Enhanced recovery after surgery in elderly patients with non-small cell lung cancer who underwent video-assisted thoracic surgery

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.

Impact of the Rapid Recovery Concept on Complications and Patient Quality of Life in the Perioperative Nursing of Robot-Assisted Radical Oesophageal Cancer

Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .

Gastroparesis after video-assisted thoracic surgery:A case report

BACKGROUND Video-assisted thoracic surgery(VATS)lobectomy is a common treatment for patients with early-stage lung cancer.Some patients can experience slight gastrointestinal discomfort after lobectomy for a moment.Gastroparesis is a gastrointestinal disorder that can be severe;it is associated with an increased risk of aspiration pneumonia and impaired postoperative recovery.Here,we report a rare case of gastroparesis after VATS lobectomy.CASE SUMMARY A 61-year-old man underwent VATS right lower lobectomy uneventfully but had an obstruction of the upper digestive tract 2 d after surgery.Acute gastroparesis was diagnosed after emergency computed tomography and oral iohexol X-ray imaging.After gastrointestinal decompression and administration of prokinetic drugs,the patient’s gastrointestinal symptoms improved.Since perioperative medication was applied according to the recommended dose and there was no evidence of electrolyte imbalance,intraoperative periesophageal vagal nerve injury was the most likely underlying cause of gastroparesis.CONCLUSION Although gastroparesis is a rare perioperative complication following VATS,clinicians should be on the alert when patients complain about gastrointestinal discomfort.When surgeons resect paraesophageal lymph nodes with electrocautery,excessive ambient heat and compression of paraesophageal hematoma might induce vagal nerve dysfunction.

Robot-assisted lobectomy in a patient with poor lung function:Another advantage of robot-assisted thoracoscopic surgery

Patients with poor lung function have a high-risk for pulmonary complications following lobectomy.The development of minimally invasive thoracic surgical techniques allows sicker patients to safely undergo lung resection.Robotic lobectomy could benefit these higher risk patients.Here we present a case of a 58-year-old female patient with poor lung function presented with a 3-cm mass in her lower left pulmonary lobe,who successfully underwent lobectomy via robot-assisted thoracoscopic surgery.Her forced expiratory volume in one second was slightly improved compared to the preoperative value.Her forced vital capacity continued to improve in the follow-up period.There was no recorded recurrence during the three years follow-up period.

Evolving thoracic surgery: from open surgery to single port thoracoscopic surgery and future robotic

Thoracic Surgery is a continuous evolving specialty. In the past, thoracic surgeons had to make large incisions in order to operate any pathology inside the chest. This often meant big, painful and ugly scars and long recovery times after surgery. But he history of thoracic surgery changed since the begining of video-assisted thoracoscoDic surgery （VATg3

Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery

With the continuous development of digital medicine,minimally invasive precision and safety have become the primary development trends in hepatobiliary surgery.Due to the specificity and complexity of hepatobiliary surgery,traditional preoperative imaging techniques such as computed tomography and magnetic resonance imaging cannot meet the need for identification of fine anatomical regions.Imaging-based three-dimensional(3D)reconstruction,virtual simulation of surgery and 3D printing optimize the surgical plan through preoperative assessment,improving the controllability and safety of intraoperative operations,and in difficult-to-reach areas of the posterior and superior liver,assistive robots reproduce the surgeon’s natural movements with stable cameras,reducing natural vibrations.Electromagnetic navigation in abdominal surgery solves the problem of conventional surgery still relying on direct visual observation or preoperative image assessment.We summarize and compare these recent trends in digital medical solutions for the future development and refinement of digital medicine in hepatobiliary surgery.

Effect of Nalmefene on Delayed Neurocognitive Recovery in Elderly Patients Undergoing Video-assisted Thoracic Surgery with One Lung Ventilation

The intravenous use of nalmefene has been found to exert neuroprotective effect in patients with severe traumatic brain injury and acute cerebral infarction;nonetheless,it is unknown whether nalmefene alleviates delayed neurocognitive recovery.Our purpose of the current research was to clarify the impact of nalmefene on delayed neurocognitive recovery in aged patients experiencing video-assisted thoracic surgery(VATS)with intraoperative use of one lung ventilation(OLV).The present study involved 120 paticents undergoing selective VATS,randomized to accept low-dose nalmefene(N1 group,n=40),high-dose nalmefene(N2 group,1n=40)or equal volume of physiologic saline(control group,1=40).A battery of neuropsychological tests were used to estimate cognitive function I day before surgery(o)and 10 days after surgery or before discharge(t).Regional cerebral oxygen saturation(rSO2)was detected 5 min before induction(t),5 min after induction(1),15 and 60 min after onset of OLV(62 and 13),and 15 min after termination of OLV(4).The plasma values of interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-a1 and adiponectin(ADP)were also detected prior to induction of anesthesia(T0),1 h,2 h and 6 h after surgery(TI,T2,T3).On 1,delayed neurocognitive recovery occurred in 5/40(12.5%)patients of NI group,in 5/40(12.5%)patients of N2 group and in 13/40(32.5%)patients of control group(P<0.05).There were no statistical differences in rSO2 among three groups at different time points.At Tl,T2 and T3,IL-1β,IL-6 and TNF-a values significantly increased and ADP value significantly decreased(P<0.05)in control group.In contrast,at TI,T2 and T3,IL-1β,IL-6 and TNF-a values decreased and ADP value decreased less in N1 and N2 groups(P<0.05).At TI,T2 and T3,IL-1β,IL-6 and TNF-a concentrations presented a trend of N2 group<N1 group<control group and ADP presented a trend of N2 group>Nl group>control group(P<0.05).The result of our present research supports the hypothesis that the perioperative intravenous treatment with nalmefene to VATS with OLV ameliorates postoperative cognitive function and decreases the incidence of delayed neurocognitive recovery,most likely by suppression of inflammatory responses.

Case Report:Pulmonary actinomycosis:a case undergoing resection through video-assisted thoracic surgery (VATS)

Actinomycosis is an uncommon disease, which is usually manifested as cervicofacial infection and related to poor oral hygiene or compromised immune function. Pulmonary actinomycosis is rare, but its diagnosis is changing due to its variable presentation and the similarity in appearance to other intrapulmonary diseases. Here we report an 80-year-old man with a solitary pulmonary nodule over the left upper lobe. Pulmonary neoplasm was highly suspected in this patient and thus resection of the mass was undertaken through video-assisted thoracic surgery (VATS). Histopathological examination demonstrated this patient had an Actinomyeces infection. While the application of VATS in patients with pulmonary actinomycosis has rarely been reported in literature, we conclude that VATS is valuable for the diagnosis and treatment of patients with undetermined pulmonary nodule(s).

Partial removal of the pulmonary artery in video-assisted thoracic surgery for non-small cell lung cancer

Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery （VATS） currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techniques in open thoracic surgery into video-assisted thoracic surgery （VATS） procedures. In this study, we reported a surgical technique simultaneously blocking the pulmonary artery and the pulmonary vein for partial removal of the pulmonary artery under VATS. Seven patients with non-small-cell lung cancer （NSCLC） received lobectomy with partial removal of the pulmonary artery using the technique between December 2007 and March 2012. Briefly, rather than using a small clamp on the distal pulmonary artery to the area of invading cancer, we replaced a vascular clamp with a ribbon and Hem-o-lock clip to block the preserved pulmonary veins so as to prevent back bleeding and yield a better view for surgeons. The mean occlusion time of the pulmonary artery and pulmonary veins were 44.0±10.0 and 41.3±9.7 minutes, respectively. The mean repair time of the pulmonary artery was 25.3±13.7 minutes. No complications occurred. No patients showed abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. In conclusion, the technique for blocking the pulmonary artery and veins is feasible and safe in VATS and reduces the risk of abrupt intraoperative bleeding and the chance of converting to open thoracotomy, and extends the indications of VATS lobectomy.

Malignant pleural mesothelioma mimics thoracic empyema: A case report

BACKGROUND Thoracic empyema and malignant pleural mesothelioma(MPM)are distinct medical conditions with similar symptoms,including cough,chest pain,and breathing difficulty.We present a rare MPM case mimicking thoracic empyema.Physicians must consider MPM risks for patients exposed to building material who exhibit lobulated pleural effusions,indicating thoracic empyema.CASE SUMMARY A 68-year-old retired male construction worker suffered from shortness of breath and chest tightness over 10 d,particularly during physical activity.A poor appetite and 4 kg weight loss over the past 3 wk were also reported.Chest images and laboratory data concluded a tentative impression of empyema thoracis(right).Video-assisted thoracic surgery with decortication and delobulation(right)was conducted.The pathological report yielded an MPM diagnosis.Refractory pleural bilateral effusions and respiratory failure developed postoperatively,and the patient died three weeks after the operation.CONCLUSION Thoracic empyema and MPM are distinct medical conditions that can present similar symptoms,and video-assisted thoracic surgery facilitates an accurate diagnosis.Empyema-mimicking presentations and postoperative refractory pleural effusion may indicate a poor MPM outcome.

Nonintubated video-assisted thoracic surgery under epidural anesthesia—Encouraging early results encourage randomized trials

Nonintubated video-assisted thoracic surgery （VATS） that is also defined awake VATS entails thoracoscopic procedures performed by regional anesthesia in spontaneously ventilating,mildly sedated or fully awake patients.

The Application of Specific Nursing in Perioperative Patients of Thoracic Surgery and Postoperative Recovery and Improvement of Patients’ Negative Emotions

Objective: To study the application of specific nursing in perioperative patients of thoracic surgery and postoperative recovery and improvement of patients’ negative emotions. Patients and Methods: A total of 88 patients in the thoracic surgery operating room of our hospital were selected and divided into group A (specific nursing, n = 44) and group B (routine nursing, n = 44). The anxiety and depression status of the two groups were assessed by the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS). The relevant respiratory parameters after surgery, including total lung capacity, maximum respiration flow-rate, tidal volume, and vital capacity were observed. The extubation time, ICU hospitalization time, and VAS scores of postoperative pain were compared, with a score of 10 being full. The higher the score, the higher the pain. The in-cidence of postoperative wound infection, pulmonary infection, respiratory tract infection and the satisfaction with the operation were compared. Sf-36 scale was used to score the physical function, life function, psychological function and quality of life of the patients in the two groups. Results: The surgical effect of group A was significantly higher than that of group B (all p < 0.05). The total lung capacity, maximum respiration flow-rate, tidal volume and vital capacity of group A were significantly higher than those of group B (all p < 0.05). The extubation time and hospitalization time of group A were significantly higher than those of group B (all p < 0.05). VAS score of group A was significantly lower than that of group B (all p < 0.05). The infection rate of group A was significantly lower than that in group B (all p < 0.05). Conclusion: Specific nursing has higher application value than routine nursing, which is worth further promotion in clinic.

Video-assisted thoracic surgery―the past, present status and the future

Video-assisted thoracic surgery (VATS) has developed very rapidly in these two decades, and has replaced conven-tional open thoracotomy as a standard procedure for some simple thoracic operations as well as an option or a complementary procedure for some other more complex operations. In this paper we will review its development history, the present status and the future perspectives.

Video-Assisted Thoracic Surgery as a Less-Invasive Management for Acute Hemothorax in Blunt Trauma

Purpose: We report our experience of Video-assisted thoracic surgery (VATS) to treat acute blunt traumatic hemothorax using mini-thoracotomy. Methods: We designed a prospective study to determine if VATS with mini-thoracotomy benefits for patients with blunt traumatic hemothorax compared with conventional repair through full thoracotomy. Twenty-five patients underwent emergency operation for acute hemothorax from 2000. Five patients with less than 5% probability of survival (PS) were excluded, leaving 20 as the subjects. Results: Ten patients underwent conventional thoracotomy (conventional group) and the other 10 patients underwent VATS with mini-thoracotomy (VATS group). There was no difference between conventional group and VATS group in injury severity score (29.1 and 27.0) or PS (81.2% and 80.7%). Hospital mortality rates were 10% in conventional group and 0% in VATS group (N.S). Total amounts of intra-operative bleeding and post-operative transfusion until day 7 were 735 ml and 19.3 units in conventional group and 303 ml and 9.2 units in VATS group respectively (N.S). The length of ICU stay was 9.7 days in conventional group and 5.9 days in VATS group (N.S). Conclusion: VATS with mini-thoracotomy can be alternative for patients with blunt traumatic hemothorax in most emergency operations.

Application of video-assisted thoracic surgery in the standard operation for thoracic tumors

Objective: To evaluate the short-term outcomes of video-assisted thoracic surgery (VATS) for thoracic tumors. Methods: The data of 1,790 consecutive patients were retrospectively reviewed. These patients underwent VATS pulmonary resections, VATS esophagectomies, and VATS resections of mediastinal tumors or biopsies at the Cancer Institute & Hospital, Chinese Academy of Medical Sciences between January 2009 and January 2012. Results: There were 33 patients converted to open thoracotomy (OT, 1.84%). The overall morbidity and mortality rate was 2.79% (50/1790) and 0.28% (5/1790), respectively. The overall hospitalization and chest tube duration were shorter in the VATS lobectomy group (n=949) than in the open thoracotomy (OT) lobectomy group (n=753). There were no significant differences in morbidity rate, mortality rate and operation time between the two groups. In the esophageal cancer patients, no significant difference was found in the number of nodal dissection, chest tube duration, morbidity rate, mortality rate, and hospital length of stay between the VATS esophagectomy group (n=81) and open esophagectomy group (n=81). However, the operation time was longer in the VATS esophagectomy group. In the thymoma patients, there was no significant difference in the chest tube duration, morbidity rate, mortality rate, and hospital length of stay between the VATS thymectomy group (n=41) and open thymectomy group (n=41). However, the operation time was longer in the VATS group. The median tumor size in the VATS thymectomy group was comparable with that in the OT group. Conclusions: In early-stage (I/II) non-small cell lung cancer patients who underwent lobectomies, VATS is comparable with the OT approach with similar short-term outcomes. In patients with resectable esophageal cancer, VATS esophagectomy is comparable with OT esophagectomy with similar morbidity and mortality. VATS thymectomy for Masaoka stage I and II thymoma is feasible and safe, and tumor size is not contraindicated. Longer follow-ups are needed to determine the oncologic equivalency of VATS lobectomy, esophagectomy, and thymectomy for thymoma vs. OT.

Quality of Sleep at the Ward after Cardiothoracic Surgery

Objective: Sleeping problems are among the issues most mentioned by patients after cardiothoracic surgery. These problems can have a negative effect on duration of the hospital stay and recovery. In the ward of our cardiothoracic surgery department, a study was initiated to assess the quality of sleep after cardiothoracic surgery. The primary objective was to investigate the effect of cardiothoracic surgery on the quality of sleep. The secondary objective was to investigate the quality of sleep. Correlations with perioperative factors and related issues such as the type of surgery and medication were sought. Methods: A consecutive prospective cohort study was initiated (N = 72). The study used validated questionnaires to assess sleep: the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Verran Snyder-Halpern Sleep Scale (VSH) and the Factors Influencing Sleep Quality (FISQ). Results: The PSQI showed that the quality of sleep one month after surgery was inferior to the quality of sleep before surgery (p-value: 0.03). The efficiency of sleep (time spent in bed) was higher after surgery then before surgery (p-value: 0.01). The VSH showed increased impaired sleep on the third night after surgery. The most disruptive factors were not being comfortable in a hospital bed, pain and the noise of medical devices. Conclusions: The quality of sleep after cardiothoracic surgery is worse when compared with the preoperative situation. The chief influencing factors are discomfort in bed, pain and disturbance from medical devices. The use of pain medication does not improve the quality of sleep.

Application of a continuous respiratory sound monitoring system in thoracic surgery

Dear Editor,We would like to present a novel system for monitoring double-lumen tube(DTL)positions in thoracic surgery by respiratory sounds at the trachea and the bronchi,based on our previously described methodology,algorithms,and patented technology[1-2].Most thoracic surgeries require one-lung ventilation(OLV).A DLT or a bronchial blocker(BB)is the most common means for managing OLV.Intraoperative DLT or BB malposition is a critical issue that needs to be accurately and promptly detected to prevent the incidence of hypoxemia and unintended re-expansion of operated lung during OLV[3-4].A multi-center study of 2127 patients requiring OLV during thoracic surgery revealed that DLTs were used in 95%of patients with a malposition rate of 14%,and BBs were used in 5%of patients with a malposition rate of 33%[5].

MARKER-BASED MAPPING BETWEEN MEDICAL IMAGE AND ROBOT SPACE IN ROBOT-ASSISTED SURGERY

This paper focuses on the problems of matching a virtual and a real environments by means of hardware and software tools. The real space is represented by a patient’s bone where a set of cuts by means of robot system is to be made. The virtual space is a 3D model of the bone reconstructed from a set of CT slices. Robot system is then not only to machine bones but also to perform the fundamental step of registration between the two spaces. An external force sensor is used to adjust robot stiffness in order to perform the tactile searching necessary for the registration. A simple but reliable software algorithm is used to control the robot for matching between medical image and robot space in robot-assisted surgery. The results show the system proposed is precise enough for application, and tests been made also clarify the way to improve it.