Uniportal video-assisted thoracoscopic fissureless right upper lobe anterior segmentectomy for inflammatory myofibroblastic tumor:A case report

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.

Surgical approaches for stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis:feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy in comparison with trans-sternal resection

Complete resection could be achieved in virtually all myasthenic patients with Masaoka stage I and II thymoma us- ing the trans-sternal technique. Whether this is appropriate for minimally invasive approach is not yet clear. We evalu- ated the feasibility of complete video-assisted thoracoscopic surgery （VATS） thymectomy for the treatment of Ma- saoka 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 us- ing 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 pneuomo- mediastinum 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.

Nonintubated uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

Objective： The objective of the current study was to evaluate the feasibility and safety of nonintubated nniportal 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 epidnral anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6th 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 rain （range, 33-65 rain）. No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 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 ofpneumothorax 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.

Video-assisted thoracoscopic surgery (VATS) for bilateral primary spontaneous pneumothorax

Objective： To review our experience of the treatment of bilateral primary spontaneous pneumothorax （PSP） by video-assisted thoracoscopic surgery （VATS）. Materials and methods： Retrospective chart review was followed by an on-clinic or telephone interview. Patients were cared for by one thoracic surgeon in four medical centers or community hospitals in Northern and Central Taiwan. Thirteen patients with bilateral PSP underwent bilateral VATS simultaneously or sequentially from July 1994 to December 2005. Results： Twelve males and one female, with age ranging from 15 to 36 years （mean 23.1 years）, were treated with VATS for bilateral PSP, under the indications of bilateral pneumothoracis simultaneously （n=4） or sequentially （n=9）. The interval between the first and second contra-lateral VATS procedure for non-simultaneous PSP patients ranged from 7 d to 6 years. Eleven of 13 patients （84.6%） had prominent pulmonary bullae/blebs, and underwent bullae resection with mechanical or chemical pleurodesis. The mean operative time was （45.6±18.3） min （range 25-96 min） and （120.6±28.7） min （range 84-166 min） respectively for the non-simultaneous （second VATS for the recurrence of contralateral side after first VATS） and simultaneous （bilateral VATS in one operation） procedures. There was no postoperative mortality. However, prolonged air leakage （〉7 d） occurred in one patient （7.7%） who recovered after conservative treatment. The mean duration of chest tube drainage was 3.1 d and the median follow up period was 3.4 years. Conclusions： VATS is a safe and effective procedure in the treatment of bilateral PSP. Bilateral VATS is only recommended for patients with simultaneously bilateral PSP, because the incidence of recurrence, even with visible bullae, was not so high in my group and in some previous literature. Bilateral VATS in a supine position should only be used in selective cases, because of possible pleural adhesion or hidden bullae on the posterior side.

Safety and feasibility of video-assisted thoracoscopic surgery for stage IIIA lung cancer

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.

A single institution experience using the LigaSure vessel sealing system in video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

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.

Experiences and benefits of positron emitted tomography-computed tomography (PET-CT) combined with video-assisted thoracoscopic surgery (VATS) in the diagnosis of Stage 1 sarcoidosis

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 involvement） 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 satisfactory results. Conclusion： VATS biopsy is a minimally invasive, safe and effective procedure. It can be used as a diagnostic altermative 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.

Uniportal video-assisted thoracoscopic surgery for complex mediastinal mature teratoma:A case report

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.

Middle lobe torsion after right upper and lower lobectomy:repositioning of lobar torsion using a3-cm uniportal video-assisted thoracoscopic surgery

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.

Comparison of the body pain and trauma degree between uni-portal and three-portal video-assisted thoracoscopic surgery for the treatment of lung cancer

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.

Risk factors for conversion to thoracotomy from video-assisted thoracoscopic surgery of lung cancer

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.

Phrenic Nerve Injury Is a Differential Diagnosis of Hypoxemia after Video-Assisted Thoracoscopic Thymectomy:2 Cases Report and Literature Review

Hypoxemia after general anesthesia is not uncommon.For patients after thoracotomy,the differential diagnosis is usually difficult.Surgical,anesthetic,and patient-associated factors may contribute to postoperative hypoxemia.We described two patients who underwent videassisted thoracoscopic thymectomy and developed hypoxemia immediately after extubation.Phrenic nerve injury was suspected in both patients.One case recovered spontaneously without intervention.The second case who had been demonstrated as bilateral phrenic nerve injury after the operation was continuously on ventilator after physical therapy and respiratory training for 2 months.

Video-assisted thoracoscopic surgery in thoracic oncology

Objective： The purpose of this study was to summarize and discuss the application of video-assisted thoracoscopic surgery （VATS） in the treatment of 58 chest cancers. Methods： The clinical data of 58 patients with thoracic tumor were analyzed retrospectively in treatment with VATS from July 2005 to June 2007. The surgery treatments included pulmonary wedge resection, enucleation of esophageal leiomyoma, bronchogenic cyst excision, mediastinal cyst excision, etc. Results： All patients were treated with VATS. Three patients of those with lung cancer underwent open-chest Iobectomy resection. All patients had no death and few complications, and all discharged. Conclusion： VATS has advantages of less trauma, suffering light, quick recovery and small postoperative complications and has a great advantage in the treatment of chest benign tumors. But in the treatment of chest malignant tumors we should strictly control indications.

Long-term survival outcomes of video-assisted thoracic surgery for patients with non-small cell lung cancer

Background： Video-assisted thoracic surgery （VATS） has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer （NSCLC）. However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival. Methods： Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival. Results： Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients （69%）. The median 5-year overall survival for Stage Ⅰ, Ⅱ, Ⅲ and Ⅳ disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis. Conclusions： VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectableNSCLC

Clinical experiences with 20 cases of single-direction thoracoscopic lobectomy and systematic lymph node dissection for peripheral NSCLC

Objective: To evaluate the safety, efficacy, feasibility of single-direction thoracoscopic lobectomy for peripheral lung cancer. Methods: From December 2009 to March 2011, 20 patients with peripheral lung cancer were treated with single-direction thoracoscopic lobectomy and systemic lymph nodes dissection. Results: Surgeries were successfully performed. No significant complications occurred perioperatively. The average operation time was 193 min, the average blood loss was 234 ml, the average duration of drainage was 6 d, the postoperative hospital stay was 12 d, and the average number of lymph nodes dissected was 16. Conclusion: Single-direction thoracoscopic lobectomy is feasible and safe in the treatment of peripheral lung cancer and can simplify the surgical procedures.

Removal of esophageal benign tumors with gastroscope-assisted thoracoscopic surgery

The purpose of the study was to report our experience in the treatment of benign esophageal tu- mors with fiberoptic gastroscope-assisted thoracoscopic surgery. Methods： We retrospectively analyzed the clinical data of 24 consecutive patients （22 with esophageal leiomyoma and 2 with esophageal mesenchymoma） who underwent gas-troscope-assisted thoracoscopic surgery. There were 17 male and 7 female with a mean age of 36 years. The tumors were located in the upper and middle part of the esophagus in 17 cases and lower part in 7 cases. Results： All 24 procedures were successfully performed. The median operative time was 84 minutes and the median hospital stay was 7.5 days. One esophageal perforation due to dissection of a large lesion occurred intraoperatively, which was repaired by suturing. No deaths or other severe postoperative complications were encountered during the median follow-up period of 20.5 months. Conclusion： Gastroscope-assisted thoracoscopic surgery provides a safe and effective alternative to open thoracotomy in the treatment of benign esophageal tumors.

Completely video-assisted thoracoscopic lobectomy versus open lobectomy for non-small cell lung cancer greater than 5 cm：a retrospective study

Background Completely video-assisted thoracoscopic Iobectomy is a reasonable treatment for early-stage non-small-cell lung cancer （NSCLC）.At present,the indication for this procedure is stage la and Ib peripheral lung cancer （（〈-）5 cm）; however,for larger tumors,it remains controversial whether this surgical technique is comparable to open Iobectomy.This study aimed to evaluate the safety,completeness,and efficacy of thoracoscopic Iobectomy,and to compare this technique with open Iobectomy for the treatment of non-small-cell lung cancer when the tumor＇s diameter was greater than 5 cm.Methods From May 2001 to April 2011,802 patients underwent a Iobectomy for treatment of non-small-cell lung cancer at our center.In 133 patients,the tumor was 〉 5 cm.There were 98 men and 35 women,median age 63 years （range：29-81 years）.We divided the patients into two groups,group V （completely video-assisted thoracoscopic surgery）,and group T （open Iobectomy）,and evaluated the two groups for age,gender,tumor size,pathological type,location,duration of surgery,blood loss,lymph node dissection,pathological stage,time of drainage,hospitalization,complications,overall survival and recurrence.Results There were 46 cases in group V and 87 cases in group T.Age,gender,tumor size,location,pathological type and stage were similar between the two groups.Group V had shorter operative duration （（186.5±62.8） minutes vs.（256.7±67.5） minutes,P 〈0.001） and reduced bleeding （（218.5±174.6） ml vs.（556.9±187.2） ml,P 〈0.001）.There were no significant differences between the two groups in complications,lymph node dissection,time of drainage and hospitalization.The recurrence between the two groups was equivalent （2.4% vs.3.8%,P=0.670）.The overall survival at 1,2 and 3 years was 95.1%,81.6% and 69.6% for group V and 88.3%,78.8% and 64.0% for group T.Kaplan-Meier survival curves showed that there was no significant differences between the two groups （P=0.129）.Conclusions Completely video-assisted thoracoscopic lobectomy was similar to open lobectomy in safety,completeness,and efficacy,but had a shorter operative duration,and reduced bleeding.This is a minimally invasive procedure that is feasible for a subset of non-small-cell lung cancer patients with tumor size 〉 5 cm.

Value of video-assisted thoracoscopic surgery in the diagnosis and treatment of pulmonary tuberculoma:53 cases analysis and review of literature

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.

Comparative study of video-assisted thoracoscopic surgery ablation and radiofrequency catheter ablation on treating paroxysmal atrial fibrillation： a randomized, controlled short-term trial

Background It is unclear whether the effect of video-assisted thoracoscopic surgery ablation is better than catheter ablation on paroxysmal atrial fibrillation （PAF） or not. This study aimed to compare the effects of catheter ablation and video-assisted thoracoscopic surgery ablation on PAF. Methods From March 2008 to March 2012, 138 consecutive patients with PAF were randomly assigned to receive either video-assisted thorecoscopic surgery ablation （thoracoscopy group, n=66） or the traditional catheter ablation （catheter group, n=72）. Results No patient died during the study and all were successfully followed and included in analysis. There were no significant differences in clinical and echocardiographic characteristics between the two groups. All patients were evaluated at 1 week, 1 month, 3 months, 6 months, and 12 months after discharge by physical examination and related laboratory tests. Preoperative left atrium dimensions （LADs） of the recurrent AF were （47±4） mm in the thoracoscopy group and （46±8） mm in the catheter group, whereas the LADs were （40±5） and （39±9） mm, respectively, in non-recurrent PAF. Conclusions The short-term outcome of video-assisted thoracoscopic surgery ablation is safe and effective; and the indications are wider than those for catheter ablation. The larger left atrium diameter is related to the recurrence of atrial fibrillation. Chin Med J 2014;127 （14）： 2567-2570

Video-assisted thoracoscopic surgery (VATS) for the treatment of hepatic hydrothorax:report of twelve cases

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 （T1PS） or a bridge to liver transplantation for patients with refractory hepatic hydrothorax. Pleurodesis with electrocauterization can be an alternative therapy if talc is unavailable.