ObjectiveTo investigate the clinical effect of thoracoscopic lobectomy versus segmentectomy in the treatment of T1bN0M0 non-small cell lung cancer (NSCLC). MethodsClinical data of 181 patients with T1bN0M0 NSCLC admitted to our hospital from 2012 to 2015 were retrospectively analyzed. They were divided into a lobectomy group and a segmentectomy group according to surgical methods. There were 117 patients in the lobectomy group (46 males and 71 females aged 61.32±8.94 years) and 64 patients in the segmentectomy group (20 males and 44 females aged 58.55±12.57 years). Perioperative indicators and prognosis were compared between the two groups. ResultsThe segmentectomy group had longer operation time, less intraoperative blood loss, shorter postoperative hospital stay and more preservation of lung function compared with the lobectomy group (P<0.05). The lobectomy group had higher consolidation tumor ratio, bigger tumor diameter, and more lymph node sampling compared with the segmentectomy group (P<0.05). There was no statistical difference in 5-year overall survival or recurrence-free survival between the two groups (P<0.05). ConclusionFor patients with T1bN0M0 NSCLC, thoracoscopic segmentectomy and lobectomy have similar prognosis, but segmentectomy has advantages with less injury and faster recovery over lobectomy.
ObjectiveTo investigate the diagnostic value of internal medicine thoracoscope combined with pleural GeneXpert MTB/RIF for tuberculous pleurisy.MethodsEighty patients with tuberculous pleurisy admitted to hospital with pleural effusion were treated as tuberculous pleurisy group, and 20 patients with clinical diagnosis of malignant pleural effusion were used as control group. After admission to the hospital, the pre-operative examination of internal medicine thoracoscope were analyzed. All patients were extracted pleural effusion with thoracic puncture in order to send pleural tuberculosis smear and culture. Patients who had no contraindications were arranged internal medicine thoracoscope to get pleural effusion which will be sent to GeneXpert MTB/RIF and pathological tissue biopsy.ResultsIn the tuberculous pleurisy group, nine patients were positive in pleural tuberculous smear, and the positive rate was 11.3%; 4 patients were positive in pleural tuberculous culture, and the positive rate was 5.0%; 75 patients were diagnosed with pathological biopsy, and the positive rate was 93.8%; 69 patients were positive with pleural GeneXpert MTB/RIF, and the positive rate was 86.3%. The positive rate of internal medicine thoracoscopic pleural biopsy combined with pleural GeneXpert MTB/RIF could reached 96.3%. The pleural GeneXpert MTB/RIF lifampin resistance gene was positive in 5 patients, 4 of them were positive for tuberculosis culture, and the drug sensitivity results showed rifampicin resistance. In the control group, patients had negative result in pleural effusion tuberculosis smear, tuberculosis culture and the pleural GeneXpert MTB/RIF.ConclusionsThe diagnosis of tuberculous pleurisy by the combination of internal medicine thoracoscope and pleural GeneXpert MTB/RIF has high specificity and sensitivity. The diagnosis of tuberculous pleurisy by the combination of internal medicine thoracoscope and pleural GeneXpert MTB/RIF has high specificity and sensitivity, which has the value of rapid and accurate diagnosis and early guidance of anti-tuberculosis chemotherapy based on the early judgment of whether rifampin resistance exists.
Objective To evaluate the effectiveness and safety of pure carbon dioxide (CO2) combined with a modified inflation-deflation technique for identifying the intersegmental plane during thoracoscopic segmentectomy. Methods A prospective study was conducted, enrolling 30 patients diagnosed with pulmonary nodules who underwent thoracoscopic anatomical segmentectomy at the Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, from March 2024 to March 2025. Patients were randomly assigned to one of two groups using a random number table: A pure oxygen group (O2 group, n=15, 8 females, 7 males, age 28-75 years) and a pure carbon dioxide group (CO2 group, n=15, 8 females, 7 males, age 37-69 years). All patients underwent preoperative three-dimensional computed tomography bronchovascular angiography to reconstruct pulmonary vessels, bronchi, and the virtual intersegmental plane. The time to identification of the ideal intersegmental plane was recorded intraoperatively, along with arterial blood gas measurements before lung inflation and at 5 and 15 minutes after lung inflation on the surgical side. Results The time to identify the intersegmental plane was significantly shorter in the CO2 group compared to the O2 group [(151.1±39.5) s vs. (998.7±78.9) s, P<0.001], and there were no significant fluctuations in intraoperative oxygen saturation in patients in the CO2 group. Furthermore, there were no statistically significant differences between the two groups in terms of operation duration, intraoperative blood loss, postoperative extubation time, total postoperative chest tube drainage, postoperative length of hospital stay, or postoperative complication rate (all P>0.05). Conclusion Pure CO2 combined with a modified inflation-deflation technique can rapidly, accurately, and clearly identify the intersegmental plane, and its safety is non-inferior to that of the pure O2 method, making it worthy of clinical promotion and application.
ObjectiveTo introduce the application of mixed reality technique to the preoperative and intraoperative pulmonary nodules surgery.MethodsOne 49-year female patient with multiple nodules in both lobes of the lung who finally underwent uniportal thoracoscopic resection of superior segment of left lower lobe and wedge resection of left upper lobe was taken as an example. The Mimics medical image post-processing software was used to reconstruct the patient's lung image based on the DICOM data of the patient's chest CT image before the surgery. The three-dimensional reconstructed image data was imported into the HoloLens glasses, and the preoperative discussions were conducted with the assistance of mixed reality technology to formulate the surgical methods, and the preoperative conversation with the patients was also conducted. At the same time, mixed reality technology was used to guide the surgery in real time.ResultsMixed reality technology can clearly pre-show the important anatomical structures of blood vessels, trachea, lesions and their positional relationship. With the help of mixed reality technology, the operation went smoothly. The total operation time was 49 min, the precise dorsal resection time was 27 min, and the intraoperative blood loss was about 39 mL. The patient recovered well and was discharged from hospital smoothly after surgery.ConclusionMixed reality technology has certain application value before and during the surgery for pulmonary nodules. The continuous maturity of this technology and its further application in clinics will not only bring a new direction to the development of thoracic surgery, but also provide a wide prospect.
ObjectiveTo investigate the safety and efficacy of totally no tube three-port thoracoscopic surgery (TNTT) for thymic tumor via lateral thoracic approach. MethodsThe clinical data of patients with thymoma admitted to the Department of Thoracic Surgery of the General Hospital of Northern Theater Command from November 2021 to May 2022 were retrospectively analyzed. The patients were divided into a TNTT group and a single utility port video-assisted thoracic surgery (SVATS) group according to different surgical methods. The clinical data were compared between the two groups. ResultsA total of 111 patients were collected. There were 44 patients in the TNTT group, including 20 males and 24 females, with an average age of 60.11±8.64 years, and 67 patients in the SVATS group, including 30 males and 37 females, with an average age of 62.40±7.92 years. There was no significant difference between the two groups in the baseline data (P>0.05). The postoperative hospital stay and intraoperative blood loss were shorter or less in the TNTT group (P<0.05), and the visual analogue scale score 48 hours after the operation was smaller in the SVATS group (P<0.05). ConclusionTNTT has a good surgical safety, and can shorten postoperative hospital stay, reduce intraoperative blood loss, and has significant advantages in enhanced recovery after surgery, but SVATS can reduce postoperative pain in patients.
Objective To verify whether hybrid surgical and interventional ablation(HA) for the treatment of persistent atrial fibrillation (AF) is superior to video-assisted thoracoscopic surgical radiofrequency ablation (VATS-RA). Methods From September 2010 to December 2017, 79 consecutive patients with persistent AF underwent VATS-RA or HA in Fuwai Hospital. VATS-RA was performed in sixty patients (a stand-alone surgical group, 48 males and 12 females, at average age of 56.0±7.6 years, and HA was performed in nineteen patients (a hybrid group, 14 males and 5 females, at average age of 58.0±7.3 years). Follow-up was completed at 3 months, 6 months, 1 year and annually thereafter. Postoperative sinus rhythm was defined as sinus rhythm recorded in 24-hour or 7-day Holter during follow-up, without exhibited rapid atrial tachyarrhythmia≥30 s including AF, atrial flutter, or atrial tachycardia. Results Seventy-eight patients (98.7%) completed the follow-up. Although the preoperative left atrial diameter (49.1±5.3 mm) in the hybrid group was significantly greater than that in the stand-alone surgical group (41.7±6.2 mm, P<0.001). Overall sinus rhythm maintenance rate in the hybrid group was significantly greater than that in the stand-alone surgical group (94.7% versus 64.4%,P=0.011). And sinus rhythm maintenance rate free from anti-arrhythmic drugs (AADs) and catheter ablation in the hybrid group was significantly greater than that in the stand-alone surgical group (84.2% versus 50.8%, P=0.010). Conclusion HA is superior to VATS-RA in the treatment of persistent AF, but a larger sample size is needed for further validation in prospective randomized studies.
ObjectiveTo investigate the effect of multidisciplinary team (MDT) on perioperative complications and clinical efficacy of patients who were receiver radical operation to treat lung cancer by video-assisted thoracoscopic surgery (VATS). MethodsEighty patients in the Thoracic Surgery Department of First Hospital of Lanzhou University from December 2017 to February 2019 who were diagnosed lung cancer were divided into two groups. Forty patients in the MDT group were treated with MDT discussion. The control group consisted of 40 patients who were treated without MDT discussion. The incidence of postoperative complications and clinical efficacy were compared between the two groups . ResultsThere was no statistical difference in incision infection, atelectasis, pleural effusion and pulmonary leakage between the two groups. However, the incidence of postoperative pulmonary infection (5% vs. 20%, P=0.043) and the overall postoperative complications (17.5% vs. 42.5%, P=0.015) in the MDT group was lower than that in the control group with a statistical difference. In the MDT group, the operative time (140.3±8.0 min vs. 148.8±6.8 min, P<0.001), intraoperative bleeding ( 207.8±19.4 mL vs. 222.0±28.3 mL, P=0.010), lymph node dissection number (25.1±6.2 vs. 20.1±7.0, P=0.001), postoperative drainage (273.0±33.5 mL vs. 24.0±52.5 mL, P<0.001), drainage duration (81.9±6.1 h vs. 85.3±8.1 h, P=0.039), pain on the first day after surgery (4.6±0.7 vs. 5.4±0.7), P<0.001), pain on the second day (2.5±0.7 vs. 3.0±0.8, P=0.002), pain on the third day (1.1±0.8 vs. 1.5±0.6, P=0.014), postoperative activity time (40.7±6.7 h vs. 35.3±7.1 h, P<0.001), postoperative recovery time (6.8±0.9 d vs. 7.4±0.7 d, P=0.003), patient satisfaction (8.1±1.4 vs. 7.2±2.0, P=0.020) were significantly better than those of the control group with statistical differences. But there was no statistical difference in the conversion to thoracotomy between the two group. ConclusionMDT discussion can reduce the surgical risk and postoperative complications, improve the clinical efficacy and accelerate the postoperative rehabilitation of patients, which has a good clinical significance.
ObjectiveTo investigate the safety and efficacy of naked eye 3D thoracoscopic surgery in minimally invasive esophagectomy.MethodsClinical data of 65 patients, including 50 males and 15 females aged 47-72 years, with esophageal cancer who underwent minimally invasive thoracoscopic esophagectomy from October 2018 to April 2019 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods including a naked eye 3D thoracoscopic group (group A: 30 patients) and a traditional 2D thoracoscopic group (group B: 35 patients). The effects of the two groups were compared.ResultsThe operation time in the group A was significantly shorter than that in the group B (P<0.05). The number of dissected lymph nodes in the group A was more than that in the group B (P<0.05). The thoracic drainage volumes on the 1th-3th days after operation in the group A were significantly larger than those in the group B (P<0.05), but there was no significant difference between the two groups on the 4th-5th days after operation (P>0.05). The indwelling time in the group A was longer than that in the group B (P<0.05). Postoperative hospital stay, pulmonary infection, arrhythmia, anastomotic leakage, and recurrent laryngeal nerve injury were not significantly different between the two groups (P>0.05).ConclusionNaked eye 3D thoracoscopic surgery for minimally invasive esophagectomy is a safe and effective surgical procedure. Compared with traditional 2D minimally invasive thoracoscopic surgery, it is safer in operation and more thorough in clearing lymph nodes. The operation is more efficient and can be promoted.
ObjectiveTo analyze the feasibility, advantages and disadvantages of the fluorescence method and the inflation-deflation method in defining the intersegmental plane during thoracoscopic lung segmental resection.MethodsFrom February to October 2018, 60 patients underwent thoracoscopic anatomical segmentectomy in Thoracic Surgery Department of Nanjing Chest Hospital, with 28 males and 32 females, aged from 25 to 82 years. Three-dimension computed tomography bronchography and angiography was used to reconstruct pulmonary vessels, bronchus and virtual intersegmental plane. Among them, 20 patients used the fluorescence method to define the intersegmental plane, and the other 40 patients used the traditional inflation-deflation method to define the intersegmental plane.ResultsFluorescent injection of indocyanine green (ICG) showed a clear intersegmental line with a duration sufficient to complete the label. With the fluorescence method, the intersegmental plane occurrence time was significantly shortened (10.75±3.78 s vs. 988.00±314.24 s, P<0.001) and had satisfactory repeatability. The lungs did not need to be inflated, which was convenient for the operation. And the operation time was shortened (108.75±31.28 min vs 138.00±32.47 min, P=0.002). No obvious ICG injection-related concurrency symptoms was found.ConclusionCompared with the traditional inflation-deflation method, the fluorescence method can display the intersegmental line quickly, accurately and clearly, reduce the difficulty of surgery, shorten the operation time, and provide reliable technical support for thoracoscopic anatomical segmentectomy. The fluorescence is a safe and effective method that is worthy of clinical application.
ObjectiveTo investigate the safety and effectiveness of near-infrared fluorescence imaging of the thoracic duct (NFITD) using indocyanine green (ICG) during inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) for esophageal cancer. MethodsA retrospective analysis was conducted on patients with esophageal cancer who underwent IVMTE at the Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China, from January 2024 to October 2024. Patients were divided into two groups based on whether they underwent NFITD: an ICG NFITD group (ITD group) and a non-ICG NFITD group (NITD group). Propensity score matching was used to balance confounding factors, and perioperative data and short-term follow-up results (within 6 months) of the two groups were compared. ResultsA total of 66 patients were included, of which 51 were males and 15 were females, with an average age of (70.9±7.2) years. In the comparison of general information between the two groups, the proportion of patients in the ITD group with preoperative chronic obstructive pulmonary disease was higher than that in the NITD group (P=0.044), and the proportion of patients with preoperative bronchiectasis was lower than that in the NITD group (P=0.035). After propensity score matching at a 1:1 ratio, a total of 15 pairs of patients were successfully matched. There was no statistically significant difference between the two groups in terms of intraoperative blood loss, postoperative hospital stay, complications, maximum tumor diameter, pT stage, pN stage, and pTNM stage (P>0.05). The 6-month postoperative follow-up results showed no statistically significant difference between the two groups in terms of anastomotic stricture, hoarseness, gastric paralysis, anastomotic leakage, and postoperative adjuvant treatment (P>0.05). ConclusionThe application of NFITD in IVMTE is safe and effective, with a thoracic duct visualization rate of 100.0%. Compared with NITD, ITD prolonged the operation time but increased the number and stations of lymph node dissection without increasing perioperative and short-term postoperative complications (within 6 months), making it worthy of further clinical promotion.