Objective To monitor surgical quality and analyze learning curve of minimally invasive totally thoracoscopic cardiac surgery. Methods We retrospectively analyzed the clinical data of 150 consecutive patients who underwent minimally invasive totally thoracoscopic cardiac surgery in the Guangdong General Hospital between January 2013 and December 2015. There were 60 males and 90 females at age of 43.1 years. There were 60 patients with atrial or ventricular septal defect repair, 12 patients with cardiac tumor resection, 53 patients with mitral valve replacement and 25 patients with mitral valve repair. According to the surgical sequence, all the patients were divided into 3 groups including a group A, group B, and group C with 50 patients in each group (every 10 patients as a sequence, every 5 sequence as a group). Surgical outcomes were compared among the 3 groups, and surgical quality was analyzed with descriptive statistics. Results Surgical failure rate was 6.7% (10/150). There was no in-hospital mortality. Aortic cross-clamp time, cardiopulmonary bypass time and duration of mechanical ventilation, duration of ICU stay, duration of hospital stays of the group C were significantly shorter than those of the group A and group B. Analysis showed a significant learning curve effect in totally thoracoscopic cardiac surgery. When surgical cases reached about 100 cases, cardiopulmonary bypass and aortic cross-clamp time was shorter than the average value stably. Conclusion Totally thoracoscopic cardiac surgery is safe and reliable. For the beginners, it needs about 100 patients of surgery to master the totally thoracoscopic cardiac surgery.
Objective Through a retrospective study on esophageal function changes and symptom relief after video-assisted thoracoscopic surgery treatment for achalasia of cardia (AC) to assess the clinical value of this operation. Methods We reviewed the data of 34 AC patients who received modified Heller operation by video-assisted thoracoscopic surgery in the Affiliated Hospital of Guizhou Medical University from March 2012 to September 2014. There were 11 males and 23 females with a median age of 35 (11–67) years. These patients were divided into four groups according to the time of treatment and follow-up: preoperative group, postoperative one-month group, postoperative three-month group and postoperative six-month group. Changes of symptoms, radiography and esophageal dynamics before and after therapy were collected. These different groups were analyzed based on statistical methods. Results There was no statistical difference in ages and genders among groups (P>0.05). The surgery was successful and no complication or death occurred. Symptoms of patients showed different degrees of relief and the postoperative grade of clinical symptoms decreased (P<0.05). After surgery, lower esophageal sphincter pressure (LESP), lower esophageal sphincter resting pressure (LESRP) and esophageal body pressure (EBP) decreased significantly, while lower esophageal sphincter relax rate (LESRR) increased (P<0.05). While there was no significant difference in length of lower esophageal sphincter (LESL,P>0.05). Angiography of upper digestive tract revealed that compared to the preoperative group, the maximum width in postoperative three-month group decreased significantly (P<0.05). During the follow-up, 3 patients suffered gastroesophageal reflux, 2 patients esophageal perforation and 1 patient empyema due to esophago-pleural fistula. No massive hemorrhage of upper digestive tract and hiatal hernia occured. Conclusion Sugery can significantly ameliorate the clinical symptoms of the patients with AC, and improve esophageal dynamics. And it is simple and easy to perform with less complications and better long-term outcomes. Improved Heller operation by video-assisted thoracoscopy is a less invasive procedure when compared with the traditional thoracotomy. Moreover, esophageal manometry can objectively assist in the diagnosis and degree of the disease and effect of therapy.
ObjectiveTo discuss the safety and feasibility of no chest tube (NCT) after thoracoscopic pneumonectomy.MethodsThe online databases including PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to October 2020 to collect the research on NCT after thoracoscopic pneumonectomy. Two reviewers independently screened the literature, extracted the data, and evaluated the quality of the included studies. The RevMan 5.3 software was used for meta-analysis.ResultsA total of 17 studies were included. There were 12 cohort studies and 5 randomized controlled trials including 1 572 patients with 779 patients in the NCT group and 793 patients in the chest tube placement (CTP) group. Meta–analysis results showed that the length of postoperative hospital stay in the NCT group was shorter than that in the CTP group (SMD=–1.23, 95%CI –1.59 to –0.87, P<0.000 01). Patients in the NCT group experienced slighter pain than those in the CTP group at postoperative day (POD)1 (SMD=–0.97, 95%CI –1.42 to –0.53, P<0.000 1), and POD2 (SMD=–1.10, 95%CI –2.00 to –0.20, P=0.02), while no statistical difference was found between the two groups in the visual analogue scale of POD3 (SMD=–0.92, 95%CI –1.91 to 0.07, P=0.07). There was no statistical difference in the 30-day complication rate (RR=0.93, 95%CI 0.61 to 1.44, P=0.76), the rate of postoperative chest drainage (RR=1.51, 95%CI 0.68 to 3.37, P=0.31) or the rate of thoracocentesis (RR=2.81, 95%CI 0.91 to 8.64, P=0.07) between the two groups. No death occurred in the perioperative period in both groups.ConclusionIt is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.
ObjectiveTo investigate the effects of closed thoracic drainage with single tube or double tubes after video-assisted thoracoscopic lung volume reduction surgery.MethodsRetrospective analysis was performed on 50 patients (39 males, 11 females) who underwent three-port thoracoscopic lung volume reduction surgery in our hospital from January 2013 to March 2019. Twenty-five patients with single indwelling tube after surgery were divided into the observation group and 25 patients with double indwelling tubes were divided into the control group.ResultsThere was no significant difference in pulmonary retension on day 3 after surgery, postoperative complications, the patency rate of drainage tube before extubation, retention time or postoperative hospital stay (P>0.05). Postoperative pain and total amount of nonsteroidal analgesics use in the observation group was less than those in the control group (P<0.05). ConclusionIt is safe and effective to perform closed thoracic drainage with single indwelling tube after video-assisted thoracoscopic lung volume reduction surgery, which can significantly reduce the incidence of related adverse drug reactions and facilitate rapid postoperative rehabilitation with a reduction of postoperative pain and the use of analgesic drugs.
ObjectiveTo investigate the clinical feasibility and safety of uniportal video-assisted thoracoscopic surgery (VATS) without chest tube in enhanced recovery thoracic surgery.MethodThe clinical data of patients with pulmonary bulla, pulmonary nodules and mediastinal tumors who underwent uniportal VATS in Department of Thoracic Surgery in the Affiliated Hospital of Inner Mongolia Medical University between January 2015 to May 2018 were retrospectively analyzed. A total of 78 patients did not receive closed thoracic drainage tube (a tube-free group), including 30 males and 48 females aged 32.5±8.3 years, 92 patients closed thoracic drainage tube after operation (a control group), including 38 males and 54 females aged 31.4±13.6 years. The surgery-related indicators, postoperative complications and visual analogue score (VAS) were compared between the two groups.ResultsThe time of early ambulation and hospital stay after operation in the tube-free group (1.0±0.3 d, 3.3±0.7 d) were significantly shorter than those in the control group (1.8±0.6 d, 5.2±0.8 d) (P=0.000, P=0.000). The VAS pain scores on the first, second and third day after operation in the tube-free group (4.5±1.8, 3.6±2.4, 2.5±1.4) were also significantly lower than those in the control group (6.8±2.2, 5.7±2.9, 3.9±1.2) (P=0.000, P=0.000, P=0.000). Operation time and intraoperative blood loss in the tube-free group (55.3±12.2 min, 21.5±5.1 mL) and the control group (57.1±6.5 min, 22.2±3.5 mL) were not statistically different (P=0.220, P=0.146). There was no pulmonary infection in both groups, and the wound healing rate was 100.0%. There was no significant difference in pneumothorax, pleural effusion, arrhythmia and re-insertion of chest drain between the tube-free group (5 patients, 8 patients, 1 patient, 3 patients) and the control group (1 patient, 4 patients, 2 patients, 1 patient, P=0.145, P=0.134, P=0.885, P=0.499).ConclusionIn strictly screened patients undergoing uniportal thoracoscopic surgery, no thoracic closed drainage tube can relieve postoperative pain, promote early ambulation activities and enhanced recovery of patients.
ObjectiveTo investigate the effectiveness and safety of robotic lobectomy in clinical N0 lung malignant tumor≥3 cm. MethodsWe retrospectively analyzed the clinical data of 182 patients with lung malignant tumor≥3 cm receiving robotic or thoracoscopic lobectomy at Shanghai Chest Hospital in 2019. The patients were divided into a robotic surgery group (RATS group) and a thoracoscopic surgery group (VATS group). There were 39 males and 38 females with an average age of 60.55±8.59 years in the RATS group, and 51 males and 54 females with an average age of 61.58±9.30 years in the VATS group. A propensity score matching analysis was applied to compare the operative data between the two groups. ResultsA total of 57 patients were included in each group after the propensity score matching analysis. Patients in the RATS group had more groups of N1 lymph node dissected (2.53±0.83 groups vs. 2.07±0.88 groups, P=0.005) in comparison with the VATS group. No statistical difference was found in operation time, blood loss, postoperative hospital stay, number of N1 and N2 lymph nodes dissected, groups of N2 lymph node dissected, lymph node upstage rate or postoperative complications. The hospitalization cost of RATS was higher than that of VATS (P＜0.001). ConclusionIn contrast with thoracoscopic lobectomy, robotic lobectomy has similar operative safety, and a thorough N1 lymphadenectomy in patients with clinical N0 lung malignant tumor≥3 cm.
Objective To compare video-assisted thoracic surgical technique (VATS) and conventional surgical technique (CSM) in mitral valve replacement (MVR). Methods We retrospectively analyzed clinical data of 93 patients in our hospital with mitral valve replacement between January 2010 and January 2015. The patients were divided into two groups including a VATS group and a CSM group.There were 43 patients with 25 males and 18 females at age of 57.43±5.65 years in the VATS group, and 50 patients with 27 males and 23 females at age of 56.40±6.32 years in the CSM group.The clinical outcomes of the two groups were compared. Results There was no mortality. Echocardiography was normal in both groups during 1-year follow-up. There was no significant difference between the two groups in the operative time, aortic clamping time, cardiopulmonary bypass (CPB) time, or ventilation time. As compared with the CSM group, the patients in the VATS group had a significantly lower complication rate, shorter chest incision length (5.23±1.36 cm vs. 18.21±3.89 cm), less blood transfusion (1.75±0.25 U vs. 3.15±1.50 U), less chest drainage (202.34±12.12 ml vs. 412.32±21.56 ml) and lower pain score (1.26±0.86 vs. 3.01±1.13), shorter time of postoperative hospital stay (8.20±2.36 d vs. 12.10±3.26 d). Conclusion MVR under VATS is not only technically feasible, but also with excellent clinical results.
Objective To explore the diagnostic and treatment value of computed tomography (CT)-guided embolization coil localization of pulmonary nodules accurately resected under the thoracoscope. Methods Between October 2015 and October 2016, 40 patients with undiagnosed nodules of 15 mm or less were randomly divided into a no localization group (n=20, 11 males and 9 females with an average age of 60.50±8.27 years) or preoperative coil localization group (n=20, 12 males and 8 females with an average age of 61.35±8.47 years). Coils were placed with the distal end deep to the nodule and the superficial end coiled on the visceral pleural surface with subsequent visualization by video-assisted thoracoscopic (VATS). Nodules were removed by VATS wedge excision using endo staplers. The tissue was sent for rapid pathological examination, and the pulmonary nodules with definitive pathology found at the first time could be defined as the exact excision. Results The age, sex, forced expiratory volume in the first second of expiration, nodule size/depth were similar between two groups. The coil group had a higher rate of accurate resection (100.00% vs. 70.00%, P=0.008), less operation time to nodule excision (35.65±3.38 minvs. 44.38±11.53 min,P=0.003), and reduced stapler firings (3.25±0.85vs. 4.44±1.26,P=0.002) with no difference in total costs. Conclusion Preoperative CT-guided coil localization increases the rate of accurate resection.
Minimally invasive surgery (MIS) is currently mainly used for the treatment of early thymic tumors. In recent years, minimally invasive thymic surgery has been rapidly promoted at home and abroad. However, because of the low incidence of thymic tumors, the unbalanced experience of doctors, there are still many issues worthy of discussion in MIS. Standard MIS must follow similar oncological and resection principles. This paper involves the definitions of minimally invasive thymic surgery and general principles that should be adhered to when performing MIS for thymic malignances.
ObjectiveTo analyze the occurrence of postoperative pulmonary complications (PPC) and the risk factors in patients with spontaneous pneumothorax who underwent micro single-port video-assisted thoracoscopic surgery (VATS).MethodsA total of 158 patients with spontaneous pneumothorax who underwent micro single-port VATS in our hospital from April 2017 to December 2019 were retrospectively included, including 99 males and 59 females, with an average age of 40.53±9.97 years. The patients were divided into a PPC group (n=21) and a non-PPC group (n=137) according to whether PPC occurred after the operation, and the risk factors for the occurrence of PPC were analyzed.ResultsAll 158 patients successfully completed the micro single-port VATS, and there was no intraoperative death. The postoperative chest tightness, chest pain, and dyspnea symptoms basically disappeared. During the postoperative period, there were 3 patients of pulmonary infection, 7 patients of atelectasis, 4 patients of pulmonary leak, 6 patients of pleural effusion, 1 patient of atelectasis and pleural effusion, and the incidence of PPC was 13.29% (21/158). Multivariate logistic regression analysis showed that lung disease [OR=32.404, 95%CI (2.717, 386.452), P=0.006], preoperative albumin level≤35 g/L [OR=14.912, 95%CI (1.719, 129.353), P=0.014], severe pleural adhesions [OR=26.023, 95%CI (3.294, 205.557), P=0.002], pain grade Ⅱ-Ⅲ 24 hours after the surgery [OR=64.024, 95%CI (3.606, 1 136.677), P=0.005] , age [OR=1.195, 95%CI (1.065, 1.342), P=0.002], intraoperative blood loss [OR=1.087, 95%CI (1.018, 1.162), P=0.013] were the risk factors for PPC after micro single-port VATS.ConclusionThere is a close relationship between PPC after micro single-port VATS and perioperative indexes in patients with spontaneous pneumothorax. Clinically, targeted prevention and treatment can be implemented according to the age, pulmonary disease, preoperative albumin level, intraoperative blood loss, degree of pleural adhesion and pain grading 24 hours after surgery.