （228.8±121.7 ml vs. 157.1±123.8 ml, t=2.592, P=0.011）. Postoperative thoracic drainage （866.7±439.5 ml vs. 1 805.3±466.7 ml, t=9.003，P=0.000）, duration of chest tube drainage （6.6±3.3 d vs. 9.8±4.6 d,t=3.339，P=0.001）, and postoperative hospitalization （7.5±2.2 d vs. 11.2±5.4 d, t=3.424，P=0.001） of cVATS group were significantly lower than those of thoracotomy group. The cost of hospitalization of cVATS group was significantly higher than that of thoracotomy group （38 543.6±11 051.8 yuan vs. 30 523.4±10 028.5 yuan，t=3.423, P=0.001）. There was no statistical difference in postoperative complications between the two groups （P＞0.05）. Forty-five patients in cVATS group were followed up for 2 to 14 months. Among them, 42 patients completely had no sputum or haemoptysis and 3 patients still intermittently had some sputum. Conclusion cVATS lobectomy is safe and feasible for the treatment of bronchiectasis. Compared with routine thoracotomy lobectomy, cVATS lobectomy does not increase surgical risk, but can significantly reduce operation injury and length of hospital stay. During cVATS, the lung residual should be handled cautiously especially for patients with nonanatomic pulmonary resection, and the non-single-order operation is recommended.