ObjectiveTo discuss the safety and feasibility of no chest tube (NCT) after thoracoscopic pneumonectomy.MethodsThe online databases including PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to October 2020 to collect the research on NCT after thoracoscopic pneumonectomy. Two reviewers independently screened the literature, extracted the data, and evaluated the quality of the included studies. The RevMan 5.3 software was used for meta-analysis.ResultsA total of 17 studies were included. There were 12 cohort studies and 5 randomized controlled trials including 1 572 patients with 779 patients in the NCT group and 793 patients in the chest tube placement (CTP) group. Meta–analysis results showed that the length of postoperative hospital stay in the NCT group was shorter than that in the CTP group (SMD=–1.23, 95%CI –1.59 to –0.87, P<0.000 01). Patients in the NCT group experienced slighter pain than those in the CTP group at postoperative day (POD)1 (SMD=–0.97, 95%CI –1.42 to –0.53, P<0.000 1), and POD2 (SMD=–1.10, 95%CI –2.00 to –0.20, P=0.02), while no statistical difference was found between the two groups in the visual analogue scale of POD3 (SMD=–0.92, 95%CI –1.91 to 0.07, P=0.07). There was no statistical difference in the 30-day complication rate (RR=0.93, 95%CI 0.61 to 1.44, P=0.76), the rate of postoperative chest drainage (RR=1.51, 95%CI 0.68 to 3.37, P=0.31) or the rate of thoracocentesis (RR=2.81, 95%CI 0.91 to 8.64, P=0.07) between the two groups. No death occurred in the perioperative period in both groups.ConclusionIt is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.
ObjectiveTo compare the perioperative efficacy and safety of robot-assisted thoracoscopic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (UVATS) in the lobectomy for early lung adenocarcinoma.MethodsClinical data of 70 early lung adenocarcinoma patients, receiving RATS or UVATS lobectomy by the same surgical team in our hospital from November 2018 to May 2020 were retrospectively analyzed. There were 24 males and 46 females with an average age of 59.3±8.9 years. According to different surgical methods, the patients were divided into a RATS group (31 patients) and a UVATS group (39 patients). The operation time, intraoperative blood loss, postoperative hospital stay, indwelling time, drainage volume, number of lymph node dissected, stations of lymph node dissected and perioperative complications were compared between the two groups.ResultsThere was no conversion to thoracotomy or perioperative death in both groups. There was no significant difference in intraoperative blood loss, postoperative hospital stay, indwelling time of thoracic drainage tube, thoracic drainage volume or stations of lymph node dissected between the two groups (P>0.05). There was no significant difference in the incidence of pulmonary infection, persistent lung leakage, chylothorax, arrhythmia or overall complications between the two groups (P>0.05). The operation time of the RATS group was longer than that of the UVATS group (195.8±52.8 min vs. 154.0±43.1 min, P=0.001). The number of lymph node dissected in the RATS group was more than that of the UVATS group (P=0.016).ConclusionBoth RATS and UVATS are safe and feasible in the treatment of lung cancer. The number of lymph nodes removed by RATS is significantly more than that of UVATS.
Objective Through a retrospective study on esophageal function changes and symptom relief after video-assisted thoracoscopic surgery treatment for achalasia of cardia (AC) to assess the clinical value of this operation. Methods We reviewed the data of 34 AC patients who received modified Heller operation by video-assisted thoracoscopic surgery in the Affiliated Hospital of Guizhou Medical University from March 2012 to September 2014. There were 11 males and 23 females with a median age of 35 (11–67) years. These patients were divided into four groups according to the time of treatment and follow-up: preoperative group, postoperative one-month group, postoperative three-month group and postoperative six-month group. Changes of symptoms, radiography and esophageal dynamics before and after therapy were collected. These different groups were analyzed based on statistical methods. Results There was no statistical difference in ages and genders among groups (P>0.05). The surgery was successful and no complication or death occurred. Symptoms of patients showed different degrees of relief and the postoperative grade of clinical symptoms decreased (P<0.05). After surgery, lower esophageal sphincter pressure (LESP), lower esophageal sphincter resting pressure (LESRP) and esophageal body pressure (EBP) decreased significantly, while lower esophageal sphincter relax rate (LESRR) increased (P<0.05). While there was no significant difference in length of lower esophageal sphincter (LESL,P>0.05). Angiography of upper digestive tract revealed that compared to the preoperative group, the maximum width in postoperative three-month group decreased significantly (P<0.05). During the follow-up, 3 patients suffered gastroesophageal reflux, 2 patients esophageal perforation and 1 patient empyema due to esophago-pleural fistula. No massive hemorrhage of upper digestive tract and hiatal hernia occured. Conclusion Sugery can significantly ameliorate the clinical symptoms of the patients with AC, and improve esophageal dynamics. And it is simple and easy to perform with less complications and better long-term outcomes. Improved Heller operation by video-assisted thoracoscopy is a less invasive procedure when compared with the traditional thoracotomy. Moreover, esophageal manometry can objectively assist in the diagnosis and degree of the disease and effect of therapy.
ObjectiveTo analyze the occurrence of postoperative pulmonary complications (PPC) and the risk factors in patients with spontaneous pneumothorax who underwent micro single-port video-assisted thoracoscopic surgery (VATS).MethodsA total of 158 patients with spontaneous pneumothorax who underwent micro single-port VATS in our hospital from April 2017 to December 2019 were retrospectively included, including 99 males and 59 females, with an average age of 40.53±9.97 years. The patients were divided into a PPC group (n=21) and a non-PPC group (n=137) according to whether PPC occurred after the operation, and the risk factors for the occurrence of PPC were analyzed.ResultsAll 158 patients successfully completed the micro single-port VATS, and there was no intraoperative death. The postoperative chest tightness, chest pain, and dyspnea symptoms basically disappeared. During the postoperative period, there were 3 patients of pulmonary infection, 7 patients of atelectasis, 4 patients of pulmonary leak, 6 patients of pleural effusion, 1 patient of atelectasis and pleural effusion, and the incidence of PPC was 13.29% (21/158). Multivariate logistic regression analysis showed that lung disease [OR=32.404, 95%CI (2.717, 386.452), P=0.006], preoperative albumin level≤35 g/L [OR=14.912, 95%CI (1.719, 129.353), P=0.014], severe pleural adhesions [OR=26.023, 95%CI (3.294, 205.557), P=0.002], pain grade Ⅱ-Ⅲ 24 hours after the surgery [OR=64.024, 95%CI (3.606, 1 136.677), P=0.005] , age [OR=1.195, 95%CI (1.065, 1.342), P=0.002], intraoperative blood loss [OR=1.087, 95%CI (1.018, 1.162), P=0.013] were the risk factors for PPC after micro single-port VATS.ConclusionThere is a close relationship between PPC after micro single-port VATS and perioperative indexes in patients with spontaneous pneumothorax. Clinically, targeted prevention and treatment can be implemented according to the age, pulmonary disease, preoperative albumin level, intraoperative blood loss, degree of pleural adhesion and pain grading 24 hours after surgery.
Objective To explore the safety, feasibility and learning curve of video-assisted thoracoscopic surgery(VATS) in treatment of thoracic diseases. Method We retrospectively analyzed the clinical data of 591 patients of thoracic surgery in our hospital between September 2009 and September 2016. There were 378 males and 213 females at age of 14–82 years. Result All patients were successfully completed surgery. Twelve patients converted to open chest with conversion rate of 2.0%. Postoperative complications occurred in 24 patients (4.1%). Four patients died during the perioperative period, and mortality rate was 0.7%. The learning curve of VATS for lung cancer was about 25 patients. And the learning curve of video-assisted laparoscopy for resection of esophageal cancer was about 15 patients. Conclusion VATS is safety and feasible for the chest disease patients in municipal hospital, and is worthy to popularize.
ObjectiveTo explore the safety and feasibility of 3D precise localization based on anatomical markers in the treatment of pulmonary nodules during video-assisted thoracoscopic surgery (VATS).MethodsFrom June 2019 to April 2015, 27 patients with pulmonary nodules underwent VATS in our Hospital were collected in the study, including 3 males and 24 females aged 51.8±13.7 years. The surgical data were retrospectively reviewed and analyzed, such as localization time, localization accuracy rate, pathological results, complication rate and postoperative hospital stay.ResultsA total of 28 pulmonary nodules were localized via this method. All patients received surgery successfully. No mortality or major morbidity occurred. The general mean localization time was 17.6±5.8 min, with an accuracy of 96.4%. The mean diameter of pulmonary nodules was 14.0±8.0 mm with a mean distance from visceral pleura of 6.5±5.4 mm. There was no localization related complication. The mean postoperative hospital stay was 6.7±4.3 d. The routine pathological result showed that 78.6% of the pulmonary nodules were adenocarcinoma.Conclusion3D precise localization based on anatomical markers in the treatment of pulmonary nodules during thoracoscopic surgery is accurate, safe, effective, economical and practical, and it is easy to master with a short learning curve.
ObjectiveTo investigate the perioperative efficacy and safety of all-port robotic lobectomy versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer. MethodsThe clinical data of patients with stageⅠA non-small cell lung cancer who underwent lobectomy with lymph node dissection performed by the same operator in our center from June 2019 to June 2022 were retrospectively analyzed. The patients were divided into a robotic group and a thoracoscopic group according to different procedures. We compared the relevant indexes such as operation time, intraoperative bleeding, number of lymph node dissection stations, number of lymph node dissection, postoperative tube time, postoperative hospitalization time, closed chest drainage volume, postoperative pain, postoperative complications and hospitalization cost between the two groups. ResultsThere were 83 patients in the robotic group, including 34 males and 49 females with a median age of 60.0 (53.0, 67.0) years, and 94 patients in the thoracoscopic group, including 36 males and 58 females with a median age of 60.5 (54.0, 65.3) years. There was no conversion to thoractomy or death in postoperative 90 days in both groups. No statistical difference was seen in the operation time, total postoperative drainage volume and postoperative complication rates between the two groups (P>0.05). Patients in the robotic group had less intraoperative bleeding (P<0.001), more lymph node dissection stations (P=0.002) and numbers (P=0.005), less postoperative pain (P=0.002), and shorter postoperative time with tubes (P=0.031) and hospital stay (P<0.001). However, the surgery was more expensive in the robotic group (P<0.001). ConclusionAll-port robotic surgery is safe and effective for patients with early-stage non-small cell lung cancer with less intraoperative bleeding, more lymph node dissection, less postoperative pain, and shorter hospital stay compared with the thoracoscopic surgery.
ObjectiveTo investigate the effectiveness and safety of robotic lobectomy in clinical N0 lung malignant tumor≥3 cm. MethodsWe retrospectively analyzed the clinical data of 182 patients with lung malignant tumor≥3 cm receiving robotic or thoracoscopic lobectomy at Shanghai Chest Hospital in 2019. The patients were divided into a robotic surgery group (RATS group) and a thoracoscopic surgery group (VATS group). There were 39 males and 38 females with an average age of 60.55±8.59 years in the RATS group, and 51 males and 54 females with an average age of 61.58±9.30 years in the VATS group. A propensity score matching analysis was applied to compare the operative data between the two groups. ResultsA total of 57 patients were included in each group after the propensity score matching analysis. Patients in the RATS group had more groups of N1 lymph node dissected (2.53±0.83 groups vs. 2.07±0.88 groups, P=0.005) in comparison with the VATS group. No statistical difference was found in operation time, blood loss, postoperative hospital stay, number of N1 and N2 lymph nodes dissected, groups of N2 lymph node dissected, lymph node upstage rate or postoperative complications. The hospitalization cost of RATS was higher than that of VATS (P＜0.001). ConclusionIn contrast with thoracoscopic lobectomy, robotic lobectomy has similar operative safety, and a thorough N1 lymphadenectomy in patients with clinical N0 lung malignant tumor≥3 cm.
ObjectiveTo investigate the feasibility and clinical effect of controlled hypotension in 3 cm single-port video-assisted thoracoscopic surgery (VATS) for the lymph node group 7 dissection in the left lung resection. MethodsWe retrospectively analyzed the clinical data of 37 patients with lung cancer who underwent 3 cm single-port VATS from May 2015 to August 2015 in Tongji Hospital, and systolic blood pressure of 12 patients (7 males, 5 females, average age of 58.3 years, range 42-69 years) was controlled between 80-90 mm Hg by nitroglycerin or sodium nitroprusside while the pressure of 25 patients (14 males, 11 females, average age of 57.7 years, range 43-68 years) was not controlled when receiving lymph node group 7 dissection. ResultsControlled hypotension in lymphadenectomy achieved satisfactory results. The lymphadenectomy time of 12 patients with controlled hypotension (18.5±4.3 min on average, range 15.6-25.3 min) was shorter than that of 25 patients without controlled hypotension (24.3±5.1 min on average, range 18.2-29.8 min); the difference was statistically significant (P<0.05). ConclusionControlled hypotension is a simple and feasible method that increases the operating space, and reduces the difficulty of cleaning lymph nodes and the risk of bleeding.
Objective To summarize the clinical data about mediastinal lesions, then to analyze the treatment effect of da Vinci robot system in the surgical treatment of mediastinal lesions. Methods We retrospectively analyzed the clinical data of 49 patients with mediastinal lesions in our hospital between January 2016 and October 2017. These patients were divided into two groups including a da Vinci robot group and a video-assisted thoracoscopic surgery (VATS) group according to the selection of the treatments. There were 25 patients with 14 males and 11 females at age of 56.5±17.9 years in the da Vinci group and 24 patient with 15 males and 11 females at age of 53.0±17.8 years in the VATS group. Results There was no statistical difference in surgery time between the two groups (t=–0.365, P=0.681). Less intraoperative blood loss (t=–2.569, P<0.001), less postoperative drainage amount within three days after surgery (t=–6.325, P=0.045), shorter period of bearing drainage tubes after surgery (t=–1.687, P=0.024), shorter hospital stays (t=–3.689, P=0.021), lower visual analogue scale (VAS) scores of postoperative 48 hours (t=–7.214, P=0.014) with a statistical difference in the da Vinci robot group compared with the VATS group. Conclusion The da Vinci robot system is safe and efficient in the treatment of mediastinal lesions compared with video-assisted thoracoscopic approach.