ObjectiveTo systematically review the efficacy and safety of single-port video-assisted thoracoscopic surgery (VATS) vs. multiple-port VATS in lobectomy for non-small cell lung cancer (NSCLC).MethodsThe PubMed, EMbase, the Cochrane Library, CBM, CNKI, Wanfang, VIP and Web of Science were searched to collect clinical studies about single- vs. multiple-port VATS for patients with NSCLC from inception to August 2018. The literatures were screened, data were extracted and the risk of bias of included studies was assessed independently by two reviewers. The meta-analysis with the collected data was performed by using RevMan 5.3 software.ResultsEleven studies (4 randomized controlled trials, 1 prospective cohort study and 6 retrospective cohort studies), including 1 574 patients. Among them, 779 patients were in the single-port group, and 795 in the multiple-port group. The results of meta-analysis showed that there was no significant difference between the two groups in the operation time (MD=3.60, 95%CI –8.59 to 15.79, P=0.56), the conversion rate (OR=1.06, 95%CI 0.54 to 2.06, P=0.87), the incidence of postoperative complications (OR=0.76, 95%CI 0.53 to 1.10, P=0.15), postoperative hospitalization time (MD=0.74, 95%CI –1.60 to 0.12, P=0.09), chest tube placement time (MD=0.63, 95%CI –1.28 to 0.02, P=0.06) or harvested lymph nodes (MD=–0.11, 95%CI –0.46 to 0.24, P=0.54). The intraoperative blood loss (MD=–17.12, 95%CI –31.16 to –3.08, P=0.02) was less in the single-port group than that in the multiple-port group. The visual analogue score (VAS) on postoperative first day (MD=–1.30, 95%CI –1.85 to –0.75, P<0.000 01) and on postoperative third day (MD=–0.82, 95%CI –1.00 to –0.65, P<0.000 01) were lower in the single-port group than those in the multiple-port group.ConclusionThe meta-analysis indicates that the efficacy of single-port VATS for NSCLC is equivalent to multiple-port VATS. However the intraoperative blood loss, the VAS scores on postoperative first and third days in the single-port group are better.
ObjectiveTo investigate the efficacy of total thoracoscopy (VATS) lobectomy and the thoracotomy for the treatment of benign lung disease. MethodsWe retrospectively analyzed the clinical data of 70 patients with benign lung diseases in the First People's Hospital of Qujing between January 2012 and September 2013. According to the surgical way, the patients were divided into two groups including a total VATS group involved in 35 patients with 25 males and 10 females, aged 18 to 71 years, mean age of 41.3±6.4 years and a thoracotomy group involved in 35 patients with 26 males and 9 females, aged 19 to 72 years, mean age of 42.4±5.6 years. Then we compared the efficacy of the two groups. ResultsThere was no statistical difference (P > 0.05) in operative time and postoperative survival rate comparison. While in the total VATS group, the total thoracoscopic incision length, bleeding volume or pain time, postoperative day time of analgesia, thoracic drainage volume, postoperative drainage tube pulling time and hospitalization time were all lower than those in the thoracotomy group with statistical differeces (P < 0.05). ConclusionThe thoracoscopic lobectomy for treatment of benign pulmonary lesions is superior to the conventional thoracotomy with much less bleeding and pain, more faster postoperative recovery and less impact on the patient's body. It's suitable for clinical application in normal hospital.
Objective To evaluate the validity of video-assisted thoracoscopic surgery (VATS) pneumonectomy in thoracic diseases treatment. Methods We retrospectively analyzed the clinical data of 34 consecutive patients who underwent VATS pneumonectomy in Xiangya Hospital Central South University between January 2013 and October 2015. There were 26 males and 8 females at age of 35–69 (53.8±7.7) years. Results VATS pneumonectomy was completed successfully in 32 patients (5.8% conversion rate). The average operation time was 182.5±52.4 min. The average blood loss was 217.1±1 834.8 ml. Chest tube drainage flow was 3–11 (6.0±1.7) days and postoperative hospital stay was 5–12 (7.6±1.8) days. Eleven patients got postoperative complications (34.3%), mainly pulmonary infections. The 32 patients were followed up for 10 (1–21) months. Two patients died of lung metastasis 16 or 17 months after the operation. One patient died of sudden cardiac arrest 3 months after operation. Bronchopleural fistula (BPF) happened in one patient after hospital discharge in 2 months. Conclusion VATS is feasible for pneumonectomy. However, further studies and follow-up are needed to verify the benefits of VATS pneumonectomy for lung cancer.
Objective To explore the minimal invasiveness and practability of combined video-assisted thoracic surgery (VATS) with two trocars and endoscopic ultrasonography (EUS) in the treatment of esophageal leiomyoma. Methods Between February 2007 and February 2012, we retrospectively analysed the clinical data of 166 patients who underwent various surgeries for the treatment of esophageal leiomyoma. Among them, 62 received routine thoracotomy (group A), 49 accepted conventional VATS surgery with three trocars (group B), and 55 underwent combined VATS surgery with two trocars and EUS (group C). Then, we summarized the clinical indexes of patients in all the three groups for further comparative analysis. Results There was no significant difference among the three groups in age, gender, and lesion location, origin level and size (P > 0.05). There were significant differences between group A and C in blood loss, surgery time, intraoperative localization, postoperative incision pain, hospitalization expenses, length of hospital stay, fasting time, pulmonary infection, and the complications during the follow-up (P < 0.05). There were significant differences between group C and B in blood loss, surgery time, intraoperative localization, fasting time and pulmonary infection (P < 0.05). Conclusion Combined VATS surgery with two trocars and EUS is safe, minimally invasive, thorough with few complications, which is worthy of clinical promotion.
ObjectiveTo investigate surgical indications and techniques of video-assisted thoracoscopic surgery (VATS) for mediastinal lymph node tuberculosis. MethodsClinical data of 27 patients who underwent VATS for mediastinal lymph node tuberculosis between January 2010 and March 2013 in Wuhan Medical Treatment Center were retrospectively analyzed. There were 16 male and 11 female patients with their age of 18-67 (30.23±10.72) years. ResultsThere was no in-hospital death. Postoperative complications included recurrent laryngeal nerve injury in 1 patient, delayed wound healing in 1 patient and pneumothorax in 1 patient. Postoperatively, all the patients received intensified anti-tubercular treatment, and were engaged in normal physical activities during follow-up of 6 months. ConclusionVATS is safe and reliable for the treatment of mediastinal lymph node tuberculosis, and anti-tubercular treatment is needed before and after the operation.
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.
ObjectiveTo determine if comfort level was associated with chest tube size(16F or 28F) among lung cancer patients with video-assisted thoracoscopic surgery (VATS) lobectomy. MethodsWe performed VATS lobectomy for 163 patients with lung cancer in our hospital between February and May 2014. There were 70 males 93 females. The patients were allocated into two groups including a 28F group and a 16F group. There were 75 patients at age of 53.18±14.73 years with insertion of one chest drain of 28F in the 28F group. And there were 88 patients at age of 56.62±12.62 years with insertion of one chest drain of 16F in the 16F group. Heart rate and variation of pulse, breathing rate and variation of breathing rate, pain scores, comfort level, and activities daily living (ADL) of the two groups were compared. ResultsThere was no significant difference in the patient characteristics and operation data between the two groups. There were statistical differences in variation of heart rates on the 1st day, 2nd day, and 3rd day after operation between the 16Fgroup and the 28F group (9.67±3.33 times/min vs.18.54±5.33 times/min, P=0.037; 7.89±2.88 times/min vs. 19.01±4.67 times/min, P=0.045; 7.67±3.01 times/min vs. 20.88±5.34 times/min, P=0.021). The percentage patients of mild pain in the 16F group (77.65%) was higher than that in the 28F group (49.78%, P=0.023) with a statistical difference. The independent ambulation and comfort level in the 16F group(67.05%, 67.05%) were significant higher than those in the 28F group (45.78%,55.11%, P=0.023, P=0.026). ConclusionOur findings suggest that drainage via a small-bore chest tube provides meaningful postoperative comfort level in the patients with VATS lobectomy.
[Abstract]Acute cardiac tamponade after thoracoscopic lobectomy is extremely rare and highly lethal once it occurs. This paper reports a case of a 64-year-old male with preoperative hypertension and coronary heart disease who underwent video-assisted thoracoscopic right upper lung wedge resection for early-stage lung adenocarcinoma. Three hours postoperatively, he suddenly developed hypotension and loss of consciousness. Ultrasound indicated a large amount of pericardial effusion, suggesting cardiac tamponade. Despite emergency pericardiocentesis, his hemodynamics did not improve, and the patient went into cardiac arrest. Subsequent veno-arterial extracorporeal membrane oxygenation was performed to support systemic circulation, and emergency thoracotomy was carried out. During the surgery, a needle-like tear in the anterior wall of the ascending aorta was found, corresponding exactly to a prominent staple at the lung resection margin, suggesting a stapler malfunction. After vascular repair, the patient recovered smoothly and was discharged. This case suggests that during lung resection, great attention should be paid to the integrity of staples and anatomical variations of large vessels, and vigilance is needed for rare but potentially fatal stapler-related complications.
Treatment of Non-small Cell Lung Cancer by Single-direction Four-hole Complete Video-assisted Thoracoscopic Lobectomy HUANG Jia, ZHAO Xiao-jing, LIN Hao, TAN Qiang, DING Zheng-ping, LUO Qing-quan. (Shanghai Lung Tumor Clinical Medical Center, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, P. R. China) Corresponding author：LUO Qing-quan, Email：luoqingquan@hotmail. com Abstract： Objective To explore the feasibility and safety of single-direction four-hole video-assisted thoracoscopic lobectomy in the treatment of non-small cell lung cancer (NSCLC). Methods Between January 2007 and December 2010, 428 patients with NSCLC were surgically treated by single-direction complete video-assisted thoracoscopic lobectomy in Shanghai Chest Hospital. There were 186 males and 242 females; aged 33 to 78 years. All the patients were diagnosed as primary NSCLC at early clinical stage. Among the 428 patients, 134 patients underwent right upper lobectomy, 48 patients underwent right middle lobectomy, 98 patients underwent right lower lobectomy, 4 patients underwent right middle and lower lobectomy, 72 patients underwent left upper lobectomy, and 72 patients underwent left lower lobectomy. All the 428 patients were divided into two groups according to their surgical approach：a three-hole group (300 patients) and a four-hole group (128 patients).The clinical results of the two groups were analyzed. Results A total of 412 patients underwent complete video-assisted thoracoscopic lobectomy, and 16 patients (3.7%) underwent conversion to open surgery. The average operation time was 132.1 (120-180) min, average length of incision was 3.7 (3-5) cm, and average blood loss was 150.0 (50-800) ml. There was no statistical difference in extubation time, intraoperative blood loss, and postoperative hospital stay between the two groups. But the operation time of the four-hole group is significantly shorter than that of the three-hole group （P＜0.05）. The 16 patients who underwent conversion to open surgery received intraoperative blood transfusion. Five patients died of severe pulmonary infection, pulmonary embolism, and acute cerebral infarction. Fifty two patients had squamous cancer, 340 patients had adenocarcinoma, 20 patients had adenosquamous carcinoma, 8 patients had poorly differentiated carcinoma, 6 patients had big cell lung cancer, and 2 patients had carcinoid. Postoperative persistent lung air leak occurred in 4 patients, thoracic empyema in 2 patients, pulmonary infection in 4 patients, arrhythmia in 26 patients, pulmonary embolism in 2 patients, chylothorax in 2 patients, and acute cerebral infarction in 2 patients. The overall 3-year survival rate was 83.6%（358/428）. Conclusion Single-direction four-hole complete video-assisted thoracoscopic lobectomy is feasible, safe and consistent with the operation standard in the surgical treatment for NSCLC patient. It is also helpful to reduce the operation time and facilitate lymph node dissection. Key words： Video-assisted thoracoscopic surgery； Lobectomy； Single-direction； Four-hole； Non-small cell lung cancer
Surgery has played an important role in treating non-small cell lung cancer (NSCLC). Resection is usually the first choice for NSCLC patients in stage Ⅰ and stage Ⅱ, and it is also an important part of the comprehensive treatment for the stage ⅢA patients. Standard surgery of NSCLC includes resection of the primary tumor lesion and swee-ping of ipsilateral lymph nodes and mediastinal lymph nodes. The goal of treatment for lung cancer in early stage aims to decrease the rate of recurrence and mortality. In recent years, video-assisted thoracoscopic surgery and da Vinci robotic minimal invasive surgery have made gratifying achievements, especially for small peripheral lung nodules surgery. For patients with NSCLC at stage ⅢA, the central focus of research is about identifying patients who will benefit in the surgery combining with chemotherapy and radiotherapy, therefore to choose the appropriate surgery.