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 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 lu...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.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
Background Prosthetic mitral valve replacement is a common surgical treatment of mitral valve disease.Complete video-assisted mitral valve replacement represents the contemporary minimally invasive cardiac surgery in ...Background Prosthetic mitral valve replacement is a common surgical treatment of mitral valve disease.Complete video-assisted mitral valve replacement represents the contemporary minimally invasive cardiac surgery in valve disease surgical therapy. In the field of minimally invasive cardiac surgery, the success of the operation is largely depending on surgical incision, it also reflects the surgeon’s technique level. Method From February 2010 to February 2013, 80 cases of cardiac patients with mitral valve pathological changes in our department who had received surgical treatment of complete video-assisted mitral valve replacement were recruited, they were divided into two groups according to the surgical incision： midclavicular group（M group,n = 50） and parasternal group（P group, n = 30）. The clinical data were recorded including： cardiopulmonary bypass time, aortic clamping time, volume of thoracic drainage after operation, ICU tracheal intubation time,postoperative days of hospital stay and time for observing the postoperative complications. The comparison between two groups was performed using t-test analysis. Result Both M Group and P Group had favorable surgical view, there were no emergency situation of redo median sternotomy during initial operative period or intraoperative death, no pericardial tamponade, no infection, and no other serious postoperative complications.Whereas, there were 2 cases of redo operation for stanch bleeding in M Group and 1 case of perivalvular leakage in P Group. Nevertheless, 3 months later, the result of reexamine showed that the perivalvular leakage had vanished. The clinical data was shown as follow（M Group vs. P Group）： cardiopulmonary bypass time（90.2 ± 28.7 vs. 87.3 ± 24.5 min, P 〉 0.05）, aortic clamping time（65.2 ± 17.4 vs. 68.6 ± 21.9 min, P 〉 0.05）,1st day volume of thoracic drainage after operation 1（75.8 ± 35.6 vs. 53.2 ± 25.6 mL, P 〉 0.05）, ICU tracheal intubation time（9.6 ± 3.4 vs. 8.4 ± 4.5 hours, P 〉 0.05）, postoperative days of hospital stay（7.3 ± 2.2 vs. 6.9± 3.2 days, P 〉 0.05）. T-test analysis of the data of each groups showed that there were no significant statistically difference. Conclusions Appropriate surgical incisions guarantee a favorable surgical view and the success of the whole process during intraoperative period. In both midclavicular and parasternal approaches, the complete video-assisted mitral valve replacement is able to be accomplished safely and successfully. Due to the current development level of thoracoscopic instruments and equipment, the surgical incision and approach for video-assisted mitral valve replacement are diversified. As a result, diversified surgical incisions can be customized according to the variegated pathological changes of cardiac patients.展开更多
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.
文摘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.
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Background Prosthetic mitral valve replacement is a common surgical treatment of mitral valve disease.Complete video-assisted mitral valve replacement represents the contemporary minimally invasive cardiac surgery in valve disease surgical therapy. In the field of minimally invasive cardiac surgery, the success of the operation is largely depending on surgical incision, it also reflects the surgeon’s technique level. Method From February 2010 to February 2013, 80 cases of cardiac patients with mitral valve pathological changes in our department who had received surgical treatment of complete video-assisted mitral valve replacement were recruited, they were divided into two groups according to the surgical incision： midclavicular group（M group,n = 50） and parasternal group（P group, n = 30）. The clinical data were recorded including： cardiopulmonary bypass time, aortic clamping time, volume of thoracic drainage after operation, ICU tracheal intubation time,postoperative days of hospital stay and time for observing the postoperative complications. The comparison between two groups was performed using t-test analysis. Result Both M Group and P Group had favorable surgical view, there were no emergency situation of redo median sternotomy during initial operative period or intraoperative death, no pericardial tamponade, no infection, and no other serious postoperative complications.Whereas, there were 2 cases of redo operation for stanch bleeding in M Group and 1 case of perivalvular leakage in P Group. Nevertheless, 3 months later, the result of reexamine showed that the perivalvular leakage had vanished. The clinical data was shown as follow（M Group vs. P Group）： cardiopulmonary bypass time（90.2 ± 28.7 vs. 87.3 ± 24.5 min, P 〉 0.05）, aortic clamping time（65.2 ± 17.4 vs. 68.6 ± 21.9 min, P 〉 0.05）,1st day volume of thoracic drainage after operation 1（75.8 ± 35.6 vs. 53.2 ± 25.6 mL, P 〉 0.05）, ICU tracheal intubation time（9.6 ± 3.4 vs. 8.4 ± 4.5 hours, P 〉 0.05）, postoperative days of hospital stay（7.3 ± 2.2 vs. 6.9± 3.2 days, P 〉 0.05）. T-test analysis of the data of each groups showed that there were no significant statistically difference. Conclusions Appropriate surgical incisions guarantee a favorable surgical view and the success of the whole process during intraoperative period. In both midclavicular and parasternal approaches, the complete video-assisted mitral valve replacement is able to be accomplished safely and successfully. Due to the current development level of thoracoscopic instruments and equipment, the surgical incision and approach for video-assisted mitral valve replacement are diversified. As a result, diversified surgical incisions can be customized according to the variegated pathological changes of cardiac patients.
