ObjectiveTo share the clinical experience of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament.MethodsAll the patients were in the healthy lateral position, with endoscopy holes in the 8th intercostal space of the middle axillary line and 2-3 cm operation holes in the 5th intercostal space of the front axillary line. Anatomical segmentectomy of the posterolateral basal vein, bronchus and artery was performed through the inferior pulmonary ligament upward in turn. The clinical data of this group were analyzed retrospectively.ResultsFrom December 2015 to October 2018, 32 patients underwent thoracoscopic unidirectional posterolateral basal segmentectomy, including 8 males and 24 females, aged 13-71 (52.6±13.7) years. All patients successfully completed the operation, including 9 patients of left lower pulmonary posterolateral basal segmentectomy, 23 patients of right lower pulmonary posterolateral basal segmentectomy. The operation time was 80-295 (133.4 ±40.5) minutes, intraoperative bleeding volume was 20-300 (52.6±33.8) mL, drainage time was 2-14 (4.2±2.3) days, hospitalization time was 4-15 (6.9 ±2.4) days. No death occurred during hospitalization. Postoperative complications included atelectasis in 1 patient and persistent pulmonary leakage over 3 days (4 or 6 days respectively) in 2 patients , chylothorax in 1 patient. All of them recovered smoothly after non-operative treatments. Postoperative pathology showed that 29 patients of primary adenocarcinoma or atypical adenomatoid hyperplasia, including 5 patients of adenocarcinoma in situ, 9 patients of micro-invasive adenocarcinoma, 12 patients of invasive adenocarcinoma, 3 patients of atypical adenomatoid hyperplasia. One patient was of intestinal metastatic adenocarcinoma, 1 patient of inflammatory lesion and 1 patient of bronchiectasis. 3-21(9.6±4.6) lymph nodes were resected in the patients with primary pulmonary malignant tumors. And no metastasis was found.ConclusionThe operation of thoracoscopic unidirectional posterolateral basal segmentectomy via inferior pulmonary ligament is easy. There is no need to open intersegmental tissue. It can protect lung tissue better. The operative method is worthy of clinical promotion.
Objective To investigate the surgical procedure selection, operation technique and safety of anatomic sublobar resection for pulmonary nodules. Methods The clinical data of 242 patients with clinical stage ⅠA lung cancer who underwent anatomic sublobar resection in our hospital between 2017 and 2020 were retrospectively analyzed. There were 81 males and 161 females with a median age of 57.0 (50.0, 65.0) years. They were divided into 4 groups according to the surgical methods, including a segmentectomy group (n=148), a combined segmentectomy group (n=31), an enlarged segmentectomy group (n=43) and an anatomic wedge resection group (n=20). The preoperative CT data, operation related indexes and early postoperative outcomes of each group were summarized. Results The median medical history of the patients was 4.0 months. The median maximum diameter of nodule on CT image was 1.1 cm, and the consolidation/tumor ratio (CTR) was ≤0.25 in 81.0% of the patients. A total of 240 patients were primary lung adenocarcinoma. The median operation time was 130.0 min, the median blood loss was 50.0 mL, the median chest drainage time was 3.0 d, and the hospitalization cost was (53.0±12.0) thousand yuan. The operation time of combined segmentectomy was longer than that of the segmentectomy group (P=0.001). The operation time (P=0.000), intraoperative blood loss (P=0.000), lymph nodes dissected (P=0.007) and cost of hospitalization (P=0.000) in the anatomic wedge resection group were shorter or less than those in the other three groups. There was no significant difference in the drainage time, total drainage volume, air leakage or postoperative hospital stay among the four groups (P>0.05). Conclusion The combined application of segmentectomy and wedge resection technique provides a more flexible surgical option for the surgical treatment of early lung cancer with ground glass opacity as the main component.
ObjectiveTo explore the safety and feasibility of the application of video-assisted thoracic surgery (VATS) anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis.MethodsFrom June 2014 to June 2018, 19 patients with bilateral localized bronchiectasis underwent single-stage bilateral thoracic surgery with VATS anatomic segmentectomy, including 11 males and 8 females aged 38.0±12.5 years. The clinical efficacy of the surgery was evaluated.ResultsAll surgeries were successfully completed, of which 17 were bilateral VATS, 2 were unilateral VATS with the other lateral converted to thoracotomy. The average number of bilateral resected segments was 4-8 (5.9±1.2). Mean operation time was 330.0±40.0 min and mean blood loss was 150.0±60.0 mL. Mean ventilator-assisted breathing time was 6.0±1.8 h, mean duration of chest-tube placement was 4.0±1.0 d and mean hospital stay time was 14.0±1.5 d. Three patients suffered pulmonary infection and 1 patient received tracheotomy. No perioperative death occurred. Arterial oxygen pressures on postoperative day (POD) 1 (F=340.18, P<0.05) and POD 3 (F=131.26, P<0.05) were significantly lower than that before operation, arterial carbon dioxide pressures on POD 1 (F=46.62, P<0.05) and POD 3 (F=48.21, P<0.05) were significantly higher than that before operation, and pulse oximeter saturation on POD 1 was significantly lower than that before operation (F=210.82, P<0.05). The patients were followed up for one to five years without recurrence.ConclusionApplication of VATS anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis is safe and feasible with strictly selected patients. Postoperative airway management is very important. The surgery is worthy of wide clinical practice.
ObjectiveTo explore the clinical application value of simple artery occlusion (SAO) in revealing intersegmental planes during thoracoscopic pulmonary segmentectomy. MethodsA retrospective analysis was conducted on the clinical data of patients who underwent thoracoscopic pulmonary segmentectomy at the First Affiliated Hospital of Xiamen University from February 2022 to December 2023. Patients were divided into a conventional group and a SAO group based on the method used to reveal the intersegmental plane during surgery. The two groups were compared in terms of intraoperative blood loss, operation time, postoperative drainage volume, time to intubation, postoperative pulmonary air leakage, and conversion to open thoracotomy rate. ResultsA total of 318 patients were included. There were 181 patients in the conventional group, including 86 males and 95 females, with an average age (53.35±9.20) years, and there were 137 patients in the SAO group, including 58 males and 79 females, with an average age (55.26±11.46) years. There were no statistical differences in general patient information between the two groups (P>0.05). The SAO group had less intraoperative blood loss [MD=17.568 (9.968, 25.168), P<0.001] and postoperative drainage volume [MD=275.587 (188.999, 362.175), P<0.001], shorter time to intubation [MD=1.000 (1.000, 2.000), P<0.001] and operation time [MD=20.709 (16.258, 25.159), P<0.001]. The incidence of postoperative pulmonary air leakage complications in the SAO group was lower than that in the conventional group [RR=0.361 (0.181, 0.722), P=0.003]. ConclusionSAO can reduce surgical difficulty, shorten operation time, decrease the incidence of postoperative pulmonary air leakage, and enhance the safety of anatomical pulmonary segmentectomy, making it worthy of clinical promotion and application.
Thoracoscopic pulmonary segmentectomy is one of the important treatment methods for early lung cancer. Only the premise of surgical precision can make the radical resection of lesions and maximum reservation of healthy lung tissue be simultaneously guaranteed. As a representative of the precise lung operation, the " cone-shaped lung segmentectomy” focuses on the lesion, and combines the anatomical characteristic of the patient to design individualized operation scheme. The technological core consists of three parts, three dimensional-computed tomography bronchography and angiography (3D-CTBA) surgery path planning, accurate definition of intersegmental demarcation and anatomic dissection of intersegmental borders along the demarcation. This paper aims to explore the technical process and quality control of the key techniques of thoracoscopic precise segmentectomy, so as to standardize the segmentectomy procedure under the principle of radical and minimally invasive therapy.
ObjectiveTo explore the clinical issues associated with video-assisted pulmonary segmentectomy and to provide reference for better implementation of thoracoscopic pulmonary segmentectomy and reduction of perioperative complications through analyzing the clinical results of thoracoscopic segmentectomy.MethodsThe clinical data of 90 patients who planned to undergo thoracoscopic segmentectomy in our department from October 2017 to December 2019 were retrospectively analyzed, including 35 males with an average age of 60.34±9.40 years and 55 females with an average age of 56.09±12.11 years. The data including lung nodule number, benign or malignant, preoperative location by Hookwire, preoperative planning and actual implementation, operation time, intraoperative blood loss, postoperative drainage volume and time of drainage tube removal, postoperative hospital stay and complications were collected and analyzed.ResultsAmong the 90 patients, 38 were preoperatively positioned by Hook-wire, 52 were directly operated on; 87 were completed under thoracoscopic surgery among whom 3 underwent passive lobectomy after segmentectomy under thoracoscopic surgery, and 3 were converted to thoracotomy among whom 1 underwent lobectomy. Operation time was 198.58±56.42 min, intraoperative blood loss was 129.78±67.51 mL, lymph node samples were 6.43±1.41, drainage time was 2.98±1.25 d, the amount of postoperation drainage was 480.00±262.00 mL, hospital stay was 7.60±2.38 d. In all patients, 73 had single nodules and 17 had multiple nodules. Totally 113 pulmonary nodules were resected, 14 (12.39%) were benign nodules and 99 (87.61%) were malignant nodules. There was no perioperative death or serious complications.ConclusionFor those pulmonary parenchymal nodules which meet the indications, it is feasible to perform thoracoscopic anatomic pulmonary segmentectomy according to preoperative thin-slice CT and three-dimensional computed tomography-bronchography and angiography (3D-CTBA) reconstruction results. Preoperative Hookwire localization can ensure effective edge resection and reduce unplanned lobotomy for intersegmental nodules and non-palpable peripheral pure ground-glass nodules.
ObjectiveTo evaluate the curative and economic effect of da Vinci robotic lung segmentectomy. MethodWe retrospectively analyzed clinical data of 13 patients who underwent robotic lung segmentectomy (as a robotic group) and 35 patients who underwent thoracoscopic lung segmentectomy (as a thoracoscopic group) in our hospital between September 2014 and April 2015. There were 4 males and 9 females at age of 43-73 (59.1±8.9) years in the robot group and 17 males and 18 females in the thoracoscopic group at age of 30-79 (59.1+12.0) years. Effects of the two groups were compared. ResultsPostoperative hospitalization time in the robotic group was shorter than that in the thoracoscopic group (4.4±0.8 d vs. 6.3±2.5 d, P<0.05). But the cost of hospitalization in the robotic group was higher than that in the thoracoscopic group (P<0.05). The surgery indwelling catheter time and incidence of complications in the robotic group were lower than those in the thoracoscopic group with no statistical difference (P=0.053, 0.081). ConclusionRobotic lung segmentectomy is a safe and feasible operation method. With the further accumulation of clinical experience and decrease of the cost of materials, the robot will play a more important role in the future of minimally invasive thoracic surgery.
ObjectiveTo compare and analyze the therapeutic effects of robot-assisted lobectomy and segmentectomy for stage ⅠA non-small cell lung cancer with a diameter≤2 cm. MethodsA total of 181 patients with pathologically confirmed stage ⅠA non-small cell lung cancer (diameter≤2 cm) who underwent robot-assisted lobectomy and segmentectomy in our hospital from 2018 to 2021 were included. There were 74 males and 107 females with an average age of 57.50±10.60 years. They were divided into two groups according to the surgical procedure: a segmentectomy group (85 patients) and a lobectomy group (96 patients). ResultsThere was no statistically significant difference between the two groups in terms of clinical data such as age, gender, smoking history, basic disease, pathological type, tumour diameter, operative time, postoperative 24 h drainage volume and overall complications (P>0.05). The intraoperative blood loss (33.88±16.26 mL vs. 39.27±19.48 mL, P=0.046), groups of dissected lymph nodes (4.76±1.19 vs. 5.52±1.46, P=0.000), number of dissected lymph nodes (14.81±7.23 vs. 18.06±7.70, P=0.004) and postoperative 72 h drainage volume (561.65±225.31 mL vs. 649.84±324.34 mL, P=0.037) of patients in the segmentectomy were less than those in the lobectomy group. The chest drainage time (5.49±3.92 d vs. 7.60±4.96 d, P=0.002) and postoperative hospital stay time (7.47±4.16 d vs. 9.67±5.50 d, P=0.003) were shorter than those in the lobectomy group. There was no conversion to thoracotomy or perioperative death in the two groups. The postoperative follow-up rate was 100.0% with a longest follow-up time of 48 months. The 3-year recurrence-free survival rates of the segmentectomy group and lobectomy group were 87.7% and 92.4%, respectively (P=0.465). ConclusionThe da Vinci robot-assisted lobectomy and segmentectomy are safe and feasible surgical procedures for patients with stage ⅠA non-small cell lung cancer (diameter≤2 cm), with a similar 3-year recurrence-free survival rate. The lobectomy group has more lymph nodes dissected, while the segmentectomy group is superior to the lobectomy group in terms of intraoperative blood loss, postoperative 72 h chest drainage volume, chest drainage time and postoperative hospitalization time.
Objective To examine the application effectiveness of dual 8F ultrafine pigtail drainage tubes versus a single 28F large-bore chest tube in single-port thoracoscopic lobectomy/segmentectomy. Methods Clinical data of patients who underwent single-port video-assisted thoracoscopic lobectomy/segmentectomy within our medical group from January 2020 to August 2023 were retrospectively analyzed. They were categorized into two groups based on postoperative drainage methods: a dual 8F ultrafine pigtail tubes group and a single 28F large-bore chest tube group. Comparative analysis was performed on perioperative data for the two groups of patients. Results The dual 8F ultrafine pigtail tubes group comprised of 68 patients, with 41 females and 27 males, and an average age of (54.72±13.34) years, while the single 28F large-bore chest tube group comprised of 80 patients, with 40 females and 40 males, and an average age of (57.60±11.04) years. There were statistical differences between the two groups in terms of postoperative drainage volume on day 1, day 2, and day 3, total postoperative drainage volume, postoperative tube placement time, postoperative pain score at 48 hours, maximum postoperative pain score, postoperative hospital stay, postoperative complications related to drainage tubes, and emergency use of pain-relieving medication after surgery (P＜0.05). Conclusion After single-port thoracoscopic lobectomy/segmentectomy, the application of dual ultrafine 8F pigtail drainage tubes can lead to a reduction in postoperative drainage volume and shorten the duration of postoperative drainage tube placement and hospital stay, thereby decreasing postoperative pain and the frequency of emergency pain-relieving medication. Moreover, it lowers the incidence of drainage tube-related complications. In alignment with current enhanced recovery after surgery principles, this approach is advantageous for postoperative recovery.