Abstract： Objective To explore the method and effect of single utility port video-assisted thoracoscopic surgery （VATS） for the treatment of pulmonary diseases. Methods From Jan. 2008 to Jun. 2010, 158 patients with pulmonary diseases were treated by single working pore VATS in the Department of Thoracic Surgery of West China Hospital, Sichuan University. Their diseases included 6 kinds of different lesions, such as pneumothorax（inflammatory pseudotumor, hamartoma, lymphangiomyomatosis） , lung tuberculoma, and lung carcinoma. Seventy patients had definite diagnosis before their operation, and the others had their final diagnosis by intraoperative frozen section evaluation and postoperative pathology examination. All the resections were carried out by pure thoracoscopic procedures with two ports, one working pore and one observing pore. A 28-Fr chest tube was placed to the pleural apex. Limited lung resection was performed in 151 patients, single lobectomy in 7 patients, and simultaneous bilateral operation in 6 patients. Results For limited lung resection patients, the average operation time was 18 （5-60） min, and the average blood loss was 33 （5-95） ml. No patient needed intraoperative blood transfusion . Ten patients received an increased pore, including 6 patients with pleural cavity obliteration or abundant pleural adhesions, and 4 patients with intraoperative bleeding . The average postoperative length of stay was 2.5 （2-4） days, and the average medical cost was 17 884 （15 476-25 387） Yuan. For patients undergoing lobectomy and lymph node dissection, the average operation time was 128 （50-220） min, and the average blood loss was 180 （80-478） ml. No patient needed intraoperative blood transfusion. One patient received an increased pore. The average postoperative length of stay was 4.7 （4-7） days, and the average medical cost was 42 385 （38 965-57 695） Yuan. No perioperative death or severe complications were observed in present series. Conclusion Single utility port VATS is a safe and efficient procedure with good patient recovery. It is a method of choice for selected patients with pulmonary diseases.
Abstract：?Objective?To evaluate clinical outcomes of single utility port complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage lung cancer.?Methods?We retrospectively analyzed the clinical data of 162 consecutive patients with early-stage lung cancer who underwent single utility port complete VATS lobectomy from September 2009 to October 2011 in Chinese PLA General Hospital （single utility port group），and compared them with 221 patients with early-stage lung cancer who underwent video-assisted mini-thoracotomy （VAMT） lobectomy in the same period （VAMT group）. The clinical outcomes including operation time, intraoperative blood loss, lymph node dissection number, time to first activity out of bed, chest drainage duration and postoperative complications, were compared between the two groups.?Results?No perioperative death was observed in both groups. There were statistical differences in the intraoperative blood loss （162.8±75.6 ml vs. 231.4±62.8 ml）, time to first activity out of bed （2.2±0.3 d vs. 3.7±0.5 d） , and chest drainage duration （3.5±0.2 d vs. 4.6±0.4 d） between the two groups （P＜0.05）. There was no statistical difference in operation time （133.7±22.0 min vs. 124.9±25.7 min） , lymph node dissection number （11.7±1.9 vs. 12.5±2.7）， and incidence of serious postoperative complications （7.4% vs. 8.1%）between the two groups.?Conclusion?Single utility port complete VATS lobectomy and lymph node dissection are safe and reliable for patients with early-stage lung cancer with less injury and better postoperative recovery compared with VAMT.
目的探索单操作孔电视胸腔镜手术治疗胸部良性疾病的有效性和安全性。 方法回顾性分析2008年3月至2013年4月德阳市人民医院单操作孔电视胸腔镜手术治疗胸部良性疾病186例患者的临床资料，其中男101例、女85例，年龄15～65（30.1±5.3）岁。 结果全组患者无围手术期死亡。手术时间18～88（47.2±7.6）min，术中出血量5.0～110.0（49.8±9.4）ml，患者术后住院时间7～16（9.2±2.1）d。2例因致密粘连转为辅助小切口手术。自发性气胸肺大泡切除术后当日及术后1～2 d出现持续肺漏气3例，1例肺漏气持续9 d，1例肺漏气持续10 d，1例肺漏气持续11 d，均经保守治疗治愈。切口脂肪液化4例，换药后治愈。术后肺部感染3例，经加强抗感染后治愈。随访3～24（6.8±3.2）个月，失访18例，总体随访率90.3%（168/186）。随访期间气胸复发4例，气胸压缩肺组织10%～20%，观察5～8 d自行吸收，未再次手术；肺及纵隔良性病变无复发；结核患者术后抗痨治疗12～18个月治愈。 结论单操作孔电视胸腔镜手术治疗胸部良性疾病创伤小，切口美观，患者恢复快，手术安全，对适应证患者可作为手术方式。
ObjectiveTo evaluate the safety and efficacy of single utility port video-assisted thoracoscopic lobec-tomy in the treatment of benign pulmonary diseases. MethodsFrom January 2011 to April 2014, 48 patients with benign pulmonary diseases underwent single utility port video-assisted thoracoscopic lobectomy in the First Affiliated Hospital of Soochow University. The patients included 21 males and 27 females, with their mean age of 47.4 years. There were 5 patients received right upper lobectomy, right middle lobectomy in 5 patients, right lower lobectomy in 5 patients, left upper lobectomy in 8 patients, and left lower lobectomy in 20 patients. the clinical outcomes included operation time, intraoperative blood loss, chest drainage duration, postoperative hospital stay and postoperative complications. ResultsThere were 2 patients conversion to open surgery. The average operation time was 147.2±50.4 min, intraopera-tive blood loss was 160.2±25.3 ml, postoperative chest drainage duration was 4.8±2.8 d, postoperative hospital stay was 7.4±1.9 d. There was no hospital death or serious postoperative complications. Postoperative pathological diagnosis showed bronchiectasis in 17 patients, inflammatory pseudotumor in 11 patients, tuberculosis in 9 patients, aspergillosis in 4 patients, pulmonary sequestration in 3 patients, bronchogenic cyst in 2 patients, pulmonary abscess in 1 patient, and hamartoma in 1 patient. No long-term complications were noticed in 48 patients during a mean follow-up of 6 months. ConclusionSingle utility port video-assisted thoracoscopic lobectomy is safe and feasible in the treatment of benign pulmonary diseases.
ObjectiveTo discuss the advantage and disadvantage of uniport video-assisted thoracic surgery (VATS) versus single utility port VATS in the surgical treatment of benign thoracic diseases. MethodsFrom January 2012 to December 2014, 125 patients with benign thoracic diseases who underwent VATS by the same performer were divided randomly into two groups including a uniport VATS group or a single utility port VATS group. There were 41 males and 24 females with a mean age of 47.5±16.6 years in the uniport VATS group. There were 39 males and 21 females with a mean age of 45.1±15.7 years in the single utility port VATS group. Then the patients were followed up. The perioperative data and follow-up results were compared between two groups. ResultsThe total 125 patients of operations were performed successfully according the established plan, without increasing incisions or transferring to thoracotomy. There were no statistical differences between two groups in operative time (48.9±11.3 min vs. 47.1±11.0 min), intraoperative bleeding volume (26.9±15.4 ml vs. 23.8±13.2 ml), postoperative 24 h chest tube drainage volume (81.5±36.9 ml vs. 77.3±31.2 ml), postoperative chest tube drainage time (2.8±2.0 d vs. 3.4±2.2 d), the pain score on the 3rd postoperative day (2.6±1.2 points vs. 2.6±1.3 points), average in-hospital stay (4.9±2.1 d vs. 5.1±2.2 d) or postoperative complications (P > 0.05). The patients were followed up for 3-24 months. All patients achieved satisfactory results with no recurrence. ConclusionsCompared with single utility port VATS, uniport VATS does not prolong operation time or consume more materials, and has advantages of minimally invasion and higher acceptance. It is a safe and feasible approach in surgical treatment of benign thoracic diseases and worthy of popularization and application.
ObjectiveTo evaluate clinical outcomes of single utility port video-assisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage peripheral non-small cell lung cancer. MethodsWe retrospectively analyzed the clinical data of 46 consecutive patients with early-stage peripheral non-small cell lung cancer who underwent single utility port complete VATS lobectomy in the First Affiliated Hospital of Hebei north University from December 2012 through November 2014. There were 39 male patients and 7 female patients with their age of 42-76 (60.26±4.38) years (VATS group). There were 58 patients with early-stage peripheral non-small cell lung cancer who underwent lobectomy via traditional thoracotomy including 47 male and 11 female patients with their age of 44-73 (61.42±3.67) years for the same period (conventional thoracotomy group). Clinical outcomes were compared between the two groups. ResultsAll the operations were successful. There was no conversions during single utility port VATS lobectomy, and no periopera-tive death in both groups. The VATS group had significantly less blood loss (126.10±48.56 ml vs. 260.84±69.70 ml), and amount of thoracic drainage (230.52±50.22 ml vs. 380.16±96.24 ml, P<0.05). Hospital stay was significantly shorter in the VATS group than the conventional thoracotomy group (6.42±1.40 days vs. 9.64±2.08 days, P<0.05). However, there was no significant difference between the VATS group and the conventional thoracotomy group with regard to the opera-ting time (146.25±19.68 minutes vs. 139.26±25.39 minutes), number of lymph nodes procured (13.56±2.31 vs. 14.12±3.06), and postoperative complications (13.0% vs. 19.0%, P>0.05). ConclusionSingle utility port VATS lobectomy for patients with early-stage peripheral non-small cell lung cancer is technically feasible, with less blood loss and shorter hospital stays for achieving acceptable standards of lymph node dissection. It is a promising surgical procedures for patients with early-stage peripheral non-small cell lung cancer.
ObjectiveTo evaluate the feasibility and safety of single utility port video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy for lung diseases. MethodsWe performed a retrospective review of 155 patients undergoing single utility port VATS anatomic segmentectomy from January 2015 to December 2016. There were 62 males and 93 females with a mean age of 53 (24–82) years. Two ports were used. The camera was through the port for observation which was about 1.5 cm in length and located at the 7th or 6th intercostal space. The instruments were through port for operation that was about 3–4 cm in length and located at the 4th or 3th intercostal space. Pulmonary segment vessel and segmental bronchi were cut and stitched by Hemolock or linear cut stapler. Different segments were separated by linear cut stapler. Perioperative data were collected and analyzed. ResultsOne patient was performed suture under the auxiliary operating hole (three holes) because of pulmonary artery bleeding. The remaining 154 patients underwent single utility port VATS anatomic segmentectomy successfully. No conversion to open procedure or lobectomy was found and there was no perioperative mortality. The median operative time was 102 (65–150) min and the median blood loss in operation was 118 (50–300) ml. The thoracic drainage time was 3.8 (2–7) d and the median hospital stay after operation was 5.6 (3–9) d . Major morbidity occurred in 8 patients (5.2%) including hemoptysis (in 2 patients), pneumonia (in 2 patients), aerodermectasia (in 1 patient), pleural effussion (in 1 patient) and local atelectasis (in 1 patient). All of them above healed after symptomatic treatment. Patholocal examination showed there were 139 patients of primary lung carcinoma (pathologically staged as Tis-T1bN0M0), 9 patients of benign diseases and 7 patients of metastasis tumor. ConclusionSingle utility port VATS anatomic segmentectomy procedure is safe and feasible. It can be utilized as an option for those with non-small cell lung cancer staged Ⅰa and those unable to tolerate pulmonary lobectomy.