Abstract: Objective To summarize the clinical experiences of applying completely videoassisted thoracoscopic lobectomy in pulmonary diseases treatment, and evaluate its safety, indication and efficacy. Methods We retrospectively analyzed the clinical data of 47 patients with pulmonary diseases undergoing completely videoassisted thoracoscopic lobectomy at the First People’s Hospital of Yunnan Province between October 2008 and November 2010. Among the patients, there were 35 males and 12 females with their age ranged from 30 to 72 years averaging at 61.5 years. Adenocarcinoma was present in 27 patients, squamous carcinoma in 9 patients, small cell carcinoma in 1 patient, tuberculosis in 3 patients, bronchiectasis in 3 patients, pulmonary inflammatory pseudotumor in 2 patients, hamartoma in 1 patient, and giant bulla in 1 patient. All patients underwent completely videoassisted thoracoscopic lobectomy which was carried out through three miniinvasive incisions without the use of rib spreader. Systemic lymph node dissection was performed for patients with malignancies. Blood loss, operation time, the rate of conversion to thoracotomy, postoperative hospital stay, and complications were observed. Results Completely videoassisted thoracoscopic lobectomy was successfully performed in 44 patients, and the other 3 patients were changed to open thoracotomy due to bleeding in one patient, T3 tumor in one patient and accidentally injured bronchus in one patient. The overall conversion rate was 6.4% (3/47). The mean operation time, blood loss and postoperative hospital stay were respectively 120±45 minutes, 150±80 ml, and 7±2 days. No perioperative death occurred. There were 9 patients of complications including lymphatic fistula, air leak, atrial fibrillation and atelectasis, and they all recovered after conservative treatment. Fortyfour- patients were followed up for -1 to 23 months with 3 patients missing. One-patient had bloody sputum during the followup, but recovered spontaneously later. Brain metastasis occurred to a stage Ⅲa patient with primary lung cancer 9 months after operation, and the patient survived after treatment with gamma knife. No recurrence happened to the other patients and their quality of life was good. Conclusion Completely videoassisted thoracoscopic lobectomy is a safe and feasible surgical procedure for patients with earlystage lung cancer and benign pulmonary lesions which need lobectomy. However, it is necessary to select the patients carefully in the early period of practising.
Objective To investigate the feasibility, curative effect and perioperative treatments of lobectomy for pulmonary diseases by complete videoassisted thoracoscopic surgery (VATS). Methods Fiftysix patients of pulmonary diseases were treated with thoracoscopic lobectomy (including mediastinal and hilar lymph node dissection for malignant diseases) from March 2006 to November 2007 in our Department. Twelve right upper lobectomy, three right middle lobectomy, fifteen right lower lobectomy, nine left upper lobectomy, fourteen left lower lobectomy and three bilobectomy were carried out. The bilobectomy included one right upper and middle lobectomy, two right middle and lower lobectomy. Mediastinal and hilar lymph node dissection was simultaneously performed in the malignant cases. The feasibility, safety and postoperative complications were retrospectively analyzed. Results Fiftytwo patients (92.8%) were performed successfully by complete VATS. The median operative duration and blood loss were respectively 107±29min(from 45min to 168min) and 121±32 ml(from 50ml to 310ml). The incision in two cases (3.6%) were elongated to around 8 cm, the ribs were retracted, and the operations were completed by the help of VATS. Another two patients (3.6%) were changed to conventional thoracotomy for pneumonectomy or hemostasis. The postoperative pathology diagnosis was lung cancer in thirty nine, tuberculoma in seven, inflammatory pseudotumor in four, indurative angioma in four, bronchiectasis in one and metastasic chondrosarcoma in one. There was no surgical mortality. One case suffered from atelectasis in the middle lobe postoperatively and was cured by phlegm suction with bronchoscopy. Two air leakage healed automatically in three days. No other severe complications was observed. The average postoperative hospitalization was 8.9±3.1 d(from 8 d to 14 d). Conclusion Lobectomy for pulmonary diseases by complete VATS is technically fieasible, safe, minimally invasive with less complications and fast rehabilitation.