Objective To analyze the feasibility of totally no tube (TNT) in da Vinci robotic mediastinal mass surgery and its significance for fast track surgery. Methods A total of 79 patients receiving robotic mediastinal TNT surgery in the General Hospital of Shenyang Military Command from January 2016 to December 2017 were enrolled as a TNT group; 35 patients receiving robotic mediastinal surgery in General Hospital of Shenyang Military Command from January 2014 to December 2017 and 54 patients receiving thoracoscopic mediastinal surgery during the same period were enrolled as a non-TNT group and a video-assisted thoracoscopic surgery (VATS) group. The muscle relaxation and tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, postoperative ICU stay, postoperative hospital stay, postoperative visual analogue scale (VAS), hospitalization costs and postoperative complications and other related indicators were retrospectively analyzed among the three groups. Results Surgeries were successfully completed in 168 patients with no transfer to thoracotomy, serious complications (postoperative complications in 9 patients) or death during the perioperative period. All patients were discharged. Compared with the non-TNT group, the TNT group had significantly less muscle relaxation-tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, VAS pain score, ICU stay, postoperative hospital stay (P<0.01); there was no significant difference in the total cost of hospitalization between the two groups (P>0.05). Between the non-TNT group and the VATS group, there was no significant difference in time of muscle relaxation and tracheal intubation, operation time and ICU stay (P>0.05). The non-TNT group was superior to the VATS group in terms of intraoperative blood loss, VAS pain scores on the following day after operation, chest drainage volume 1-3 days postoperatively, postoperative catheterization time and postoperative hospital stay (P<0.05); but the cost of hospitalization in the non-TNT group was significantly higher (P=0.000). Conclusion The da Vinci robot is safe and feasible for the treatment of mediastinal masses. At the same time, TNT is also safe and reliable on the basis of robotic surgery which has many advantages such as better comfort, less pain, ICU stay and hospital stay as well as faster recovery.
ObjectiveTo summarize experiences of diagnosis and treatment of intraperitoneal mass after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in treatment of hepatocellular carcinoma (HCC).MethodThe clinicopathologic data of a 40 years old case of HCC with intraperitoneal mass after ALPPS in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed.ResultsThe patient was admitted to this hospital because of abdominal pain and abdominal distension for 5 d. The intraperitoneal mass was found and its nature was not clear on year 1 after ALPPS on admission. After discussion of multidisciplinary team (MDT), the exploratory laparotomy and abdominal tumor resection were planned to perform. The intraperitoneal mass and appendix were removed, the resected tissues were diagnosed as chronic inflammation and retroperitoneal abscess caused by perforation of suppurative appendicitis, respectively. The anti-infection and symptomatic support treatment were strengthened to perform after operation, the patient discharged after recovery. The patient was followed up so far, the general condition was good, and there was no clinical recurrence.ConclusionsFor patient underwent ALPPS, regular follow-up should be paid attention to. If intraperitoneal mass is found and nature is not clear, MDT discussion should be performed so as to make a more reasonable treatment plan. After exclusion of contraindications, surgical treatment should be carried out to furthest benefit patients.
ObjectiveTo discuss the safety, feasibility and short-term clinical efficacy of thoracoscopic anterior mediastinal mass resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach.MethodsA total of 44 patients suffering anterior mediastinal tumor enrolled, including 21 patients (10 males and 11 females as a trial group) with an average age of 43.6±11.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach and 23 patients (13 males and 10 females as a control group) with an average age of 45.3±10.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lateral position via transthoracic approach. The clinical efficacy of the two groups was compared.ResultsPostoperative chest drainage time (3.8±1.3 d vs. 5.0±1.8 d, P=0.017), postoperative drainage volume (238.8±66.2 mL vs. 467.2±120.0 mL, P=0.000), postoperative mean visual analogue score at 24 h (2.5±0.9 point vs. 4.9±1.0 point, P=0.000), times of self-pressure analgesic pump (3.7±0.9 vs. 8.4±2.0, P=0.000), duration of postoperative hospital stay (4.7±1.3 d vs. 7.4±3.1 d, P=0.000) and hospitalization cost (34±8 kyaun vs. 44±11 kyuan P=0.001) in the trial group were all better than those in the control group. There was no significant difference between the two groups in surgical duration (59.0±18.1 min vs. 60.4±16.4 min) (P>0.05). During follow-up, no recurrence or metastasis occurred in either group.ConclusionCompared with the lateral position through the transthoracic approach, the lithotomy position through subxiphoid approach of thoracoscopic anterior mediastinal mass resection is safe and feasible, and has certain advantages.
Objective To assess the clinical value of a novel surgical technique—Tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device in the resection of anterior mediastinal masses. Methods Patients who underwent tubeless subxiphoid uniportal video-assisted thoracoscopic surgery via balance-shaped sternal elevation device in anterior mediastinal masses process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from March to April 2025 were included, and their clinical data were analyzed. Results A total of 4 patients were included, with 2 males and 2 females, aged 58-75 years. The diameter of the tumor was 2.5-3.0 cm. The operation time was 60.0-150.0 min, intraoperative blood loss was 5-10 mL, pain score on the 3rd day after surgery was 0 points, and postoperative hospital stay was 2-3 days. All patients achieved complete resection of the masses and thymus without perioperative complications. ConclusionThe tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device technique optimizes surgical visualization and instrument maneuverability while avoiding complications related to conventional anesthesia and tubing, thereby markedly enhancing the minimally invasive profile of anterior mediastinal masses resections. In addition to maintaining procedural safety, this approach effectively reduces postoperative pain and accelerates patient recovery, highlighting its potential for widespread clinical adoption.
ObjectiveTo explore the technique of arthroscopic resection of benign tumor in the knee posterior septum and to evaluate its clinical results. MethodsBetween June 2008 and June 2012, 12 cases of benign tumor in the knee posterior septum were treated by arthroscopic surgery. There were 8 males and 4 females with an average age of 36.5 years (range, 22-50 years). The average disease duration was 8.4 months (range, 3 months to 2 years). Of 12 cases, there were 2 cases of chronic synovitis, 5 cases of ganglion, 4 cases of tenosynovial giant cell tumor, and 1 case of synovial hemangioma; solitary tumor involved in the knee posterior septum in 10 cases, and in the posterior septum and other part of the knee in 2 cases. All the patients underwent tumor removal under arthroscope with routine anterolateral and anteromedial portal, additional posteromedial portal and/or posterolateral portal. Trans-septal approach was used in 6 cases because the tumors located in the middle of the posterior septum. ResultsAll wounds healed by first intention with no complications such as infection, haematoma in the knee, injury of vessels and nerves, deep vein thrombosis, osteofascial compartment syndrome, or cutaneous necrosis. All patients were followed up 12-46 months with an average of 18.5 months. All patients achieved relief of knee pain and improvement of knee movement. The range of motion of the knee was significantly improved from (57.08±12.52)° at pre-operation to (120.83±13.95)° at last follow-up (t=-12.84, P=0.00). The visual analogue scale (VAS) score was significantly reduced from 5.00±1.04 at pre-operation to 1.50±0.91 at last follow-up (t=-18.00, P=0.00). The Lysholm score was significantly improved from 49.50±9.07 at pre-operation to 84.58±6.82 at last follow-up (t=-8.04, P=0.00). ConclusionThe benign tumor in the knee posterior septum can be completely resected under arthroscope, and the procedure is minimally invasive and useful to the restore knee function.
【摘要】 目的 探讨高频彩色多普勒超声对浅表软组织肿物的诊断价值。 方法 回顾性分析2008年1-11月70例经手术、活检病理证实的浅表软组织肿物的声像图特征，包括肿物的部位、形态大小、内部回声、边界及其与周边组织的关系、长径与厚度比值（L/T）及病变周边与内部血流分布情况。 结果 超声对浅表肿块病灶的显示率为100%，良性肿瘤有脂肪瘤、表皮囊肿、滑膜囊肿、神经鞘瘤，血管瘤、异物肉芽肿等，恶性肿物包括皮肤纤维肉瘤，转移性腺癌。 结论 彩色多普勒超声对浅表肿块的检出、定位及物理性质可做出准确的诊断，综合分析肿物的边界、形态、内部回声及血流分布等特点对肿物的良恶性诊断具有重要价值。【Abstract】 Objective To evaluate the value of high-frequency color Doppler ultrasonography in diagnosing the superficial soft tissue masses. Methods The clinical data of 70 patients with superficial soft tissue masses from January to November 2008 were retrospectively analyzed. Superficial soft tissue masses was diagnosed by the surgery and biopsy. The sonographic features, including the location, morphology, size, internal echo, boundary, relationship with peripheral tissues, longitude to transverse ratio (L/T), and the vascularity, were observed. Results The results of sonographic examination showed that 100% superficial masses could be found. Benign masses included lipoma, sebaceous cysts, synovial cysts, nerve sheath tumors, haemangioma, foreign body granulomas, etc. Malignant soft tissue tumors included fibrous sarcoma and metastatic neoplasms. Conclusion Color Doppler ultrasonography can precisely diagnose the presence, localization and the physical characters of superficial soft tissue masses. It is an excellent modality to diagnose the benign or malignant masses by analyzing the boundary, configuration, internal echo and vascularity of the masses.
Objective To evaluate the safety and feasibility of remote robot-assisted thoracoscopic surgery utilizing 5G technology. Methods Clinical data from five patients who underwent 5G remote robot-assisted thoracoscopic surgery at the Thoracic Surgery Center of Gansu Provincial People's Hospital from May to October 2024 were retrospectively analyzed. Results Finally, five patients were included. There were 2 males and 3 females at median age of 50 (42-63) years. All five surgeries (including 1 patient of lobectomy, 3 patients of partial lung resection and 1 patient of mediastinal lesion resection) were successfully completed without conversion to thoracotomy, complications, or mortality. The median intraoperative signal delay across the patients was 39 (37-42) ms. The median psychological load score for the surgeons was 9 (3-13). The median operation time was 100 (80-122) minutes with a median intraoperative blood loss of 100 (30-200) mL. Catheter drainage lasted a median of 4 (3-5) days, and the median drainage volumes on the first, second, and third postoperative day were 200 (100-300) mL, 150 (60-220) mL, and 80 (30-180) mL, respectively. The median postoperative hospital stay was 4 (3-7) days, and the median pain scores on the third postoperative day were 3 (1-4), 3 (0-3), and 1 (0-3), respectively. Conclusion 5G remote robot-assisted thoracoscopic surgery is safe and effective, with good surgical experience, smooth operation and small intraoperative delay.
ObjectiveTo investigate effect of recurrent laryngeal nerve monitoring in video-assisted thyroidectomy for huge thyroid nodules. MethodsThe clinical data of 158 patients with huge thyroid nodules underwent videoassisted thyroidectomy from January 2013 to June 2015 were analyzed retrospectively, the recurrent laryngeal nerves were monitored in 79 cases (monitoring of recurrent laryngeal nerve group) while the recurrent laryngeal nerves were not monitored in the other patients (non-monitoring of recurrent laryngeal nerve group). The operative time, blood loss, postoperative drainage, postoperative hospital stay, and the incidences of transient and permanent recurrent laryngeal nerve injury were observed between these two groups. ResultsThe video-assisted miniincision thyroidectomy was successfully completed in these 158 cases. Compared with the non-monitoring of recurrent laryngeal nerve group, the operative time (min) was shorter (76.2±23.4 versus 89.2±29.8, P < 0.05), the blood loss and the postoperative drainage were less (16.3±13.6 versus 20.6±10.7, P < 0.05; 20.7±9.6 versus 25.5±9.1, P < 0.05) in the monitoring of recurrent laryngeal nerve group. But the postoperative hospital stay (d) had no significant difference between the monitoring of recurrent laryngeal nerve group and the non-monitoring of recurrent laryngeal nerve group (3.2±1.3 versus 3.3±1.9, P > 0.05). Eight weeks later, the incidence of transient recurrent laryngeal nerve injury in the monitoring of recurrent laryngeal nerve group was significantly lower than that in the non-monitoring of recurrent laryngeal nerve group [5.6% (5/90) versus 21.8% (17/78), P < 0.05], while the incidence of permanent nerve injury had no statistical difference between the monitoring of recurrent laryngeal nerve group and the non-monitoring of recurrent laryngeal nerve group [0(0/90) versus 1.3% (1/78), P > 0.05]. ConclusionRecurrent laryngeal nerve monitoring under video-assisted thyroidectomy for huge thyroid nodules could effectively reduce incidence of nerve injury and shorten operation time.