BACKGROUND Mediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor.In this report,we describe a rare case of giant mature teratoma located primarily in the anterior med...BACKGROUND Mediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor.In this report,we describe a rare case of giant mature teratoma located primarily in the anterior mediastinum and causing partial atelectasis of the upper and middle lobes of the right lung,as well as extrinsic compression of the right atrium.CASE SUMMARY A 31-year-old male with a giant mediastinal mature teratoma presented with progressive exertional dyspnea and chest pain for 1 mo.Computed tomography of the chest indicated the diagnosis of anterior mediastinal teratoma.The patient underwent right uniportal anterior approach video-assisted thoracoscopic surgery(VATS).En bloc resection of the giant teratoma,wedge resection of the upper and middle lobes of the right lung,resection of the thymus and partial excision of the pericardium were successfully performed.The pathological diagnosis revealed a mature cystic teratoma with foreign-body reaction that was closely related to the right lung,atrium dextrum,superior vena cava and ascending aorta.An atrophic thymic tissue was also discovered at the external teratoma surface.The patient was discharged on postoperative day 7.CONCLUSION This is the first report of the use of uniportal VATS for complete resection of a teratoma in combination with wedge resection of the right upper and middle lung lobes and partial resection of the pericardium.展开更多
Objectives:Intraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery(VATS)is associated with increased adverse events,which is a major concern.We aim to explore the related risk factors in lun...Objectives:Intraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery(VATS)is associated with increased adverse events,which is a major concern.We aim to explore the related risk factors in lung cancer patients.Methods:In our study,the data from 1305 patients who underwent VATS between June 2017 and May 2020 were retrospectively collected,among which 67 patients underwent unexpected conversion to thoracotomy.All patients were divided into Non-conversion Group or Conversion Group according to whether they required a conversion to thoracotomy and the risk factors were explored by univariate and multivariate analyses.Results:The most common cause of conversion was fibrocalcified lymph nodes,found in 33 patients(49.3%).Multivariable logistic regression analysis demonstrates that the independent risk factors for the conversion were age≥65 y(OR=2.696,95%CI:1.487e4.887,p=0.001),tumor size>3 cm(OR=4.527,95%CI:2.490e8.233,p<0.001),and tumor location in the left upper lung(OR=3.809,95%CI:1.737 e5.492,p<0.001).Conclusions:Advanced age,bigger tumor size and tumor at the left upper lobe could lead to conversion.In the early VATS learning cases,surgeons should try to choose patients with lower risk of conversion to thoracotomy.展开更多
The mediastinal lymph node tuberculous abscesses(MLNTAs) are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-assi...The mediastinal lymph node tuberculous abscesses(MLNTAs) are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-assisted thoracoscopic surgery(VATS) for the treatment of MLNTA. Clinical data of 16 MLNTA patients who were treated in our hospital between December 1, 2013 and December 1, 2015 were retrospectively analyzed. All of the patients underwent the radical debridement and drainage of abscesses, and intrathoracic lesions were removed by VATS. They were also administered the intensified anti-tuberculosis treatment(ATT), and engaged in normal physical activity and follow-up for 3 to 6 months. The results showed that VATS was successfully attempted in all of the 16 MLNTA patients and they all had good recovery. Two patients developed complications after surgery, with one patient developing recurrent laryngeal nerve injury, and the other reporting poor wound healing. It was concluded that VATS is easy to perform, and safe, and has high rates of success and relatively few side-effects when used to treat MLNTA.展开更多
Objective:The objective of the current study was to evaluate the feasibility and safety of nonintubated uniportal video-assisted thoracoscopic surgery(VATS) for the management of primary spontaneous pneumothorax(PSP)....Objective:The objective of the current study was to evaluate the feasibility and safety of nonintubated uniportal video-assisted thoracoscopic surgery(VATS) for the management of primary spontaneous pneumothorax(PSP).Methods:From November 2011 to June 2013,32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidural anaesthesia and sedation without endotracheal intubation.An incision 2 cm in length was made at the 6^(th) intercostal space in the median axillary line.The pleural space was entered by blunt dissection for placement of a soft incision protector.Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy.Data were collected within a minimum follow-up period of 10 months.Results:The average time of surgery was 49.0 min(range,33-65 min).No complications were recorded.The postoperative feeding time was 6 h.The mean postoperative chest tube drainage and hospital stay were19.3 h and 41.6 h,respectively.The postoperative pain was mild for 30 patients(93.75%) and moderate for two patients(6.25%).No recurrences of pneumothorax were observed at follow-up.Conclusions:The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible,but may also be a safe and less invasive alternative for select patients in the management of PSP.This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases.Further work and development of instruments are needed to define the applications and advantages of this technique.展开更多
We aimed to describe a method for repositioning of right middle lobar torsion by using a 3-cm uniportal video-assisted thoracoscopic surgery(VATS) approach. Middle lobe torsion occurred after right upper and lower lob...We aimed to describe a method for repositioning of right middle lobar torsion by using a 3-cm uniportal video-assisted thoracoscopic surgery(VATS) approach. Middle lobe torsion occurred after right upper and lower lobectomy in a 74-year-old man. Immediate re-exploratory thoracotomy using the 3-cm uniportal VATS approach was performed. The torsion was corrected, and the lobe was anchored to the anterior chest wall with Prolene stitches. The patient recovered well postoperatively with daily improvements in chest radiographic findings. Follow-up examination was performed using fiberbronchoscopy, which revealed an unobstructed right middle lobe bronchus and sticky yellow sputum. Follow-up chest computed tomography was performed 3 months after the primary surgery and revealed increased expansion of the right middle lobe. We repositioned the right middle lobe successfully by using the 3-cm uniportal VATS approach, but more cases are needed to confirm the feasibility of the approach. Lobectomy remains the primary treatment option for such cases.展开更多
Complete resection could be achieved in virtually all myasthenic patients with Masaoka stage Ⅰ and Ⅱ thymoma using the trans-sternal technique.Whether this is appropriate for minimally invasive approach is not yet c...Complete resection could be achieved in virtually all myasthenic patients with Masaoka stage Ⅰ and Ⅱ thymoma using the trans-sternal technique.Whether this is appropriate for minimally invasive approach is not yet clear.We evaluated the feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of Masaoka stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis,compared to conventional trans-sternal thymectomy.We summarized 33 patients with Masaoka stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis between April 2006 and September 2011.Of these,15 patients underwent right-sided complete VATS (the VATS group) by using adjuvant pneuomomediastinum,comparing with 18 patients using the trans-sternal approach (the T3b group).No intraoperative death was found and no VATS case required conversion to median sternotomy.Significant differences between the two groups regarding duration of surgery and volume of intraoperative blood loss (P=0.001 and P < 0.001,respectively) were observed.Postoperative morbidities were 26.7% and 33.3% for the VATS and T3b groups,respectively.All 33 patients were followed up for 12 to 61 months in the study.The cumulative probabilities of reaching complete stable remission and effective rate were 26.7% (4/15) and 93.3% (14/15) in the VATS group,which had a significantly higher complete stable remission and effective rate than those in the T3b group (P=0.026 and P=0.000,respectively).We conclude that VATS thymectomy utilizing adjuvant pneuomomediastinum for the treatment of stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis is technically feasible but deserves further investigation in a large series with long-term follow-up.展开更多
Objective: The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery(VATS) radical treatment for patients with stage IIIA lung cancer, with the primary endpoints b...Objective: The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery(VATS) radical treatment for patients with stage IIIA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery.Methods: A total of 51 patients with radiologically or mediastinoscopically confirmed stage IIIA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher.Results: A total of 51 patients with non-small cell lung cancer(NSCLC) were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41(80.4%) had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50(98%) received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage(>1,000 mL), and the postoperative recovery was satisfactory. Up to 45 patients(88.2%) did not suffer from any perioperative complication, and 6(11.8%) experienced one or more complications.Conclusions: VATS radical treatment is a safe and feasible treatment for stage IIIA lung cancer.展开更多
This study sought to report our 6-year experience with the LigaSure vessel sealing system(LVSS) in videoassisted thoracoscopic surgery(VATS) for primary spontaneous pneumothorax.A series of 180 consecutive patients wi...This study sought to report our 6-year experience with the LigaSure vessel sealing system(LVSS) in videoassisted thoracoscopic surgery(VATS) for primary spontaneous pneumothorax.A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010.Intraoperatively,large lesions(bullae or blebs) with a diameter more than 2 cm were resected by staplers,and the residual lesions were treated by LVSS.LVSS was also used to ablate the apical area when no lesions were found.Conventional apical pleural abrasion was done in all cases.All patients were successfully treated using VATS with minimal perioperative bleeding.The mean operating time was 76 minutes(range,43-160 minutes) for single-side procedures and 169 minutes(range,135-195 minutes) for bilateral procedures,the mean number of applied staples was 1.93 per patient(range,0-8 days),the duration of drainage was 3.8 days(range,2-15 days),and the duration of hospital stay was 5.8 days(range,3-16 days).Postoperative complications included persistent air leak(> 5 days) in 11 cases(6.1%) and residual pneumothorax in 6(3.3%).None required reoperation.The mean duration of follow-up was 57 months(range,24-105 months).Recurrence was seen in three cases(1.7%),and all underwent another operation thereafter.None of the lesions in the relapse cases received ablation with LVSS in the first operation.LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples.The method is safe,easy to use,and cost-effective and produces satisfactory results.展开更多
Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the tre...Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included;all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay.展开更多
Background: The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery (VATS) combined with positron emitted tomography (PET)-computed tomography (CT) in...Background: The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery (VATS) combined with positron emitted tomography (PET)-computed tomography (CT) in the diagnosis of patients with early (Stage 1) sarcoidosis. Methods: From 1995 to 2006, seven patients (two males, five females), with ages ranging from 26 to 58 years, were impressed with Stage 1 sarcoidosis (mediastinal or hilar lymph nodes involvements without lung in- volvement) by histological examination of intrathoracic lymph nodes (LNs) and/or lung parenchyma taken from VATS biopsy. Three of them received PET or PET-CT evaluation. VATS was approached from the right and left side in one and six patients, respectively, according to the locations of their lesions. Results: All the VATS biopsied LNs or lung specimens were adequate for establishing diagnosis. Mediastinal LNs were taken from Groups 3, 4 in four, Group 7 in two, and Groups 5, 6 in one of them. Hilar LNs biopsies were performed in four cases. Lung biopsy was performed in all but two cases. All of them were expressed pathologically or radiologically as Stage 1 sarcoidosis. PET-CT revealed high emission signals over these affected LNs. These patients received oral steroid treatment or follow up only. All of them were followed up from 5 months to 11 years with satis- factory results. Conclusion: VATS biopsy is a minimally invasive, safe and effective procedure. It can be used as a diagnostic alternative of transbronchial lung biopsy (TBLB), and can harvest larger and more areas of specimens than mediastinoscopy for staging patients with sarcoidosis. PET-CT can provide us more accurate information about the characteristics and localization of these lesions before biopsy. VATS combined with PET-CT can provide more accurate and earlier diagnosis of patients with unknown intrathoracic lesions, including the sarcoidosis.展开更多
Objective:To study the differences in the body pain and trauma degree between uniportal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer.Methods:A total of 108 patients with non-s...Objective:To study the differences in the body pain and trauma degree between uniportal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer.Methods:A total of 108 patients with non-small cell lung cancer who received radical operation in our hospital between February 2013 and February 2016 were selected and divided into the uniportal group (n=52) who received uniportal video-assisted thoracoscopic surgery and the three-portal group (n=56) who received three-portal video-assisted thoracoscopic surgery after the operation methods and related laboratory results were reviewed. Before operation and 24 h after operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were compared between the two groups of patients.Results: Before operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were not statistically significant between the two groups of patients. 24 h after operation, serum pain mediators NE, DA and 5-HT levels of observation group were lower than those of control group;oxidative stress indexes MDA and O2- levels were lower than those of control group while SOD and GSH-Px levels were higher than those of control group;inflammation indexes IL-6, IL-8, CRP and TNF-α levels were lower than those of control group.Conclusion: Uniportal video-assisted thoracoscopic surgery for the treatment of lung cancer causes less surgery trauma, and patients' postoperative pain and systemic inflammatory stress response are lighter.展开更多
BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE...BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE SUMMARY A 39-year-old woman presented with a growing solitary pulmonary nodule measuring 2.0 cm in the right upper lobe(RUL)of the lung.The patient underwent a RUL anterior segmentectomy using uniportal video-assisted thoracoscopy.A preliminary tissue diagnosis indicated malignancy;however,it was later revised to an IMTs.Due to the absence of a minor fissure between the right upper and middle lobes,an alternative resection approach was necessary.Therefore,we utilized indocyanine green injection to aid in delineating the intersegmental plane.Following an uneventful recovery,the patient was discharged on the third postoperative day.Thereafter,annual chest tomography scans were scheduled to monitor for potential local recurrence.CONCLUSION This case underscores the challenges in diagnosing and managing IMTs,showing the importance of accurate pathologic assessments and tailored surgical strategies.展开更多
BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate ...BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate the potential enhancement of video-assisted thoracic surgery(VATS)in postoperative recovery in elderly patients with NSCLC.METHODS We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS(the ERAS group)and 327 elderly NSCLC patients who received routine care(the control group)after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017.After propensity score matching of baseline data,we analysed the postoperative stay,total hospital expenses,postoperative 48-h pain score,and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.RESULTS After propensity score matching,ERAS significantly reduced the postoperative hospital stay(6.96±4.16 vs 8.48±4.18 d,P=0.001)and total hospital expenses(48875.27±18437.5 vs 55497.64±21168.63 CNY,P=0.014)and improved the satisfaction score(79.8±7.55 vs 77.35±7.72,P=0.029)relative to those for routine care.No significant between-group difference was observed in postoperative 48-h pain score(4.68±1.69 vs 5.28±2.1,P=0.090)or postoperative complication rate(21.2%vs 27.1%,P=0.371).Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.CONCLUSION ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.展开更多
Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperati...Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperative pain,and faster resumption of a normal lifestyle.However,there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer.Concerns regarding safety,the extent of mediastinal lymph node dissection,and long-term survival have made some surgeons apprehensive of its validity for lung cancer.In this paper,we review the development of thoracoscopy,the present status of VATS for early stage of non-small cell lung cancer(NSCLC),and comparison between VATS and open thoracotomy in the management of NSCLC.展开更多
Objective:To evaluate the effectiveness and safety of transcutaneous electrical acupoint stimulation(TEAS)for improving postoperative cognitive function in senior patients undergoing video-assisted thoracoscopic surgi...Objective:To evaluate the effectiveness and safety of transcutaneous electrical acupoint stimulation(TEAS)for improving postoperative cognitive function in senior patients undergoing video-assisted thoracoscopic surgical(VATS).Methods:From January to December 2020,97 participants were randomly assigned to the TEAS group(49 cases)and the control group(48 cases)by a random number table.The patients in the TEAS group received TEAS,at the bilateral Neiguan(PC 6)and Zusanli(ST 36)acupoints.The control group received sham TEAS.The stimulation was started from 30 min before surgery until the end of the operation.The primary outcome was the incidence of pstoperative cognitive dysfunction(POCD),diagnosed based on the changes in the Mini-Mental Status Examination(MMSE)and Montreal Cognitive Assessment(MoCA)scores.The secondary outcomes were plasma levels of S100β protein and neuron-specific enolase(NSE).Results:The incidence of POCD on day 1 and 3 after surgery in the TEAS group was significantly lower than that in the control group[day 1 after surgery:28.3%(13/46)vs.52.3%(23/44),P=0.028;day 3 after surgery:21.7%(10/46)vs.40.9%(18/44),P=0.043].Compared with baseline,the MMSE and MoCA scores decreased to various extents in both groups.The MMSE scores on day 1,3,and 5 after surgery and MoCA scores on day 1,3,5,and 7 after surgery in the TEAS group were higher than those in the control group(all P<0.05)in both groups.Compared with baseline,the plasma levels of S100β and NSE were significantly increased at 4,8,12,24 h after surgery(all P<0.05).Compared with the control group,the plasma levels of S100β and NSE were lower in the TEAS group at 4,8,12,and 24 h after surgery(all P<0.05).No obvious adverse events were found during the trial.Conclusion:Application of TEAS in senior patients after VATS could reduce incidence of POCD and improve postoperative cognitive function.展开更多
Tuberculoma of the lung is one of manifestations in tuberculosis and usually presents as a solitary pulmonary nodule(SPN).It is difficult to differentiate tuberculoma from SPN by other benign or malignant diseases.At ...Tuberculoma of the lung is one of manifestations in tuberculosis and usually presents as a solitary pulmonary nodule(SPN).It is difficult to differentiate tuberculoma from SPN by other benign or malignant diseases.At present,the crucial role of video-assisted thoracoscopic surgery(VATS) in diagnosis and treatment of pulmonary diseases has been well acknowledged.Here,we reported 53 patients undergoing VATS resection for tuberculomas in our series.No postoperative mortality was found and only two patients experienced prolonged air-leakage(>7 d) and two had minor wound infections that were recovered after anti-tuber-culosis or antibiotic treatment.Anti-tuberculosis chemotherapy from 6 to 12 months was routinely used postoperatively.We conclude that VATS is a satisfactory tool for the diagnosis and treatment of tuberculoma and can also establish a reliable diagnosis for all patients with SPNs.展开更多
Background:Hepatic hydrothorax is defined as a significant pleural effusion in patients with liver cirrhosis and without underlying cardiopulmonary diseases. Treatment of hepatic hydrothorax remains a challenge at pre...Background:Hepatic hydrothorax is defined as a significant pleural effusion in patients with liver cirrhosis and without underlying cardiopulmonary diseases. Treatment of hepatic hydrothorax remains a challenge at present. Methods:Herein we share our experiences in the treatment of 12 patients with hepatic hydrothorax by video-assisted thoracoscopic surgery(VATS) . Repair of the diaphragmatic defects,or pleurodesis by focal pleurectomy,talc spray,mechanical abrasion,electro-cauterization or injection was administered intraoperatively,and tetracycline intrapleural injection was used postoperatively for patients with prolonged(>7 d) high-output(>300 ml/d) pleural effusion. Results:Out of the 12 patients,8(67%) had uneventful postoperative course and did not require tube for drainage more than 3 months after discharge. In 4(33%) patients the pleural effusion still recurred after discharge due to end-stage cirrhosis with massive ascites. Conclusion:We conclude that the repair of the diaphragmatic defect and pleurodesis through VATS could be an alternative of transjugular intrahepatic portal systemic shunt (TIPS) or a bridge to liver transplantation for patients with refractory hepatic hydrothorax. Pleurodesis with electrocauterization can be an alternative therapy if talc is unavailable.展开更多
文摘BACKGROUND Mediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor.In this report,we describe a rare case of giant mature teratoma located primarily in the anterior mediastinum and causing partial atelectasis of the upper and middle lobes of the right lung,as well as extrinsic compression of the right atrium.CASE SUMMARY A 31-year-old male with a giant mediastinal mature teratoma presented with progressive exertional dyspnea and chest pain for 1 mo.Computed tomography of the chest indicated the diagnosis of anterior mediastinal teratoma.The patient underwent right uniportal anterior approach video-assisted thoracoscopic surgery(VATS).En bloc resection of the giant teratoma,wedge resection of the upper and middle lobes of the right lung,resection of the thymus and partial excision of the pericardium were successfully performed.The pathological diagnosis revealed a mature cystic teratoma with foreign-body reaction that was closely related to the right lung,atrium dextrum,superior vena cava and ascending aorta.An atrophic thymic tissue was also discovered at the external teratoma surface.The patient was discharged on postoperative day 7.CONCLUSION This is the first report of the use of uniportal VATS for complete resection of a teratoma in combination with wedge resection of the right upper and middle lung lobes and partial resection of the pericardium.
文摘Objectives:Intraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery(VATS)is associated with increased adverse events,which is a major concern.We aim to explore the related risk factors in lung cancer patients.Methods:In our study,the data from 1305 patients who underwent VATS between June 2017 and May 2020 were retrospectively collected,among which 67 patients underwent unexpected conversion to thoracotomy.All patients were divided into Non-conversion Group or Conversion Group according to whether they required a conversion to thoracotomy and the risk factors were explored by univariate and multivariate analyses.Results:The most common cause of conversion was fibrocalcified lymph nodes,found in 33 patients(49.3%).Multivariable logistic regression analysis demonstrates that the independent risk factors for the conversion were age≥65 y(OR=2.696,95%CI:1.487e4.887,p=0.001),tumor size>3 cm(OR=4.527,95%CI:2.490e8.233,p<0.001),and tumor location in the left upper lung(OR=3.809,95%CI:1.737 e5.492,p<0.001).Conclusions:Advanced age,bigger tumor size and tumor at the left upper lobe could lead to conversion.In the early VATS learning cases,surgeons should try to choose patients with lower risk of conversion to thoracotomy.
文摘The mediastinal lymph node tuberculous abscesses(MLNTAs) are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-assisted thoracoscopic surgery(VATS) for the treatment of MLNTA. Clinical data of 16 MLNTA patients who were treated in our hospital between December 1, 2013 and December 1, 2015 were retrospectively analyzed. All of the patients underwent the radical debridement and drainage of abscesses, and intrathoracic lesions were removed by VATS. They were also administered the intensified anti-tuberculosis treatment(ATT), and engaged in normal physical activity and follow-up for 3 to 6 months. The results showed that VATS was successfully attempted in all of the 16 MLNTA patients and they all had good recovery. Two patients developed complications after surgery, with one patient developing recurrent laryngeal nerve injury, and the other reporting poor wound healing. It was concluded that VATS is easy to perform, and safe, and has high rates of success and relatively few side-effects when used to treat MLNTA.
文摘Objective:The objective of the current study was to evaluate the feasibility and safety of nonintubated uniportal video-assisted thoracoscopic surgery(VATS) for the management of primary spontaneous pneumothorax(PSP).Methods:From November 2011 to June 2013,32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidural anaesthesia and sedation without endotracheal intubation.An incision 2 cm in length was made at the 6^(th) intercostal space in the median axillary line.The pleural space was entered by blunt dissection for placement of a soft incision protector.Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy.Data were collected within a minimum follow-up period of 10 months.Results:The average time of surgery was 49.0 min(range,33-65 min).No complications were recorded.The postoperative feeding time was 6 h.The mean postoperative chest tube drainage and hospital stay were19.3 h and 41.6 h,respectively.The postoperative pain was mild for 30 patients(93.75%) and moderate for two patients(6.25%).No recurrences of pneumothorax were observed at follow-up.Conclusions:The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible,but may also be a safe and less invasive alternative for select patients in the management of PSP.This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases.Further work and development of instruments are needed to define the applications and advantages of this technique.
文摘We aimed to describe a method for repositioning of right middle lobar torsion by using a 3-cm uniportal video-assisted thoracoscopic surgery(VATS) approach. Middle lobe torsion occurred after right upper and lower lobectomy in a 74-year-old man. Immediate re-exploratory thoracotomy using the 3-cm uniportal VATS approach was performed. The torsion was corrected, and the lobe was anchored to the anterior chest wall with Prolene stitches. The patient recovered well postoperatively with daily improvements in chest radiographic findings. Follow-up examination was performed using fiberbronchoscopy, which revealed an unobstructed right middle lobe bronchus and sticky yellow sputum. Follow-up chest computed tomography was performed 3 months after the primary surgery and revealed increased expansion of the right middle lobe. We repositioned the right middle lobe successfully by using the 3-cm uniportal VATS approach, but more cases are needed to confirm the feasibility of the approach. Lobectomy remains the primary treatment option for such cases.
文摘Complete resection could be achieved in virtually all myasthenic patients with Masaoka stage Ⅰ and Ⅱ thymoma using the trans-sternal technique.Whether this is appropriate for minimally invasive approach is not yet clear.We evaluated the feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of Masaoka stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis,compared to conventional trans-sternal thymectomy.We summarized 33 patients with Masaoka stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis between April 2006 and September 2011.Of these,15 patients underwent right-sided complete VATS (the VATS group) by using adjuvant pneuomomediastinum,comparing with 18 patients using the trans-sternal approach (the T3b group).No intraoperative death was found and no VATS case required conversion to median sternotomy.Significant differences between the two groups regarding duration of surgery and volume of intraoperative blood loss (P=0.001 and P < 0.001,respectively) were observed.Postoperative morbidities were 26.7% and 33.3% for the VATS and T3b groups,respectively.All 33 patients were followed up for 12 to 61 months in the study.The cumulative probabilities of reaching complete stable remission and effective rate were 26.7% (4/15) and 93.3% (14/15) in the VATS group,which had a significantly higher complete stable remission and effective rate than those in the T3b group (P=0.026 and P=0.000,respectively).We conclude that VATS thymectomy utilizing adjuvant pneuomomediastinum for the treatment of stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis is technically feasible but deserves further investigation in a large series with long-term follow-up.
文摘Objective: The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery(VATS) radical treatment for patients with stage IIIA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery.Methods: A total of 51 patients with radiologically or mediastinoscopically confirmed stage IIIA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher.Results: A total of 51 patients with non-small cell lung cancer(NSCLC) were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41(80.4%) had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50(98%) received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage(>1,000 mL), and the postoperative recovery was satisfactory. Up to 45 patients(88.2%) did not suffer from any perioperative complication, and 6(11.8%) experienced one or more complications.Conclusions: VATS radical treatment is a safe and feasible treatment for stage IIIA lung cancer.
文摘This study sought to report our 6-year experience with the LigaSure vessel sealing system(LVSS) in videoassisted thoracoscopic surgery(VATS) for primary spontaneous pneumothorax.A series of 180 consecutive patients with primary spontaneous pneumothorax were operated on in our institution from May 2005 to December 2010.Intraoperatively,large lesions(bullae or blebs) with a diameter more than 2 cm were resected by staplers,and the residual lesions were treated by LVSS.LVSS was also used to ablate the apical area when no lesions were found.Conventional apical pleural abrasion was done in all cases.All patients were successfully treated using VATS with minimal perioperative bleeding.The mean operating time was 76 minutes(range,43-160 minutes) for single-side procedures and 169 minutes(range,135-195 minutes) for bilateral procedures,the mean number of applied staples was 1.93 per patient(range,0-8 days),the duration of drainage was 3.8 days(range,2-15 days),and the duration of hospital stay was 5.8 days(range,3-16 days).Postoperative complications included persistent air leak(> 5 days) in 11 cases(6.1%) and residual pneumothorax in 6(3.3%).None required reoperation.The mean duration of follow-up was 57 months(range,24-105 months).Recurrence was seen in three cases(1.7%),and all underwent another operation thereafter.None of the lesions in the relapse cases received ablation with LVSS in the first operation.LVSS can optimize VATS for primary spontaneous pneumothorax and reduces the use of single-use staples.The method is safe,easy to use,and cost-effective and produces satisfactory results.
文摘Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included;all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay.
文摘Background: The purpose of this study was to describe our experiences and analyze the benefits of video-assisted thoracoscopic surgery (VATS) combined with positron emitted tomography (PET)-computed tomography (CT) in the diagnosis of patients with early (Stage 1) sarcoidosis. Methods: From 1995 to 2006, seven patients (two males, five females), with ages ranging from 26 to 58 years, were impressed with Stage 1 sarcoidosis (mediastinal or hilar lymph nodes involvements without lung in- volvement) by histological examination of intrathoracic lymph nodes (LNs) and/or lung parenchyma taken from VATS biopsy. Three of them received PET or PET-CT evaluation. VATS was approached from the right and left side in one and six patients, respectively, according to the locations of their lesions. Results: All the VATS biopsied LNs or lung specimens were adequate for establishing diagnosis. Mediastinal LNs were taken from Groups 3, 4 in four, Group 7 in two, and Groups 5, 6 in one of them. Hilar LNs biopsies were performed in four cases. Lung biopsy was performed in all but two cases. All of them were expressed pathologically or radiologically as Stage 1 sarcoidosis. PET-CT revealed high emission signals over these affected LNs. These patients received oral steroid treatment or follow up only. All of them were followed up from 5 months to 11 years with satis- factory results. Conclusion: VATS biopsy is a minimally invasive, safe and effective procedure. It can be used as a diagnostic alternative of transbronchial lung biopsy (TBLB), and can harvest larger and more areas of specimens than mediastinoscopy for staging patients with sarcoidosis. PET-CT can provide us more accurate information about the characteristics and localization of these lesions before biopsy. VATS combined with PET-CT can provide more accurate and earlier diagnosis of patients with unknown intrathoracic lesions, including the sarcoidosis.
基金Projects of Natural Science Foundation of China No:81373941.
文摘Objective:To study the differences in the body pain and trauma degree between uniportal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer.Methods:A total of 108 patients with non-small cell lung cancer who received radical operation in our hospital between February 2013 and February 2016 were selected and divided into the uniportal group (n=52) who received uniportal video-assisted thoracoscopic surgery and the three-portal group (n=56) who received three-portal video-assisted thoracoscopic surgery after the operation methods and related laboratory results were reviewed. Before operation and 24 h after operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were compared between the two groups of patients.Results: Before operation, the differences in serum levels of pain mediators, oxidative stress indexes and inflammation indexes were not statistically significant between the two groups of patients. 24 h after operation, serum pain mediators NE, DA and 5-HT levels of observation group were lower than those of control group;oxidative stress indexes MDA and O2- levels were lower than those of control group while SOD and GSH-Px levels were higher than those of control group;inflammation indexes IL-6, IL-8, CRP and TNF-α levels were lower than those of control group.Conclusion: Uniportal video-assisted thoracoscopic surgery for the treatment of lung cancer causes less surgery trauma, and patients' postoperative pain and systemic inflammatory stress response are lighter.
文摘BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE SUMMARY A 39-year-old woman presented with a growing solitary pulmonary nodule measuring 2.0 cm in the right upper lobe(RUL)of the lung.The patient underwent a RUL anterior segmentectomy using uniportal video-assisted thoracoscopy.A preliminary tissue diagnosis indicated malignancy;however,it was later revised to an IMTs.Due to the absence of a minor fissure between the right upper and middle lobes,an alternative resection approach was necessary.Therefore,we utilized indocyanine green injection to aid in delineating the intersegmental plane.Following an uneventful recovery,the patient was discharged on the third postoperative day.Thereafter,annual chest tomography scans were scheduled to monitor for potential local recurrence.CONCLUSION This case underscores the challenges in diagnosing and managing IMTs,showing the importance of accurate pathologic assessments and tailored surgical strategies.
基金Supported by the Scientific Research Foundation of Peking University Shenzhen Hospital,No.KYQD2021096the National Natural Science Foundation of China,No.81972829Precision Medicine Research Program of Tsinghua University,No.2022ZLA006.
文摘BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate the potential enhancement of video-assisted thoracic surgery(VATS)in postoperative recovery in elderly patients with NSCLC.METHODS We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS(the ERAS group)and 327 elderly NSCLC patients who received routine care(the control group)after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017.After propensity score matching of baseline data,we analysed the postoperative stay,total hospital expenses,postoperative 48-h pain score,and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.RESULTS After propensity score matching,ERAS significantly reduced the postoperative hospital stay(6.96±4.16 vs 8.48±4.18 d,P=0.001)and total hospital expenses(48875.27±18437.5 vs 55497.64±21168.63 CNY,P=0.014)and improved the satisfaction score(79.8±7.55 vs 77.35±7.72,P=0.029)relative to those for routine care.No significant between-group difference was observed in postoperative 48-h pain score(4.68±1.69 vs 5.28±2.1,P=0.090)or postoperative complication rate(21.2%vs 27.1%,P=0.371).Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.CONCLUSION ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.
基金The authors thank for the financial support from the Fundamental Research Funds for the Central Universities(HUST 2010JC051)Youth Chenguang project of Science and Technology of Wuhan City(No.201050231077).
文摘Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperative pain,and faster resumption of a normal lifestyle.However,there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer.Concerns regarding safety,the extent of mediastinal lymph node dissection,and long-term survival have made some surgeons apprehensive of its validity for lung cancer.In this paper,we review the development of thoracoscopy,the present status of VATS for early stage of non-small cell lung cancer(NSCLC),and comparison between VATS and open thoracotomy in the management of NSCLC.
基金Supported by Hebei Provincial Health Commission Research Project of China(No.20211487)。
文摘Objective:To evaluate the effectiveness and safety of transcutaneous electrical acupoint stimulation(TEAS)for improving postoperative cognitive function in senior patients undergoing video-assisted thoracoscopic surgical(VATS).Methods:From January to December 2020,97 participants were randomly assigned to the TEAS group(49 cases)and the control group(48 cases)by a random number table.The patients in the TEAS group received TEAS,at the bilateral Neiguan(PC 6)and Zusanli(ST 36)acupoints.The control group received sham TEAS.The stimulation was started from 30 min before surgery until the end of the operation.The primary outcome was the incidence of pstoperative cognitive dysfunction(POCD),diagnosed based on the changes in the Mini-Mental Status Examination(MMSE)and Montreal Cognitive Assessment(MoCA)scores.The secondary outcomes were plasma levels of S100β protein and neuron-specific enolase(NSE).Results:The incidence of POCD on day 1 and 3 after surgery in the TEAS group was significantly lower than that in the control group[day 1 after surgery:28.3%(13/46)vs.52.3%(23/44),P=0.028;day 3 after surgery:21.7%(10/46)vs.40.9%(18/44),P=0.043].Compared with baseline,the MMSE and MoCA scores decreased to various extents in both groups.The MMSE scores on day 1,3,and 5 after surgery and MoCA scores on day 1,3,5,and 7 after surgery in the TEAS group were higher than those in the control group(all P<0.05)in both groups.Compared with baseline,the plasma levels of S100β and NSE were significantly increased at 4,8,12,24 h after surgery(all P<0.05).Compared with the control group,the plasma levels of S100β and NSE were lower in the TEAS group at 4,8,12,and 24 h after surgery(all P<0.05).No obvious adverse events were found during the trial.Conclusion:Application of TEAS in senior patients after VATS could reduce incidence of POCD and improve postoperative cognitive function.
文摘Tuberculoma of the lung is one of manifestations in tuberculosis and usually presents as a solitary pulmonary nodule(SPN).It is difficult to differentiate tuberculoma from SPN by other benign or malignant diseases.At present,the crucial role of video-assisted thoracoscopic surgery(VATS) in diagnosis and treatment of pulmonary diseases has been well acknowledged.Here,we reported 53 patients undergoing VATS resection for tuberculomas in our series.No postoperative mortality was found and only two patients experienced prolonged air-leakage(>7 d) and two had minor wound infections that were recovered after anti-tuber-culosis or antibiotic treatment.Anti-tuberculosis chemotherapy from 6 to 12 months was routinely used postoperatively.We conclude that VATS is a satisfactory tool for the diagnosis and treatment of tuberculoma and can also establish a reliable diagnosis for all patients with SPNs.
文摘Background:Hepatic hydrothorax is defined as a significant pleural effusion in patients with liver cirrhosis and without underlying cardiopulmonary diseases. Treatment of hepatic hydrothorax remains a challenge at present. Methods:Herein we share our experiences in the treatment of 12 patients with hepatic hydrothorax by video-assisted thoracoscopic surgery(VATS) . Repair of the diaphragmatic defects,or pleurodesis by focal pleurectomy,talc spray,mechanical abrasion,electro-cauterization or injection was administered intraoperatively,and tetracycline intrapleural injection was used postoperatively for patients with prolonged(>7 d) high-output(>300 ml/d) pleural effusion. Results:Out of the 12 patients,8(67%) had uneventful postoperative course and did not require tube for drainage more than 3 months after discharge. In 4(33%) patients the pleural effusion still recurred after discharge due to end-stage cirrhosis with massive ascites. Conclusion:We conclude that the repair of the diaphragmatic defect and pleurodesis through VATS could be an alternative of transjugular intrahepatic portal systemic shunt (TIPS) or a bridge to liver transplantation for patients with refractory hepatic hydrothorax. Pleurodesis with electrocauterization can be an alternative therapy if talc is unavailable.
