Objective To systematically analyze and compare the research literature of thoracic surgery simulation-based medical education (SBME) at home and abroad, and provide ideas for the future development of thoracic surgery SBME in China. Methods Using word frequency analysis and cluster analysis as analysis methods, CiteSpace visualization software and Excel statistical software as tools, the domestic and foreign SBME literature retrieved from PubMed and CNKI databases were visualized and statistically analyzed respectively. Results A total of 2 491 domestic and foreign literature on SBME in thoracic surgery were included. The annual number of foreign publications showed an increasing trend. The top three countries in terms of number of publications were the USA (n=581), Canada (n=105) and Germany (n=57); "cardiac surgery", "medical knowledge medical knowledge" and "medical education" are the hotspots of research in the direction of thoracic surgery simulation, while "lung cancer", "surgical training" and "3D printing" were still in the process of explosion. The core research themes were endoscope simulation trainer, scenario-based simulation teaching methods, standardized patients and virtual reality models. Conclusion Domestic SBME in thoracic surgery should learn from foreign development experience, keep up with the frontier and integrate cutting-edge technology, innovate the curriculum and offer non-technical skills teaching, and improve the system and focus on software construction.
Some complex surgical procedures allow for day surgery benefited from the advancement of the concept of enhanced recovery after surgery and minimally invasive surgical techniques. Shanghai Chest Hospital has set up thoracic day surgery ward incorporating some lung tumor surgeries into day surgery. Through process innovation, model innovation and management innovation, relying on the full-process closed-loop day surgery management system, the day surgery ward runs efficiently. It can help effectively alleviate the difficulty of admission and operation, and improve hospital operation efficiency as well as reduce the economic burden of disease. At the same time, we hope to explore an innovative development path for the possibility of day surgery in complex thoracic surgery, and create a new mode of day surgery that can be replicated and promoted.
ObjectiveThe clinical trial evidence and expert consensus in the airway management were systematically summarized in this guideline to provide clinical guidance for healthcare professionals.MethodsA total of 40 clinical questions were proposed by 32 experts, and 12 clinical questions were finally identified through the Delphi method and the PICO (patient, intervention, control, outcome) principle from 2019 to 2020. PubMed, Web of Science, Wanfang database and CNKI were searched from establishment of each database up to November, 2020. The evidence of 160 articles was graded according to GRADE method, including 18 in class A, 36 in class B, 69 in class C, and 37 in class D. Four symposiums were organized for discussion of the recommendations. Finally, 23 recommendations were made for these 12 clinical questions, among which 10 were strongly recommended and 13 were weakly recommended.ResultsSmoking cessation for at least 4 weeks, pulmonary function assessment and pulmonary rehabilitation exercise were recommended in the perioperative period, especially at least 1 week of pulmonary rehabilitation exercise for the patients with high risk factors. Anesthesia was maintained by inhalation or intravenous anesthesia. It was recommended to choose short acting drugs, monitor the depth of anesthesia and muscle relaxation during operation, and use protective ventilation strategy. Postoperative use of drugs and mechanical measures to prevent venous thromboembolism, the appropriate application of drainage tube, preemptive analgesia and multimodal analgesia for pain management were recommended. Inhaled corticosteroids with bronchodilators could be used in perioperative period to reduce airway hyperresponsiveness and postoperative cough.ConclusionFor perioperative airway management, smoking cessation, pulmonary function assessment and pulmonary rehabilitation exercise are recommended in the perioperative period. The rational use of anesthetic drugs and protective ventilation strategy are emphasized during the operations. Postoperative pain management and cough treatment should be strengthened, and drainage tube should be used properly.
Great progress has been made in immunotherapy for esophageal squamous cell carcinoma in recent years. However, for thoracic surgeons, immunotherapy is still a new thing and they lack enough experience. Therefore, this paper attempts to discuss some hot issues of immunotherapy, including the indications, side effects, clinical efficacy and evaluation of efficacy. The author hopes that this article will help and attract the attention of thoracic surgeons.
Since the outbreak of COVID-19 pandemic, a large number of elective or limited operations, including tumor treatment, have been postponed. With the deepening of the understanding of the virus and the change of the prevention policy, the impact of the pandemic is gradually shrinking, and a large number of operations delayed by the pandemic will be rescheduled. However, there is no consensus on the best time to perform surgery for patients infected with SARS-CoV-2, and the consensus on thoracic surgery is more limited. This article reviews the research progress in the timing of surgical operations, especially thoracic surgery, after SARS-CoV-2 infection.
Abstract： Objective?To summarize the clinical experience，surgical technique and indication of coronary artery implantation with double flap extension technique in arterial switch operations （ASO） in D-transposition of the great arteries （D-TGA） and Taussig-Bing anomalies.?Methods?From January 2006 to June 2011， 21 patients （13 males and 8 females；age 110.0±84.5 d；weight 5.4±4.2 kg） with D-TGA or Taussig-Bing anomalies associated with complex coronary artery malformations underwent ASO with double flap extension technique for coronary artery implantation in Shanghai Children’s Medical Center affiliated to Medical College of Shanghai Jiaotong University. All the patients had a main trunk of right coronary artery or dilated right ventricular conus branch originated from the left or right aortic sinus，with abnormal course of anterior looping to the aorta. The double flap extension technique was described as followed： a long coronary button was excised as a flap from the aorta; another pedicle flap on the pulmonary artery （neoaorta） was cut to extend to the button of coronary artery with an equal distance; the side edges of the flap and the button were sutured together to form a lengthened coronary artery tube.?Results?No operative death occurred in hospital. The postoperative duration of mechanical ventilation was 101.6±53.6 h. The duration of ICU stay was 9.5±4.9 d. Postoperatively，low cardiac output syndrome occurred in 9 cases，pulmonary hypertension crisis in 2 cases，pneumonia in 6 cases，and acute kidney failure in 2 cases. Eleven patients underwent delayed sternum closure. All the patients were discharged after proper treatment. Follow-up was complete in 17 cases. The duration of follow-up was 2 months to 5 years. Growth and development were significantly improved in all the patients during follow-up. No patient had ischemic ECG changes. One patient underwent reoperation for supravalvular pulmonary stenosis 2 years after ASO.?Conclusion?Double flap extension technique for coronary implantation in complicated ASO can significantly decrease postoperative death due to coronary artery malformations，especially for patients who have two-stage ASO and patients whose main trunk of right coronary artery or dilated right ventricular conus branch originates from the left or right aortic sinus with abnormal course of anterior looping to the aorta.
ObjectiveTo evaluate the feasibility and clinical value of robot-assisted lung segmentectomy through anterior approach.MethodsWe retrospectively analyzed the clinical data of 77 patients who underwent robotic lung segmentectomy through anterior approach in our hospital between June 2018 to October 2019. There were 22 males and 55 females, aged 53 (30-71) years. Patients' symptoms, general conditions, preoperative imaging data, distribution of resected lung segments, operation time, bleeding volume, number of lymph node dissected, postoperative duration of chest tube insertion, drainage volume, postoperative hospital stay, postoperative complications, perioperative death and other indicators were analyzed.ResultsAll operations were successfully completed. There was no conversion to thoracotomy, serious complications or perioperative death. The postoperative pathology revealed early lung cancer in 48 patients, and benign tumors in 29 patients. The mean clinical parameters were following: the robot Docking time 1-30 (M=4) min, the operation time 30-170 (M=76) min, the blood loss 20-400 (M=30) mL, the drainage tube time 2-15 (M=4) days, the drainage fluid volume 200-3 980 (M=780) mL and the postoperative hospital time 3-19 (M=7) days.ConclusionRobotic lung segmentectomy through anterior approach is a safe and convenient operation method for pulmonary nodules.
Mediastinal and chest wall tumors contain various benign and malignant tumors. In order to further standardize the whole-course diagnosis and treatment of mediastinal and chest wall tumors, the consensus was formulated through discussion by the expert group. Based on the clinical diagnosis and treatment experience and various prospective and retrospective studies, the consensus was formed.