Introduction: Thoracoscopy is a video-assisted surgical approach that mirrors the techniques used in thoracotomy. Our aim is to map the current state of thoracoscopy practice in Cameroon’s hospitals. Methods: This wa...Introduction: Thoracoscopy is a video-assisted surgical approach that mirrors the techniques used in thoracotomy. Our aim is to map the current state of thoracoscopy practice in Cameroon’s hospitals. Methods: This was a descriptive study that collected both retrospective and prospective data over 57 months across four hospitals in Cameroon. It included 13 patients and focused on variables such as socio-demographic factors, clinical profiles, surgical procedures, and postoperative follow-up. Results: Thirteen patients, predominantly male (84.6%, n = 11), with a mean age of 37.5 ± 16 years, were enrolled. Alcohol use (61.5%) and smoking (38.5%) were the most common past histories. The major complaints were dyspnea (84.6%) and chest pain (58.3%). The primary surgical procedure was clot-free thoracoscopy in 30.8% of cases, mainly for persistent hemothorax (41.8%). Most surgeries were elective (76.9%) and performed under general anesthesia with selective intubation (61.5%). The most common approach was single-port thoracoscopy (U-VATS) (76.9%), with no reported difficulties;however, one intraoperative incident occurred and was successfully treated. Drainage was performed systematically in all patients, and one case required conversion to open surgery. Postoperative complications were minor (Clavien-Dindo grade I) and mainly consisted of pain, with a mortality rate of 15.4%. No significant association was found between risk factors and the occurrence of complications or postoperative mortality. Conclusion: Thoracoscopy, a novel approach in our context, primarily focuses on minor thoracic surgeries.展开更多
Magnetic compression anastomosis is a promising treatment option for patients with complex esophageal atresia;but,at the present time,should not be the first therapeutic option in those cases where the surgeon can per...Magnetic compression anastomosis is a promising treatment option for patients with complex esophageal atresia;but,at the present time,should not be the first therapeutic option in those cases where the surgeon can perform a primary anastomosis of the two ends of the esophagus with acceptable tension.展开更多
A 47-year-old woman presented to our hospital with complaints of dysphagia. Esophagogastroduodenoscopy identified a submucosal tumor in the left wall of the esophagus that was diagnosed as a benign schwannoma on biops...A 47-year-old woman presented to our hospital with complaints of dysphagia. Esophagogastroduodenoscopy identified a submucosal tumor in the left wall of the esophagus that was diagnosed as a benign schwannoma on biopsy. Computed tomography revealed a tumor of length 60 mm in the thoracic esophagus, with its cranial edge at the level of the aortic arch. On endoscopy, a submucosal tunnel was created 40 mm proximal to the cranial edge of the tumor, and its oral end was dissected from the mucosal and muscular layers. This was followed by the resection of the entire tumor by left-sided thoracoscopy. The esophageal defect was closed in layer by continuous suture from the thoracic side. Endoscopic closure was achieved by using clips. No postoperative complications were observed. Oral diet was resumed from postoperative day 7 and the patient was discharged on postoperative day 9. This combined approach has not been described for similar tumors. Our experience demonstrated that large esophageal tumors can be safely excised with minimally invasive surgery by using a combination of thoracoscopy and endoscopy.展开更多
BACKGROUND Anatomical segmentectomy has been proposed as a substitution for lobectomy for early-stage lung cancer.However,it requires technical meticulousness due to the complex anatomical variations of segmental vess...BACKGROUND Anatomical segmentectomy has been proposed as a substitution for lobectomy for early-stage lung cancer.However,it requires technical meticulousness due to the complex anatomical variations of segmental vessels and bronchi.AIM To assess the safety and feasibility of three-dimensional computed-tomography bronchography and angiography(3D-CTBA)in performing video-assisted thoracoscopic surgery(VATS)for lung cancers.METHODS In this study,we enrolled 123 patients who consented to undergo thoracoscopic segmentectomy and lobectomy assisted by 3D-CTBA between May 2017 and June 2019.The image data of enhanced computed tomography(CT)scans was reconstructed three-dimensionally by the Mimics software.The results of preoperative 3D-CTBA,in combination with intraoperative navigation,guided the surgery.RESULTS A total of 59 women and 64 men were enrolled,of whom 57(46.3%)underwent segmentectomy and 66(53.7%)underwent lobectomy.The majority of tumor appearance on CT was part-solid ground-glass nodule(pGGN;55.3%).The mean duration of chest tube placement was 3.5±1.6 d,and the average length of postoperative hospital stay was 6.8±1.8 d.Surgical complications included one case of pneumonia and four cases of prolonged air leak lasting>5 d.Notably,there was no intraoperative massive hemorrhage,postoperative intensive-care unit stay,or 30-d mortality.Preoperative 3D-CTBA images can display clearly and vividly the targeted structure and the variations of vessels and bronchi.To reduce the risk of locoregional recurrence,the application of 3D-CTBA with a virtual 3D surgical margin help the VATS surgeon determine accurate distances and positional relations among the tumor,bronchial trees,and the intersegmental vessels.Three-dimensional navigation was performed to confirm the segmental structure,precisely cut off the targeted segment,and avoid intersegmental veins injury.CONCLUSION VATS and 3D-CTBA worked in harmony in our study.This combination also provided a new pattern of transition from lesion-directed location of tumors to computer-aided surgery for the management of early lung cancer.展开更多
BACKGROUND Small pulmonary nodules are tissue shadows and thoracoscopic segmentectomy in China is still at the exploratory stage with limited application.AIM To evaluate the efficacy of thoracoscopic anatomical segmen...BACKGROUND Small pulmonary nodules are tissue shadows and thoracoscopic segmentectomy in China is still at the exploratory stage with limited application.AIM To evaluate the efficacy of thoracoscopic anatomical segmentectomy for small pulmonary nodules.METHODS Medical records of 86 patients with small pulmonary nodules treated at our hospital between August 2016 and October 2019 were retrospectively analyzed;40 cases who underwent thoracoscopic lobectomy were set as a reference group,and 46 cases who underwent thoracoscopic anatomical segmentectomy were set as an observation group.Preoperative and postoperative parameters were measured in both groups,including the percentage of forced expiratory volume in the first second(FEV1%),the percentage of forced vital capacity(FVC%),and the FEV1/FVC ratio(FEV1/FVC).Patients with positive pathological diagnosis received tests for neuron-specific enolase,carbohydrate antigen 125(CA125),CA19-9,and squamous cell carcinoma antigen.Intraoperative bleeding volume,drainage volume,the number of dissected lymph nodes,drainage time,hospital stay,treatment cost,postoperative complications,and postoperative pain condition were compared between the two groups.RESULTS No significant difference was observed in the results of four serum tumor marker(CA125,CA19-9,squamous cell carcinoma antigen,and neuron-specific enolase),the number of dissected lymph nodes,treatment cost,or preoperative pulmonary ventilation index between the two groups.Intraoperative bleeding volume,drainage volume,drainage time,hospital stay,and visual analogue scale score were significantly lower in the observation group(P<0.05).The results of FEV1%,FVC%,and FEV1/FVC were significantly higher in the observation group(P<0.05).CONCLUSION The efficacy of thoracoscopic anatomical segmentectomy and lobectomy for small pulmonary nodules shows no significant difference in terms of lesion removal,but anatomical segmentectomy is less invasive with fewer postoperative complications and less influence on lung function.展开更多
Since the concept of Natural Orifice Translumenal Endoscopic Surgery(NOTES) was introduced,it has continued to gain significantly in popularity and enthusiasm for its potential clinical applications.The ability to per...Since the concept of Natural Orifice Translumenal Endoscopic Surgery(NOTES) was introduced,it has continued to gain significantly in popularity and enthusiasm for its potential clinical applications.The ability to perform conventional laparoscopic and thoracoscopic procedures without the creation of scars and perhaps faster and less painful recovery has prompted a worldwide devotion to further this field.While intraabdominal NOTES has rapidly transitioned from animal models to human trials,applying the NOTES concept to perform thoracic procedures has been slower to gain momentum.The goal of this review is to summarize the current state of transesophageal NOTES thoracoscopy by looking at its potential for diagnostic and therapeutic interventions as well as the challenges in transitioning to human trials.展开更多
Objective To evaluate the operative technique and preliminary results of video-assisted thoracoscopic anterior correction and fusion of scoliosis. Methods Eleven cases underwent thoracoscopic anterior correction and f...Objective To evaluate the operative technique and preliminary results of video-assisted thoracoscopic anterior correction and fusion of scoliosis. Methods Eleven cases underwent thoracoscopic anterior correction and fusion of scoliosis from March 2003 to April 2005 in our hospital were reviewed. They were all females with an average age of 13.1 years old. Of which, 9 cases were idiopathic scoliosis, 1 case was congenital scoliosis, and 1 case was Marian syndrome scoliosis. The coronal Cobb angle and apical vertebral translation before and after surgery as well as at final follow-up were measured. The operation time, blood loss during operation, and peri-operative complications were recorded. The mean operation time was 6. 4 hours, mean instrumented vertebrae were 6.4 segments, and mean blood loss during operation was 364 mU The coronal Cobb angles of the thoracic curve before and after surgery were 45.5° and 15.4° respectively, with an average correction rate of 65.4%. The lumbar curve was corrected from 28.4° to 11.8° , with an average simultaneous correction rate of 57.2%. All of the patients were followed up regularly with an average time of 21.4 months. At the final foUow-up, the coronal Cobb angles of the thoracic and lumbar curves were 19.0° and 20. 1° , with a 3.6° and 8. 3° loss of correction, respectively. The apical vertebral translation was improved from 32. 3 mm to 10.5 mm for the thoracic curve, and from 13.1 mm to 8.2 mm for the lumbar curve. There were 6 cases with peri-opemtive complications, including 1 case of thoracic effusion, 1 case of chylothomx, 1 case of locking plug loosing, 2 cases of aggravation of the unfused lumbar curve （ 1 case also with thoracolumbar kyphosis）, and 1 case with a screw tip causing a contour deformity of the aorta. And 4 of them underwent revision surgery.Conclusions Video-assisted thoracoscopic anterior correction and fusion of scoliosis has good correction capability, less intraoperative bleeding, and favorable cosmetic effect for mild and moderate thoracic scoliosis, but with higher rates of cor- rection loss of the lumbar curve and peri-operative complications. A surgeon should be cautious to perform this technique.展开更多
BACKGROUND Pleural effusions occur for various reasons,and their diagnosis remains challenging despite the availability of different diagnostic modalities.Medical thoracoscopy(MT)can be used for both diagnostic and th...BACKGROUND Pleural effusions occur for various reasons,and their diagnosis remains challenging despite the availability of different diagnostic modalities.Medical thoracoscopy(MT)can be used for both diagnostic and therapeutic purposes,especially in patients with undiagnosed pleural effusion.AIM To assess the diagnostic efficacy and safety of MT in patients with pleural effusion of different causes.METHODS Between January 1,2012 and April 30,2021,patients with pleural effusion underwent MT in the Department of Respiratory Medicine,The Second Affiliated Hospital of Xi’an Jiaotong University(Shaanxi,China).According to the discharge diagnosis,patients were divided into malignant pleural effusion(MPE),tuberculous pleural effusion(TBPE),and inflammatory pleural effusion(IPE)groups.General information,and tuberculosis-and effusion-related indices of the three groups were analyzed.The diagnostic yield,diagnostic accuracy,performance under thoracoscopy,and complications of patients were compared among the three groups.Then,the significant predictive factors for diagnosis between the MPE and TBPE groups were analyzed.RESULTS Of the 106 patients enrolled in this 10-year study,67 were male and 39 female,with mean age of 57.1±14.184 years.Among the 74 thoracoscopy-confirmed patients,41(38.7%)had MPE,21 had(19.8%)TBPE,and 32(30.2%)were undiagnosed.Overall diagnostic yield of MT was 69.8%(MPE:75.9%,TBPE:48.8%,and IPE:75.0%,with diagnostic accuracies of 100%,87.5%,and 75.0%,respectively).Under thoracoscopy,single or multiple pleural nodules were observed in 81.1%and pleural adhesions in 34.0%with pleural effusions.The most common complication was chest pain(41.5%),followed by chest tightness(11.3%)and fever(10.4%).Multivariate logistic regression analyses showed effusion appearance[odds ratio(OR):0.001,95%CI:0.000-0.204;P=0.010]and carcinoembryonic antigen(OR:0.243,95%CI:0.081-0.728;P=0.011)as significant for differentiating MPE and TBPE,with area under the receiver operating characteristic curve of 0.977(95%CI:0.953-1.000;P<0.001).CONCLUSION MT is an effective,safe,and minimally invasive procedure with high diagnostic yield for pleural effusion of different causes.展开更多
BACKGROUND Paragonimiasis is a parasitic disease that has multiple symptoms,with pulmonary types being common.According to our clinical practices,the pleural effusion of our patients is full of fibrous contents.Draina...BACKGROUND Paragonimiasis is a parasitic disease that has multiple symptoms,with pulmonary types being common.According to our clinical practices,the pleural effusion of our patients is full of fibrous contents.Drainage,praziquantel,and triclabendazole are recommended for the treatment,but when fibrous contents are contained in pleural effusion,surgical interventions are necessary.However,no related reports have been noted.Herein,we present a case of pulmonary paragonimiasis treated by thoracoscopy.CASE SUMMARY A 12-year-old girl presented to our outpatient clinic complaining of shortness of breath after exercise for several days.Enzyme-linked immunosorbent assay revealed positivity for antibodies against Paragonimus westermani,serological test showed eosinophilia,and moderate left pleural effusion and calcification were detected on computed tomography(CT).She was diagnosed with paragonimiasis,and praziquantel was prescribed.However,radiography showed an egg-sized nodule in the left pleural cavity during follow-up.She was then admitted to our hospital again.The serological results were normal except slight eosinophilia.CT scan displayed a cystic-like node in the lower left pleural cavity.The patient underwent a thoracoscopic mass resection.A mass with a size of 6 cm×4 cm×3 cm adhered to the pleura was resected.The pathological examination showed that the mass was composed of non-structured necrotic tissue,indicating a granuloma.The patient remainded asymptomatic and follow-up X-ray showed complete removal of the mass.CONCLUSION This case highlights that thoracoscopic intervention is necessary when fibrous contents are present on CT scan or chest roentgenogram to avoid later fibrous lump formation in patients with pulmonary paragonimiasis.展开更多
Background: Distinguishing tuberculous pleural effusion (TPE) from other causes of exudative effusion is often challenging. Delay in treatment initiation can occur while awaiting histo-microbiologic confirmation owing...Background: Distinguishing tuberculous pleural effusion (TPE) from other causes of exudative effusion is often challenging. Delay in treatment initiation can occur while awaiting histo-microbiologic confirmation owing to the paucibacillary nature of the disease. Sago-like nodules are the most common visual finding on gross thoracoscopic appearance. The primary objective was to determine the diagnostic utility of the presence of sago-like nodules on gross thoracoscopic appearance in TPE to help justify early initiation of tuberculosis (TB) treatment based on their finding while awaiting final histo-microbiologic confirmation. Secondary objective was to study the correlation between the presence of sago-like nodules and the final histo-microbiologic findings in pleural biopsy specimens. Methods: This was a retrospective-descriptive study of all patients with exudative pleural effusion who underwent diagnostic medical thoracoscopy (MT) at Hamad General Hospital during an eight-year period (from January, 2008 to December, 2015). Results: The presence of sago-like nodules on gross thoracoscopic appearance of the pleural surface had a sensitivity of 58%, a specificity of 89% and a positive predictive value of 97% for TPE with a diagnostic accuracy of 62%. There is significant association between the presence of sago-like nodules and demonstration of granulomatous inflammation in pleural biopsy specimens (P = 0.000). There is no association between sago-like nodules and positive TB smear and culture in biopsy specimens. Conclusion: The presence of sago-like nodules on gross thoracoscopic appearance has a high specificity and positive predictive value for TPE and significantly correlates with the presence of granulomatous inflammation. Patients from TB prevalent areas with exudative pleural effusion and sago-like nodules on gross thoracoscopic appearance may be commenced on TB chemotherapy while awaiting final histologic confirmation.展开更多
Minimally invasive resection of lung cancer remains surprisingly uncommon in comparison to the adoption of similar techniques in other surgical disciplines. The reported use of video-assisted thoracic surgery (VATS) l...Minimally invasive resection of lung cancer remains surprisingly uncommon in comparison to the adoption of similar techniques in other surgical disciplines. The reported use of video-assisted thoracic surgery (VATS) lobectomy for anatomic resections in comparison to open lobectomy ranges from 10% -40% even though it has been demonstrated to be equivalent in safety and accomplishes the same oncologic goals. Further, it may provide improved survival outcomes as others have reported benefits in perioperative recovery and patient satisfaction. VATS pneumonectomy has been far less commonly described despite the physiologic advantages such as less blood loss, shorter intensive care stay, and less respiratory compromise. This report specifically addresses this lacuna by drawing upon the successful case of a VATS pneumonectomy with fissure invasion and then considering why minimally invasive VATS techniques remain underutilized. In conclusion, we suggest that focused thoracic surgery fellowship training in VATS techniques will make thoracoscopic surgery a more conventional technique rather than a challenging procedure.展开更多
Thoracoscopy is a well established invasive method for the diagnosis and management of pleural nosologies. The role and the impact that this procedure exerts in settings alongside the diagnostic yield in pleural malig...Thoracoscopy is a well established invasive method for the diagnosis and management of pleural nosologies. The role and the impact that this procedure exerts in settings alongside the diagnostic yield in pleural malignancies are unquestionable. New insights and novel techniques promise an even greater future towards the usefulness of this technique in interventional pneumonology. This is a short review highlighting the principles and novel aspects in the evolutionary progress of pleuroscopy.展开更多
Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires tho...Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires thoracotomy.In recent years,there have been several reports of resection of substernal goiters by minimally invasive surgery.Here,we present a 75-year-old female with a giant substernal goiter who successfully underwent resection of the goiter extending to the posterior mediastinum using low cervical incision combined with video-assisted thoracoscopy.展开更多
BACKGROUND Paragangliomas(PGLs)are rare catecholamine-secreting neuroendocrine tumors,which often present with secondary hypertension.The most common location is the retroperitoneal space.For the first time,we report ...BACKGROUND Paragangliomas(PGLs)are rare catecholamine-secreting neuroendocrine tumors,which often present with secondary hypertension.The most common location is the retroperitoneal space.For the first time,we report a rare case of large retroperitoneal compound PGL,and we have innovatively applied a new surgical plan to completely remove the tumor.CASE SUMMARY A 55-year-old middle-aged man was admitted to the hospital for fluctuating blood pressure for more than 1 year with intermittent headache.He suffered dozens of attacks every day.Blood and urine catecholamines were elevated,somatostatin receptor imaging was positive,and the diagnosis of PGL was clear.The imaging examination revealed a large tumor on the right front of the mediastinal spine at the level of T10-L1(the posterior space of the right phrenic foot).For the first time in our department,a combined thoracoscopic and laparoscopic operation was used to detect and remove large tumors.CONCLUSION This is the first reported case of using a thoracoscopic and laparoscopic approach simultaneously to remove a large retroperitoneal compound PGL,which may provide a new surgical approach for similar cases.展开更多
BACKGROUND Giant hernias present a significant challenge for digestive surgeons.The approach taken(laparoscopic vs thoracoscopic)depends largely on the preferences and skills of each surgeon,although in most cases tod...BACKGROUND Giant hernias present a significant challenge for digestive surgeons.The approach taken(laparoscopic vs thoracoscopic)depends largely on the preferences and skills of each surgeon,although in most cases today the laparoscopic approach is preferred.AIM To determine whether patients presenting inadequate laparoscopic access to the intrathoracic hernial sac obtain poorer postoperative results than those with no such problem,in order to assess the need for a thoracoscopic approach.METHODS For the retrospective series of patients treated in our hospital for hiatal hernia(n=112),we calculated the laparoscopic field of view and the working area accessible to surgical instruments,by means of preoperative imaging tests,to assess the likely outcome for cases inaccessible to laparoscopy.RESULTS Patients with giant hiatal hernias for whom a preoperative calculation suggested that the laparoscopic route would not access all areas of the intrathoracic sac presented higher rates of perioperative complications and recurrence during follow-up than those for whom laparoscopy was unimpeded.The difference was statistically significant.Moreover,the insertion of mesh did not improve results for the non-accessible group.CONCLUSION For patients with giant hiatal hernias,it is essential to conduct a preoperative evaluation of the angle of vision and the working area for surgery.When parts of the intrathoracic sac are inaccessible laparoscopically,the thoracoscopic approach should be considered.展开更多
文摘Introduction: Thoracoscopy is a video-assisted surgical approach that mirrors the techniques used in thoracotomy. Our aim is to map the current state of thoracoscopy practice in Cameroon’s hospitals. Methods: This was a descriptive study that collected both retrospective and prospective data over 57 months across four hospitals in Cameroon. It included 13 patients and focused on variables such as socio-demographic factors, clinical profiles, surgical procedures, and postoperative follow-up. Results: Thirteen patients, predominantly male (84.6%, n = 11), with a mean age of 37.5 ± 16 years, were enrolled. Alcohol use (61.5%) and smoking (38.5%) were the most common past histories. The major complaints were dyspnea (84.6%) and chest pain (58.3%). The primary surgical procedure was clot-free thoracoscopy in 30.8% of cases, mainly for persistent hemothorax (41.8%). Most surgeries were elective (76.9%) and performed under general anesthesia with selective intubation (61.5%). The most common approach was single-port thoracoscopy (U-VATS) (76.9%), with no reported difficulties;however, one intraoperative incident occurred and was successfully treated. Drainage was performed systematically in all patients, and one case required conversion to open surgery. Postoperative complications were minor (Clavien-Dindo grade I) and mainly consisted of pain, with a mortality rate of 15.4%. No significant association was found between risk factors and the occurrence of complications or postoperative mortality. Conclusion: Thoracoscopy, a novel approach in our context, primarily focuses on minor thoracic surgeries.
文摘Magnetic compression anastomosis is a promising treatment option for patients with complex esophageal atresia;but,at the present time,should not be the first therapeutic option in those cases where the surgeon can perform a primary anastomosis of the two ends of the esophagus with acceptable tension.
文摘A 47-year-old woman presented to our hospital with complaints of dysphagia. Esophagogastroduodenoscopy identified a submucosal tumor in the left wall of the esophagus that was diagnosed as a benign schwannoma on biopsy. Computed tomography revealed a tumor of length 60 mm in the thoracic esophagus, with its cranial edge at the level of the aortic arch. On endoscopy, a submucosal tunnel was created 40 mm proximal to the cranial edge of the tumor, and its oral end was dissected from the mucosal and muscular layers. This was followed by the resection of the entire tumor by left-sided thoracoscopy. The esophageal defect was closed in layer by continuous suture from the thoracic side. Endoscopic closure was achieved by using clips. No postoperative complications were observed. Oral diet was resumed from postoperative day 7 and the patient was discharged on postoperative day 9. This combined approach has not been described for similar tumors. Our experience demonstrated that large esophageal tumors can be safely excised with minimally invasive surgery by using a combination of thoracoscopy and endoscopy.
基金National Natural Science Foundation of China,No.81800050Natural Science Fund of Yangzhou City,No.YZ2017119Science and Technology Innovation Cultivation Program of Yangzhou University,No.2017CXJ122.
文摘BACKGROUND Anatomical segmentectomy has been proposed as a substitution for lobectomy for early-stage lung cancer.However,it requires technical meticulousness due to the complex anatomical variations of segmental vessels and bronchi.AIM To assess the safety and feasibility of three-dimensional computed-tomography bronchography and angiography(3D-CTBA)in performing video-assisted thoracoscopic surgery(VATS)for lung cancers.METHODS In this study,we enrolled 123 patients who consented to undergo thoracoscopic segmentectomy and lobectomy assisted by 3D-CTBA between May 2017 and June 2019.The image data of enhanced computed tomography(CT)scans was reconstructed three-dimensionally by the Mimics software.The results of preoperative 3D-CTBA,in combination with intraoperative navigation,guided the surgery.RESULTS A total of 59 women and 64 men were enrolled,of whom 57(46.3%)underwent segmentectomy and 66(53.7%)underwent lobectomy.The majority of tumor appearance on CT was part-solid ground-glass nodule(pGGN;55.3%).The mean duration of chest tube placement was 3.5±1.6 d,and the average length of postoperative hospital stay was 6.8±1.8 d.Surgical complications included one case of pneumonia and four cases of prolonged air leak lasting>5 d.Notably,there was no intraoperative massive hemorrhage,postoperative intensive-care unit stay,or 30-d mortality.Preoperative 3D-CTBA images can display clearly and vividly the targeted structure and the variations of vessels and bronchi.To reduce the risk of locoregional recurrence,the application of 3D-CTBA with a virtual 3D surgical margin help the VATS surgeon determine accurate distances and positional relations among the tumor,bronchial trees,and the intersegmental vessels.Three-dimensional navigation was performed to confirm the segmental structure,precisely cut off the targeted segment,and avoid intersegmental veins injury.CONCLUSION VATS and 3D-CTBA worked in harmony in our study.This combination also provided a new pattern of transition from lesion-directed location of tumors to computer-aided surgery for the management of early lung cancer.
文摘BACKGROUND Small pulmonary nodules are tissue shadows and thoracoscopic segmentectomy in China is still at the exploratory stage with limited application.AIM To evaluate the efficacy of thoracoscopic anatomical segmentectomy for small pulmonary nodules.METHODS Medical records of 86 patients with small pulmonary nodules treated at our hospital between August 2016 and October 2019 were retrospectively analyzed;40 cases who underwent thoracoscopic lobectomy were set as a reference group,and 46 cases who underwent thoracoscopic anatomical segmentectomy were set as an observation group.Preoperative and postoperative parameters were measured in both groups,including the percentage of forced expiratory volume in the first second(FEV1%),the percentage of forced vital capacity(FVC%),and the FEV1/FVC ratio(FEV1/FVC).Patients with positive pathological diagnosis received tests for neuron-specific enolase,carbohydrate antigen 125(CA125),CA19-9,and squamous cell carcinoma antigen.Intraoperative bleeding volume,drainage volume,the number of dissected lymph nodes,drainage time,hospital stay,treatment cost,postoperative complications,and postoperative pain condition were compared between the two groups.RESULTS No significant difference was observed in the results of four serum tumor marker(CA125,CA19-9,squamous cell carcinoma antigen,and neuron-specific enolase),the number of dissected lymph nodes,treatment cost,or preoperative pulmonary ventilation index between the two groups.Intraoperative bleeding volume,drainage volume,drainage time,hospital stay,and visual analogue scale score were significantly lower in the observation group(P<0.05).The results of FEV1%,FVC%,and FEV1/FVC were significantly higher in the observation group(P<0.05).CONCLUSION The efficacy of thoracoscopic anatomical segmentectomy and lobectomy for small pulmonary nodules shows no significant difference in terms of lesion removal,but anatomical segmentectomy is less invasive with fewer postoperative complications and less influence on lung function.
文摘Since the concept of Natural Orifice Translumenal Endoscopic Surgery(NOTES) was introduced,it has continued to gain significantly in popularity and enthusiasm for its potential clinical applications.The ability to perform conventional laparoscopic and thoracoscopic procedures without the creation of scars and perhaps faster and less painful recovery has prompted a worldwide devotion to further this field.While intraabdominal NOTES has rapidly transitioned from animal models to human trials,applying the NOTES concept to perform thoracic procedures has been slower to gain momentum.The goal of this review is to summarize the current state of transesophageal NOTES thoracoscopy by looking at its potential for diagnostic and therapeutic interventions as well as the challenges in transitioning to human trials.
文摘Objective To evaluate the operative technique and preliminary results of video-assisted thoracoscopic anterior correction and fusion of scoliosis. Methods Eleven cases underwent thoracoscopic anterior correction and fusion of scoliosis from March 2003 to April 2005 in our hospital were reviewed. They were all females with an average age of 13.1 years old. Of which, 9 cases were idiopathic scoliosis, 1 case was congenital scoliosis, and 1 case was Marian syndrome scoliosis. The coronal Cobb angle and apical vertebral translation before and after surgery as well as at final follow-up were measured. The operation time, blood loss during operation, and peri-operative complications were recorded. The mean operation time was 6. 4 hours, mean instrumented vertebrae were 6.4 segments, and mean blood loss during operation was 364 mU The coronal Cobb angles of the thoracic curve before and after surgery were 45.5° and 15.4° respectively, with an average correction rate of 65.4%. The lumbar curve was corrected from 28.4° to 11.8° , with an average simultaneous correction rate of 57.2%. All of the patients were followed up regularly with an average time of 21.4 months. At the final foUow-up, the coronal Cobb angles of the thoracic and lumbar curves were 19.0° and 20. 1° , with a 3.6° and 8. 3° loss of correction, respectively. The apical vertebral translation was improved from 32. 3 mm to 10.5 mm for the thoracic curve, and from 13.1 mm to 8.2 mm for the lumbar curve. There were 6 cases with peri-opemtive complications, including 1 case of thoracic effusion, 1 case of chylothomx, 1 case of locking plug loosing, 2 cases of aggravation of the unfused lumbar curve （ 1 case also with thoracolumbar kyphosis）, and 1 case with a screw tip causing a contour deformity of the aorta. And 4 of them underwent revision surgery.Conclusions Video-assisted thoracoscopic anterior correction and fusion of scoliosis has good correction capability, less intraoperative bleeding, and favorable cosmetic effect for mild and moderate thoracic scoliosis, but with higher rates of cor- rection loss of the lumbar curve and peri-operative complications. A surgeon should be cautious to perform this technique.
基金Supported by Shaanxi Science and Technology Research Plan Program,Shaanxi,China,No. 2020SF-106
文摘BACKGROUND Pleural effusions occur for various reasons,and their diagnosis remains challenging despite the availability of different diagnostic modalities.Medical thoracoscopy(MT)can be used for both diagnostic and therapeutic purposes,especially in patients with undiagnosed pleural effusion.AIM To assess the diagnostic efficacy and safety of MT in patients with pleural effusion of different causes.METHODS Between January 1,2012 and April 30,2021,patients with pleural effusion underwent MT in the Department of Respiratory Medicine,The Second Affiliated Hospital of Xi’an Jiaotong University(Shaanxi,China).According to the discharge diagnosis,patients were divided into malignant pleural effusion(MPE),tuberculous pleural effusion(TBPE),and inflammatory pleural effusion(IPE)groups.General information,and tuberculosis-and effusion-related indices of the three groups were analyzed.The diagnostic yield,diagnostic accuracy,performance under thoracoscopy,and complications of patients were compared among the three groups.Then,the significant predictive factors for diagnosis between the MPE and TBPE groups were analyzed.RESULTS Of the 106 patients enrolled in this 10-year study,67 were male and 39 female,with mean age of 57.1±14.184 years.Among the 74 thoracoscopy-confirmed patients,41(38.7%)had MPE,21 had(19.8%)TBPE,and 32(30.2%)were undiagnosed.Overall diagnostic yield of MT was 69.8%(MPE:75.9%,TBPE:48.8%,and IPE:75.0%,with diagnostic accuracies of 100%,87.5%,and 75.0%,respectively).Under thoracoscopy,single or multiple pleural nodules were observed in 81.1%and pleural adhesions in 34.0%with pleural effusions.The most common complication was chest pain(41.5%),followed by chest tightness(11.3%)and fever(10.4%).Multivariate logistic regression analyses showed effusion appearance[odds ratio(OR):0.001,95%CI:0.000-0.204;P=0.010]and carcinoembryonic antigen(OR:0.243,95%CI:0.081-0.728;P=0.011)as significant for differentiating MPE and TBPE,with area under the receiver operating characteristic curve of 0.977(95%CI:0.953-1.000;P<0.001).CONCLUSION MT is an effective,safe,and minimally invasive procedure with high diagnostic yield for pleural effusion of different causes.
文摘BACKGROUND Paragonimiasis is a parasitic disease that has multiple symptoms,with pulmonary types being common.According to our clinical practices,the pleural effusion of our patients is full of fibrous contents.Drainage,praziquantel,and triclabendazole are recommended for the treatment,but when fibrous contents are contained in pleural effusion,surgical interventions are necessary.However,no related reports have been noted.Herein,we present a case of pulmonary paragonimiasis treated by thoracoscopy.CASE SUMMARY A 12-year-old girl presented to our outpatient clinic complaining of shortness of breath after exercise for several days.Enzyme-linked immunosorbent assay revealed positivity for antibodies against Paragonimus westermani,serological test showed eosinophilia,and moderate left pleural effusion and calcification were detected on computed tomography(CT).She was diagnosed with paragonimiasis,and praziquantel was prescribed.However,radiography showed an egg-sized nodule in the left pleural cavity during follow-up.She was then admitted to our hospital again.The serological results were normal except slight eosinophilia.CT scan displayed a cystic-like node in the lower left pleural cavity.The patient underwent a thoracoscopic mass resection.A mass with a size of 6 cm×4 cm×3 cm adhered to the pleura was resected.The pathological examination showed that the mass was composed of non-structured necrotic tissue,indicating a granuloma.The patient remainded asymptomatic and follow-up X-ray showed complete removal of the mass.CONCLUSION This case highlights that thoracoscopic intervention is necessary when fibrous contents are present on CT scan or chest roentgenogram to avoid later fibrous lump formation in patients with pulmonary paragonimiasis.
文摘Background: Distinguishing tuberculous pleural effusion (TPE) from other causes of exudative effusion is often challenging. Delay in treatment initiation can occur while awaiting histo-microbiologic confirmation owing to the paucibacillary nature of the disease. Sago-like nodules are the most common visual finding on gross thoracoscopic appearance. The primary objective was to determine the diagnostic utility of the presence of sago-like nodules on gross thoracoscopic appearance in TPE to help justify early initiation of tuberculosis (TB) treatment based on their finding while awaiting final histo-microbiologic confirmation. Secondary objective was to study the correlation between the presence of sago-like nodules and the final histo-microbiologic findings in pleural biopsy specimens. Methods: This was a retrospective-descriptive study of all patients with exudative pleural effusion who underwent diagnostic medical thoracoscopy (MT) at Hamad General Hospital during an eight-year period (from January, 2008 to December, 2015). Results: The presence of sago-like nodules on gross thoracoscopic appearance of the pleural surface had a sensitivity of 58%, a specificity of 89% and a positive predictive value of 97% for TPE with a diagnostic accuracy of 62%. There is significant association between the presence of sago-like nodules and demonstration of granulomatous inflammation in pleural biopsy specimens (P = 0.000). There is no association between sago-like nodules and positive TB smear and culture in biopsy specimens. Conclusion: The presence of sago-like nodules on gross thoracoscopic appearance has a high specificity and positive predictive value for TPE and significantly correlates with the presence of granulomatous inflammation. Patients from TB prevalent areas with exudative pleural effusion and sago-like nodules on gross thoracoscopic appearance may be commenced on TB chemotherapy while awaiting final histologic confirmation.
文摘Minimally invasive resection of lung cancer remains surprisingly uncommon in comparison to the adoption of similar techniques in other surgical disciplines. The reported use of video-assisted thoracic surgery (VATS) lobectomy for anatomic resections in comparison to open lobectomy ranges from 10% -40% even though it has been demonstrated to be equivalent in safety and accomplishes the same oncologic goals. Further, it may provide improved survival outcomes as others have reported benefits in perioperative recovery and patient satisfaction. VATS pneumonectomy has been far less commonly described despite the physiologic advantages such as less blood loss, shorter intensive care stay, and less respiratory compromise. This report specifically addresses this lacuna by drawing upon the successful case of a VATS pneumonectomy with fissure invasion and then considering why minimally invasive VATS techniques remain underutilized. In conclusion, we suggest that focused thoracic surgery fellowship training in VATS techniques will make thoracoscopic surgery a more conventional technique rather than a challenging procedure.
文摘Thoracoscopy is a well established invasive method for the diagnosis and management of pleural nosologies. The role and the impact that this procedure exerts in settings alongside the diagnostic yield in pleural malignancies are unquestionable. New insights and novel techniques promise an even greater future towards the usefulness of this technique in interventional pneumonology. This is a short review highlighting the principles and novel aspects in the evolutionary progress of pleuroscopy.
基金supported by the Fundamental Research Funds for the Central Universities(2021FZZX005-21).
文摘Approximately 25%of goiters extend to the substernal area,and most of them can be removed through a cervical incision.Goiters that extend into the posterior mediastinum are very rare,and resection usually requires thoracotomy.In recent years,there have been several reports of resection of substernal goiters by minimally invasive surgery.Here,we present a 75-year-old female with a giant substernal goiter who successfully underwent resection of the goiter extending to the posterior mediastinum using low cervical incision combined with video-assisted thoracoscopy.
基金Supported by the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences,No.2019XK320027the Project Management Fund for Foreign Cultural and Educational Experts,No.G20190001645.
文摘BACKGROUND Paragangliomas(PGLs)are rare catecholamine-secreting neuroendocrine tumors,which often present with secondary hypertension.The most common location is the retroperitoneal space.For the first time,we report a rare case of large retroperitoneal compound PGL,and we have innovatively applied a new surgical plan to completely remove the tumor.CASE SUMMARY A 55-year-old middle-aged man was admitted to the hospital for fluctuating blood pressure for more than 1 year with intermittent headache.He suffered dozens of attacks every day.Blood and urine catecholamines were elevated,somatostatin receptor imaging was positive,and the diagnosis of PGL was clear.The imaging examination revealed a large tumor on the right front of the mediastinal spine at the level of T10-L1(the posterior space of the right phrenic foot).For the first time in our department,a combined thoracoscopic and laparoscopic operation was used to detect and remove large tumors.CONCLUSION This is the first reported case of using a thoracoscopic and laparoscopic approach simultaneously to remove a large retroperitoneal compound PGL,which may provide a new surgical approach for similar cases.
文摘BACKGROUND Giant hernias present a significant challenge for digestive surgeons.The approach taken(laparoscopic vs thoracoscopic)depends largely on the preferences and skills of each surgeon,although in most cases today the laparoscopic approach is preferred.AIM To determine whether patients presenting inadequate laparoscopic access to the intrathoracic hernial sac obtain poorer postoperative results than those with no such problem,in order to assess the need for a thoracoscopic approach.METHODS For the retrospective series of patients treated in our hospital for hiatal hernia(n=112),we calculated the laparoscopic field of view and the working area accessible to surgical instruments,by means of preoperative imaging tests,to assess the likely outcome for cases inaccessible to laparoscopy.RESULTS Patients with giant hiatal hernias for whom a preoperative calculation suggested that the laparoscopic route would not access all areas of the intrathoracic sac presented higher rates of perioperative complications and recurrence during follow-up than those for whom laparoscopy was unimpeded.The difference was statistically significant.Moreover,the insertion of mesh did not improve results for the non-accessible group.CONCLUSION For patients with giant hiatal hernias,it is essential to conduct a preoperative evaluation of the angle of vision and the working area for surgery.When parts of the intrathoracic sac are inaccessible laparoscopically,the thoracoscopic approach should be considered.
