Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-r...Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-related mortality combined （1）. About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed （2）. Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality （3）. More recently,展开更多
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 techn...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.展开更多
Objective:To compare the clinical effect of complete thoracoscopic segmentectomy and pulmonary lobectomy for pulmonary nodules.Methods:In this study,176 patients with pulmonary nodules were treated in Changshu Hospita...Objective:To compare the clinical effect of complete thoracoscopic segmentectomy and pulmonary lobectomy for pulmonary nodules.Methods:In this study,176 patients with pulmonary nodules were treated in Changshu Hospital Affiliated to Nanjing University of Chinese Medicine from January 2019 to June 2021;according to the type of surgery,the patients were divided into group A(complete thoracoscopic segmentectomy)and group B(complete thoracoscopic pulmonary lobectomy),and the clinical effects were analyzed.Results:The intraoperative blood loss,postoperative drainage volume,postoperative hospitalization days,and lung function of patients in group A were significantly better than those in group B(P<0.05),while there was no significant difference in the number of dissected lymph nodes.Conclusion:The clinical effect of complete thoracoscopic segmentectomy for patients with small pulmonary nodules is more significant;it does not only ensure lymph node dissection,but also improve surgical-related indicators and treatment safety as well as speed up the recovery of pulmonary function.Its clinical application value is worthy of key analysis by medical institutions.展开更多
Aim: To report a case of fused fissure between the right upper and middle lobes that we treated using a surgical stapler rather than a Ligasure device for the benefit of creating a better division between the right up...Aim: To report a case of fused fissure between the right upper and middle lobes that we treated using a surgical stapler rather than a Ligasure device for the benefit of creating a better division between the right upper and middle lobes and to effectively seal the lung parenchyma. Case: A 2-year-old girl with congenital cystic adenomatoid malformation of the right middle lobe (RML) was referred to our institution for further management after a series of infections. The vein of the RML, which drains into the superior pulmonary vein, was isolated and divided using endoclips. The bronchus was then exposed and divided using endo-clips. The arteries of the RML could be identified and ligated, allowing a line demarcating the major fissure to be identified and dissected. A stapler device was then used to seal the lung parenchyma and create a division between the right upper and middle lobes. She is currently well after follow-up of 16 months, with no episodes of respiratory distress or recurrence of symptoms. Conclusion: Our technique for dividing the pulmonary vein, then the bronchus, then the pulmonary artery and finally the fused fissure is safe and could be applied whenever fused fissures are encountered during thoracoscopic pulmonary lobectomy.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
Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperati...Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperative pain,and faster resumption of a normal lifestyle.However,there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer.Concerns regarding safety,the extent of mediastinal lymph node dissection,and long-term survival have made some surgeons apprehensive of its validity for lung cancer.In this paper,we review the development of thoracoscopy,the present status of VATS for early stage of non-small cell lung cancer(NSCLC),and comparison between VATS and open thoracotomy in the management of NSCLC.展开更多
BACKGROUND Pulmonary sequestration-both intralobar and extralobar-is a rare congenital developmental malformation.Extralobar pulmonary sequestrations(EPS)have their own pleura but are separated from the bronchus and u...BACKGROUND Pulmonary sequestration-both intralobar and extralobar-is a rare congenital developmental malformation.Extralobar pulmonary sequestrations(EPS)have their own pleura but are separated from the bronchus and usually occur in the left lung.They are mainly found mainly between the lower lobe and the mediastinum.EPS is rarely found within the mediastinum itself,even rarer so in the posterior mediastinum.CASE SUMMARY We report the case of a 27-year-old man who was misdiagnosed with a neurogenic tumor based on preoperative contrast-enhanced computed tomography(CT)and magnetic resonance imaging findings.Contrast-enhanced chest CT revealed a posterior mediastinal mass measuring 1.2 cm×1.4 cm×3.3 cm,which consisted of some cystic areas and showed slight enhancement.The mass was in the 11th paravertebral region and attached to the 11th thoracic vertebra behind the descending aorta in the posterior mediastinum.An arteriole originating from the intercostal artery and a vein originating directly from the hemiazygos vein were found in the pedicle of the mass.The mass was resected in a uniport videoassisted thoracoscopic surgery.During the operation,the pyramid-shaped mass appeared well-encapsulated.Postoperative histopathology established a diagnosis of EPS.One month later,a follow-up CT of the thorax showed good recovery.CONCLUSION Although EPS rarely occurs in the posterior mediastinum,its diagnosis should be considered when posterior mediastinal tumors are suspected.展开更多
Buitrago and colleagues should be commended on an excellent case report on the effective use of the robotic platform for a successful minimally invasive left lower lobectomy for a patient with biopsy proven squamous c...Buitrago and colleagues should be commended on an excellent case report on the effective use of the robotic platform for a successful minimally invasive left lower lobectomy for a patient with biopsy proven squamous cell carcinoma.1 Despite a predicted postoperative forced expiratory volume in one second(ppoFEV1)of 23%and a preoperative diffusing capacity for carbon monoxide(DLCO)of 21%,the patient underwent a lobectomy without any intraoperative complications or evidence of disease at 15 months follow-up.Lymph node sampling was performed from 5 stations.The postoperative length of staywas not clearly stated.The authors made several interesting points about the impact of pulmonary function on postoperative outcomes,the oncological efficacy of lobectomy versus sublobar resections,and merits of roboticassisted thoracoscopic surgery(RATS)versus thoracotomy and conventional video-assisted thoracoscopic surgery(VATS).We would like to discuss these points in further detail based on the available evidence in the current literature.展开更多
文摘Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-related mortality combined （1）. About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed （2）. Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality （3）. More recently,
文摘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.
文摘Objective:To compare the clinical effect of complete thoracoscopic segmentectomy and pulmonary lobectomy for pulmonary nodules.Methods:In this study,176 patients with pulmonary nodules were treated in Changshu Hospital Affiliated to Nanjing University of Chinese Medicine from January 2019 to June 2021;according to the type of surgery,the patients were divided into group A(complete thoracoscopic segmentectomy)and group B(complete thoracoscopic pulmonary lobectomy),and the clinical effects were analyzed.Results:The intraoperative blood loss,postoperative drainage volume,postoperative hospitalization days,and lung function of patients in group A were significantly better than those in group B(P<0.05),while there was no significant difference in the number of dissected lymph nodes.Conclusion:The clinical effect of complete thoracoscopic segmentectomy for patients with small pulmonary nodules is more significant;it does not only ensure lymph node dissection,but also improve surgical-related indicators and treatment safety as well as speed up the recovery of pulmonary function.Its clinical application value is worthy of key analysis by medical institutions.
文摘Aim: To report a case of fused fissure between the right upper and middle lobes that we treated using a surgical stapler rather than a Ligasure device for the benefit of creating a better division between the right upper and middle lobes and to effectively seal the lung parenchyma. Case: A 2-year-old girl with congenital cystic adenomatoid malformation of the right middle lobe (RML) was referred to our institution for further management after a series of infections. The vein of the RML, which drains into the superior pulmonary vein, was isolated and divided using endoclips. The bronchus was then exposed and divided using endo-clips. The arteries of the RML could be identified and ligated, allowing a line demarcating the major fissure to be identified and dissected. A stapler device was then used to seal the lung parenchyma and create a division between the right upper and middle lobes. She is currently well after follow-up of 16 months, with no episodes of respiratory distress or recurrence of symptoms. Conclusion: Our technique for dividing the pulmonary vein, then the bronchus, then the pulmonary artery and finally the fused fissure is safe and could be applied whenever fused fissures are encountered during thoracoscopic pulmonary lobectomy.
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.
基金The authors thank for the financial support from the Fundamental Research Funds for the Central Universities(HUST 2010JC051)Youth Chenguang project of Science and Technology of Wuhan City(No.201050231077).
文摘Video-assisted thoracoscopic surgery(VATS)provides a new approach for treating early-stage lung cancer.Lobectomy by VATS has many advantages over conventional thoracotomy,such as shorter recovery time,less postoperative pain,and faster resumption of a normal lifestyle.However,there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer.Concerns regarding safety,the extent of mediastinal lymph node dissection,and long-term survival have made some surgeons apprehensive of its validity for lung cancer.In this paper,we review the development of thoracoscopy,the present status of VATS for early stage of non-small cell lung cancer(NSCLC),and comparison between VATS and open thoracotomy in the management of NSCLC.
文摘BACKGROUND Pulmonary sequestration-both intralobar and extralobar-is a rare congenital developmental malformation.Extralobar pulmonary sequestrations(EPS)have their own pleura but are separated from the bronchus and usually occur in the left lung.They are mainly found mainly between the lower lobe and the mediastinum.EPS is rarely found within the mediastinum itself,even rarer so in the posterior mediastinum.CASE SUMMARY We report the case of a 27-year-old man who was misdiagnosed with a neurogenic tumor based on preoperative contrast-enhanced computed tomography(CT)and magnetic resonance imaging findings.Contrast-enhanced chest CT revealed a posterior mediastinal mass measuring 1.2 cm×1.4 cm×3.3 cm,which consisted of some cystic areas and showed slight enhancement.The mass was in the 11th paravertebral region and attached to the 11th thoracic vertebra behind the descending aorta in the posterior mediastinum.An arteriole originating from the intercostal artery and a vein originating directly from the hemiazygos vein were found in the pedicle of the mass.The mass was resected in a uniport videoassisted thoracoscopic surgery.During the operation,the pyramid-shaped mass appeared well-encapsulated.Postoperative histopathology established a diagnosis of EPS.One month later,a follow-up CT of the thorax showed good recovery.CONCLUSION Although EPS rarely occurs in the posterior mediastinum,its diagnosis should be considered when posterior mediastinal tumors are suspected.
文摘Buitrago and colleagues should be commended on an excellent case report on the effective use of the robotic platform for a successful minimally invasive left lower lobectomy for a patient with biopsy proven squamous cell carcinoma.1 Despite a predicted postoperative forced expiratory volume in one second(ppoFEV1)of 23%and a preoperative diffusing capacity for carbon monoxide(DLCO)of 21%,the patient underwent a lobectomy without any intraoperative complications or evidence of disease at 15 months follow-up.Lymph node sampling was performed from 5 stations.The postoperative length of staywas not clearly stated.The authors made several interesting points about the impact of pulmonary function on postoperative outcomes,the oncological efficacy of lobectomy versus sublobar resections,and merits of roboticassisted thoracoscopic surgery(RATS)versus thoracotomy and conventional video-assisted thoracoscopic surgery(VATS).We would like to discuss these points in further detail based on the available evidence in the current literature.
