Objective: To sum up 121 cases of heart disease operations with the help of thoracoscope from May to August in 2000. Among these cases, 48 cases were atrial septal defect (ASD); the average age of patients is 20±...Objective: To sum up 121 cases of heart disease operations with the help of thoracoscope from May to August in 2000. Among these cases, 48 cases were atrial septal defect (ASD); the average age of patients is 20±10 years old; average weight is (43±16) kg. 67 patients with ventricular septal defects (VSD), average age13±9 years old; one male patient, 44 years old with Ebstein malformation; one female patient (21 years old) partial atrioventricular canal combined with cor triatriatum; one male (21 years old) with ruptared aneuryem of aortic sinus. 3 cases(all females ) with mitral stenosis combined with mitral valve incompetence. One male patient(aged 16)with pericardiun effusion after trauma. Methods: During operations, a patient with supine position, and his/her right shoulder was padded 30°higher. Tracheal cannula was inserted and air was piped in with high frequency jet ventilation. Three mini thoracotomies with a diameter of 2 to 3 cm were made in the 4th intercostals space of the right par sternum and the 4th and 7th intercostals spaces of the right middle axillary line respectively. An periphera extra corporeal circulation was made. the aortic clamp was clamped, cannula for cold perfusion. After the heart was sliced and a reformative operation was performed. The process of the operation of defects repairs was finished under the thoracoscope. The other operations were performed with the help of thoracoscope. 3 rheumatic heart disease patients got 25# mechanical mitral valve prosthesis. A 30# tricuspid plasty ring was applied to The Ebstein malformation patient. Results: all 121 patients were successfully operated on without death. Two VSD cases appeared transient third degree atrialventricular block.Because 4 cases had more chest drainage, so they were stanched bleeding twice. After the operation, heart murmur vanished, and ultrasonic inspection showed no diffluence inside the heart. Conclusion: Our experience showed that all atrium, ventricular septal defects can be repaired under the thoracoscope. This scope-assisted technology is more accepted by patients because of tiny incisions and also provides an alternative solution for cardiac surgeons.展开更多
Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavi...Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavity and immunohistochemistry of biopsy tissue,to classify malignant pleural effusion according to syndrome differentiation,and to explore the scientific nature of its theory.Methods:From March 1,2014 to February 28,2015,40 cases of malignant pleural effusion were treated in Beijing Chaoyang Hospital affiliated to Capital Medical University.According to the proposed TCM diagnostic criteria for yin and yang syndrome differentiation,and collect age,gender,course of disease,clinical symptoms,tumor primary focus,histomorphological manifestations and immunohistochemical results and other related information,and carry out statistical data processing.Results:The positive syndrome was mainly metastatic lung adenocarcinoma,which accounted for the majority of all MPE cases,up to 75%.The immunohistochemical results of biopsy tissues were mainly CEA and TTF-1 positive;While pleural effusion caused by pleural mesothelioma was the main type of yin syndrome,and the results of immunohistochemistry combined with biopsy were mainly positive for D2-40,Calretinin,WT-1 and CK5/6.Conclusion:TCM syndrome differentiation of MPE based on internal thoracoscopy combined with biopsy immunohistochemical results has sufficient theoretical basis and certain scientific nature,and further clinical research is needed to verify its effectiveness and practicability in the future.展开更多
BACKGROUND Esophageal cancer is sixth leading cause of cancer deaths and the eighth most common cancer worldwide.In the recent times,the incidence and mortality rates have increased.To improve the survival in esophage...BACKGROUND Esophageal cancer is sixth leading cause of cancer deaths and the eighth most common cancer worldwide.In the recent times,the incidence and mortality rates have increased.To improve the survival in esophageal carcinoma,newer tactics have to be applied to improve outcomes.It is well established that in cases of carcinoma lung and stomach,presence of micrometastasis or spread of tumor cell following surgical manipulation has been shown to predict recurrence and poor prognosis.Similarly,spread of tumor cell during esophagectomy or presence of occult micrometastatic disease in esophageal carcinoma may lead to early tumor recurrence and poor prognosis.The actual incidence of pleural micrometastasis and tumor spillage following thoracoscopic esophagectomy is not clear.The presence of malignant cells in cytologic or immunocytochemical analysis may help in prognostication and further therapeutic decision making.AIM To assess the incidence of micrometastasis and tumor spillage among the patients undergoing thoracoscopic surgery for esophageal carcinoma.METHODS An observational study was done at Department of Surgical Gastroenterology,Jawaharlal Institute of Postgraduate Medical Education and Research,Puducherry.Nineteen patients aged 18 to 70 years with slight male preponderance,undergoing elective thoracoscopic esophagectomy for esophageal carcinoma were included in this observational study from June 2021 to June 2023.Pre and post dissection pleural cavity lavage was done with 200 mL saline and the fluid was subjected to cytologic and immunocytological examination.The cytology and immunocytological examination report was interpreted as positive for malignant cells or negative for malignant cells.Immunocytological examination was done and evaluated for presence or absence of tumor markers cytokeratin 7 and p40 signifying presence or absence of tumor spillage.RESULTS Rate of pre dissection fluid was negative for the malignant cell by cytological and immunocytological analysis in all cases indicating no micrometastasis in our group of patients.Rate of post dissection fluid was negative for the malignant cell by cytological and immunocytological analysis in all cases indicating no incidence of tumor spillage post-surgery in our patients.No significant association was found between age,gender,body mass index,site of lesion,histological type,neoadjuvant therapy and tumor-nodes-metastasis staging with pre and post dissection pleural fluid cytological and immunohistochemical analysis in our study.CONCLUSION This study assessed the incidence of micrometastasis and tumor spillage following minimal invasive esophagectomy could not find any tumor cells in both pre and post dissection samples.展开更多
BACKGROUND Although thoracotomy has been the conventional treatment for patients with early esophageal cancer(EEC),its drawbacks underscore the demand for more effective therapeutic strategies to improve surgical outc...BACKGROUND Although thoracotomy has been the conventional treatment for patients with early esophageal cancer(EEC),its drawbacks underscore the demand for more effective therapeutic strategies to improve surgical outcomes.AIM To comprehensively analyze the effect of totally thoracoscopic esophagectomy(TTE)on postoperative complications and serum inflammatory factors in patients diagnosed with EEC.METHODS A total of 113 patients with EEC,who were admitted to our hospital between September 2022 and December 2024,were recruited for this study.Specifically,55 patients were assigned to the control group and underwent conventional surgical procedures,whereas 58 patients formed the research group and underwent TTE.Subsequently,a series of comparisons and analyses were conducted between the two groups.These comparisons included surgery-related parameters,such as incision length,operation duration,and the number and extent of lymph node dissection;postoperative complications,namely,empyema,pulmonary infection,incision infection,anastomotic fistula,and delayed gastric emptying;postoperative pain,which was quantitatively evaluated by the Numerical Rating Scale;postoperative hospitalization duration;serum inflammatory factors,including interleukin(IL)-6,IL-8,and tumor necrosis factor-α;and stress response-associated indicators,such as C-reactive protein,cortisol,and adrenaline.RESULTS Statistical data demonstrated that compared with the control group,the research group exhibited substantially shorter incision length and postoperative hospitalization duration.The two groups had comparable number and extent of lymph node dissection.Notably,both the overall incidence of postoperative complications and the Numerical Rating Scale score on postoperative day 3 were remarkably lower in the research group.Although the levels of IL-6,IL-8,tumor necrosis factor-α,C-reactive protein,cortisol,and adrenaline in the research group increased statistically postoperatively,they were still considerably lower than those in the control group.CONCLUSION In patients with EEC,TTE not only reduces the risk of postoperative complications but also effectively alleviates the body’s inflammatory and stress responses associated with surgery.展开更多
Objective:To comparatively analyze the readability and information quality of the educational materials for patients undergoing thoracoscopic lobectomy in both Chinese and English versions generated by three mainstrea...Objective:To comparatively analyze the readability and information quality of the educational materials for patients undergoing thoracoscopic lobectomy in both Chinese and English versions generated by three mainstream Large Language Models(LLMS),namely DeepSeek,Grok-3 and ChatGPT,Provide evidence-based basis for the clinical selection of AI-assisted educational tools.Method:A cross-sectional study design was adopted,with“education for patients undergoing thoracoscopic lobectomy”as the core requirement.Standardized Chinese and English prompts were designed to drive each of the three models to generate 3 independent educational materials(a total of 18,9 in Chinese and 9 in English).The readability was evaluated using the internationally recognized readability assessment tools(English:Flesch-Kincaid Grade Level,FKGL;Flesch Reading Ease,FRE;Chinese:average sentence length),and the DISCERN scale was used to evaluate the quality of information.The diff erences among the three models were compared by the Kruskal-Wallis H test,the diff erences between the Chinese and English versions were analyzed by the paired sample t-test,and the reliability of the raters was tested by the intraclass correlation coeffi cient(ICC).Result:1.Readability:In the English version,DeepSeek V3 had the highest FRE score(80.36±1.18)and the lowest FKGL score(4.83±0.12),which was significantly better than ChatGPT-o3(FRE:67.36±0.74,FKGL:)(6.56±0.36)and Grok3(FRE:45.67±1.65,FKGL:11.93±0.17)(P<0.05);Among the Chinese versions,Grok3 had the shortest average sentence length(17.74±1.02 characters),which was signifi cantly better than ChatGPT-o3(27.81±1.47 characters)and DeepSeek V3(26.75±1.18 characters)(P<0.05).2.Information quality:The reliability of the raters was excellent(ICC=0.92,95%CI:0.925-0.998,P<0.001);The DISCERN total scores of the Chinese and English versions of the three models were all at the“good-excellent”level(59.00-71.17 points).Among them,the total scores of the Chinese and English versions of ChatGPT-o3 were the highest(English:71.17±1.17,Chinese:70.50±0.55),and Grok3 was the lowest(English:(63.17±0.94,Chinese:59.00±0.89)),and the diff erence between groups was statistically significant(P<0.05).Conclusion:Among the educational materials for thoracoscopic lobectomy generated by the three LLMS,the English version of DeepSeeking V3 has the best readability,the Chinese version of Grok3 has outstanding reading fl uency,and the comprehensive performance of the Chinese and English versions of ChatGPT-o3 is balanced.The Chinese version still needs to be optimized in terms of terminology consistency and information details.When applying it in clinical practice,the model should be selected in combination with language requirements,and the content generated by AI should be professionally reviewed.展开更多
Background:Totally thoracoscopic surgery(TTS)and right lateral thoracotomy(RLT)are both extensively utilized in the surgical repair for atrial septal defect(ASD).However,RLT is generally considered in low-weight pedia...Background:Totally thoracoscopic surgery(TTS)and right lateral thoracotomy(RLT)are both extensively utilized in the surgical repair for atrial septal defect(ASD).However,RLT is generally considered in low-weight pediatric patients as a result of restricted surgical exposure.This study aims to introduce an RLT approach for ASD repair in adults and compare its clinical outcomes with TTS.Methods:We conducted a retrospective analysis of the clinical data of 23 adult patients who underwent ASD repair at Guangdong Provincial People’s Hospital between June and October 2024.Patients were divided into two groups based on the surgical approach they adopted:group totally thoracoscopic surgery(TTS,n=12)and group right lateral thoracotomy(RLT,n=11).All individuals finished a follow-up three months after surgery.Operative parameters,postoperative courses,echocardiographic measurements and laboratory investigations were compared between the two groups.Results:The total surgical duration was significantly longer in group RLT compared with group TTS[(234.00±47.93)min vs.(175.17±52.36)min,p=0.011].Group RLT exhibited a significantly higher respiratory index(RI)at<6 h postoperatively(1.00±0.58 vs.0.30±0.37,p=0.01)and significantly lower levels of soluble suppression of tumorigenicity 2(sST2)[(136.61±43.12)ng/mL vs.(199.08±33.56)ng/mL,p=0.037]and cardiac troponin(cTnT)[(277.04±89.85)pg/mL vs.(343.30±482.40)pg/mL,p=0.047]at 12-24 h postoperatively.Echocardiographic measurements showed no significant differences between two groups,except for a more pronounced reduction in left atrial(LA)size at discharge in group TTS[(5.00±3.64)mm vs.(0.09±4.44)mm,p=0.008].Conversely,group RLT demonstrated a less significant decrease in glutamyl transpeptidase(GGT)[(1.00±6.00)U/L vs.(5.25±3.86)U/L,p=0.026]but a more significant decrease in blood urea nitrogen(BUN)[(1.81±1.10)mg/dL vs.(0.81±1.07)mg/dL,p=0.038].Conclusions:RLT for ASD repair in adults demonstrated comparable clinical outcomes to TTS in terms of postoperative recovery and cardiac function and also produced fewer scars than TTS.Our study proved the feasibility,safety and cosmetic effects of uniport RLT for ASD repair in adults when compared with TTS.展开更多
BACKGROUND Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer(LC).This is achieved using either a thoracic paravertebral block(T...BACKGROUND Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer(LC).This is achieved using either a thoracic paravertebral block(TPVB)or sufentanil(SUF)-based multimodal analgesia.However,the efficacy and impact of their combined use on postoperative pain and postoperative cognitive dysfunction(POCD)remain unclear.AIM To explore the analgesic effect and the influence on POCD of TPVB combined with SUF-based multimodal analgesia in patients undergoing thoracoscopic radical resection for LC to help optimize postoperative pain management and improve patient outcomes.METHODS This retrospective analysis included 107 patients undergoing thoracoscopic radical resection for LC at The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital between May 2021 and January 2023.Patients receiving SUF-based multimodal analgesia(n=50)and patients receiving TPVB+SUF-based multimodal analgesia(n=57)were assigned to the control group and TPVB group,respectively.We compared the Ramsay Sedation Scale and visual analog scale(VAS)scores at rest and with cough between the two groups at 2,12,and 24 h after surgery.Serum levels of epinephrine(E),angio-tensin Ⅱ(Ang Ⅱ),norepinephrine(NE),superoxide dismutase(SOD),vascular endothelial growth factor(VEGF),transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),and S-100 calcium-binding proteinβ(S-100β)were measured before and 24 h after surgery.The Mini-Mental State Examination(MMSE)was administered 1 day before surgery and at 3 and 5 days after surgery,and the occurrence of POCD was monitored for 5 days after surgery.Adverse reactions were also recorded.RESULTS There were no significant time point,between-group,and interaction effects in Ramsay sedation scores between the two groups(P>0.05).Significantly,there were notable time point effects,between-group differences,and interaction effects observed in VAS scores both at rest and with cough(P<0.05).The VAS scores at rest and with cough at 12 and 24 h after surgery were lower than those at 2 h after surgery and gradually decreased as postoperative time increased(P<0.05).The TPVB group had lower VAS scores than the control group at 2,12,and 24 h after surgery(P<0.05).The MMSE scores at postoperative days 1 and 3 were markedly higher in the TPVB group than in the control group(P<0.05).The incidence of POCD was significantly lower in the TPVB group than in the control group within 5 days after surgery(P<0.05).Both groups had elevated serum E,Ang Ⅱ,and NE and decreased serum SOD levels at 24 h after surgery compared with the preoperative levels,with better indices in the TPVB group(P<0.05).Marked elevations in serum levels of VEGF,TGF-β1,TNF-α,and S-100β were observed in both groups at 24 h after surgery,with lower levels in the TPVB group than in the control group(P<0.05).CONCLUSION TPVB combined with SUF-based multimodal analgesia further relieves pain in patients undergoing thoracoscopic radical surgery for LC,enhances analgesic effects,reduces postoperative stress response,and inhibits postoperative increases in serum VEGF,TGF-β1,TNF-α,and S-100β levels.This scheme also reduced POCD and had a high safety profile.展开更多
BACKGROUND Pericardial rupture caused by blunt chest trauma is rare in clinical practice.Because of its atypical clinical symptoms,and because surgeons are often unfamiliar with the clinical and radiological manifesta...BACKGROUND Pericardial rupture caused by blunt chest trauma is rare in clinical practice.Because of its atypical clinical symptoms,and because surgeons are often unfamiliar with the clinical and radiological manifestations of the injury,preoperative diagnosis is difficult;it is easily misdiagnosed and causes serious consequences.CASE SUMMARY A 60-year-old man,previously healthy,was transported to the emergency room after falling from a great height.Upon arrival,his vital signs were stable.Electrocardiography and echocardiography were performed,and there was no sign of cardiac injury or ischemia.Chest and abdomen computerized tomography revealed pneumopericardium,hemopneumothorax,lung contusion,multiple rib fractures on the right side(Figure 1),and right scapula and clavicle fractures.He was admitted to the inpatient department for further observation after tube thoracostomy.The next day,the patient suddenly experienced rapid arrhythmia(the ventricular rate reached 150-180 beats/min)when turning onto his right side,accompanied by a blood pressure drop to 70/45 mm Hg and a chief complaint of palpitation.Thoracoscopy was performed urgently,and a large vertical tear(8 cm×6 cm)was found in the pericardium.The defect was successfully repaired using a heart Dacron patch.His postoperative condition was uneventful without any fluctuations in vital signs,and he was transferred to the orthopedics department for further surgery on postoperative day 8.CONCLUSION Although the possibility of pericardial rupture combined with cardiac hernia is extremely low,it is one of the causes of cardiogenic shock following blunt trauma.Therefore,clinicians need to be more familiar with its characteristic manifestations and maintain a high degree of vigilance against such injuries to avoid disastrous consequences.展开更多
BACKGROUND Pneumocephalus is a rare complication presenting in the postoperative period of a thoracoscopic operation.We report a case in which tension pneumocephalus occurred after thoracoscopic resection as well as t...BACKGROUND Pneumocephalus is a rare complication presenting in the postoperative period of a thoracoscopic operation.We report a case in which tension pneumocephalus occurred after thoracoscopic resection as well as the subsequent approach of surgical management.CASE SUMMARY A 66-year-old man who received thoracoscopic resection to remove an intrathoracic,posterior mediastinal,dumbbell-shaped,pathology-proven neurogenic tumor.The patient then reported experiencing progressively severe headaches,especially when in an upright position.A brain computed tomography scan at a local hospital disclosed extensive pneumocephalus.Revision surgery for resection of the pseudomeningocele and repair of the cerebrospinal fluid leakage was thus arranged for the patient.During the operation,we traced the cerebrospinal fluid leakage and found that it might have derived from incomplete endoscopic clipping around the tumor stump near the dural sac at the T3 level.After that,we wrapped and sealed all the possible origins of the leakage with autologous fat,tissue glue,gelfoam,and duraseal layer by layer.The patient recovered well,and the computed tomography images showed resolution of the pneumocephalus.CONCLUSION This report and literature review indicated that the risk of developing a tension pneumocephalus cannot be ignored and should be monitored carefully after thoracoscopic tumor resection.展开更多
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 ...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.展开更多
Objective: to investigate the effect of right mammary duct esophageal cancer surgery on lung function and medical history. Methods: from February 2018 to March 2019, 80 patients with esophageal cancer underwent surgic...Objective: to investigate the effect of right mammary duct esophageal cancer surgery on lung function and medical history. Methods: from February 2018 to March 2019, 80 patients with esophageal cancer underwent surgical resection were randomly selected for clinical data. They were divided into control group (n = 40) and follow-up group (n = 40). They selected clinical routine surgery for breast cancer, upper and lower esophageal cancer, and thoracic prism observation group for esophageal cancer radical surgery. The indexes of the two groups were compared, and the changes of pulmonary function parameters before and after surgery (FEV1, FEV1/FVG, and PEF) were analyzed. Bottom line: Compared with the control group, the operation indexes (operation time, leakage time, hospitalization time, hemorrhage) were significantly reduced (n < 0.05);The lung function indexes of the two groups before and after the operation treatment (n> 0.05) were significantly different from each other. After the treatment, the lung function indexes of the observation group were significantly better than those of the control group (n <0.05). Conclusion: compared with the traditional thoracotomy, the right endoscopic surgery for esophageal cancer has the advantages of fewer traumas, less pain, significantly improved operation performance, less influence on lung function and high clinical application cost.展开更多
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...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.展开更多
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 ...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.展开更多
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 foll...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.展开更多
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 ...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.展开更多
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 endpoint...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.展开更多
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...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展开更多
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
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 patient...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.展开更多
文摘Objective: To sum up 121 cases of heart disease operations with the help of thoracoscope from May to August in 2000. Among these cases, 48 cases were atrial septal defect (ASD); the average age of patients is 20±10 years old; average weight is (43±16) kg. 67 patients with ventricular septal defects (VSD), average age13±9 years old; one male patient, 44 years old with Ebstein malformation; one female patient (21 years old) partial atrioventricular canal combined with cor triatriatum; one male (21 years old) with ruptared aneuryem of aortic sinus. 3 cases(all females ) with mitral stenosis combined with mitral valve incompetence. One male patient(aged 16)with pericardiun effusion after trauma. Methods: During operations, a patient with supine position, and his/her right shoulder was padded 30°higher. Tracheal cannula was inserted and air was piped in with high frequency jet ventilation. Three mini thoracotomies with a diameter of 2 to 3 cm were made in the 4th intercostals space of the right par sternum and the 4th and 7th intercostals spaces of the right middle axillary line respectively. An periphera extra corporeal circulation was made. the aortic clamp was clamped, cannula for cold perfusion. After the heart was sliced and a reformative operation was performed. The process of the operation of defects repairs was finished under the thoracoscope. The other operations were performed with the help of thoracoscope. 3 rheumatic heart disease patients got 25# mechanical mitral valve prosthesis. A 30# tricuspid plasty ring was applied to The Ebstein malformation patient. Results: all 121 patients were successfully operated on without death. Two VSD cases appeared transient third degree atrialventricular block.Because 4 cases had more chest drainage, so they were stanched bleeding twice. After the operation, heart murmur vanished, and ultrasonic inspection showed no diffluence inside the heart. Conclusion: Our experience showed that all atrium, ventricular septal defects can be repaired under the thoracoscope. This scope-assisted technology is more accepted by patients because of tiny incisions and also provides an alternative solution for cardiac surgeons.
文摘Objective:Guided by the theory of syndrome differentiation of yin and yang in traditional Chinese medicine surgery,through visual observation of internal medicine thoracoscope,comprehensive observation of pleural cavity and immunohistochemistry of biopsy tissue,to classify malignant pleural effusion according to syndrome differentiation,and to explore the scientific nature of its theory.Methods:From March 1,2014 to February 28,2015,40 cases of malignant pleural effusion were treated in Beijing Chaoyang Hospital affiliated to Capital Medical University.According to the proposed TCM diagnostic criteria for yin and yang syndrome differentiation,and collect age,gender,course of disease,clinical symptoms,tumor primary focus,histomorphological manifestations and immunohistochemical results and other related information,and carry out statistical data processing.Results:The positive syndrome was mainly metastatic lung adenocarcinoma,which accounted for the majority of all MPE cases,up to 75%.The immunohistochemical results of biopsy tissues were mainly CEA and TTF-1 positive;While pleural effusion caused by pleural mesothelioma was the main type of yin syndrome,and the results of immunohistochemistry combined with biopsy were mainly positive for D2-40,Calretinin,WT-1 and CK5/6.Conclusion:TCM syndrome differentiation of MPE based on internal thoracoscopy combined with biopsy immunohistochemical results has sufficient theoretical basis and certain scientific nature,and further clinical research is needed to verify its effectiveness and practicability in the future.
文摘BACKGROUND Esophageal cancer is sixth leading cause of cancer deaths and the eighth most common cancer worldwide.In the recent times,the incidence and mortality rates have increased.To improve the survival in esophageal carcinoma,newer tactics have to be applied to improve outcomes.It is well established that in cases of carcinoma lung and stomach,presence of micrometastasis or spread of tumor cell following surgical manipulation has been shown to predict recurrence and poor prognosis.Similarly,spread of tumor cell during esophagectomy or presence of occult micrometastatic disease in esophageal carcinoma may lead to early tumor recurrence and poor prognosis.The actual incidence of pleural micrometastasis and tumor spillage following thoracoscopic esophagectomy is not clear.The presence of malignant cells in cytologic or immunocytochemical analysis may help in prognostication and further therapeutic decision making.AIM To assess the incidence of micrometastasis and tumor spillage among the patients undergoing thoracoscopic surgery for esophageal carcinoma.METHODS An observational study was done at Department of Surgical Gastroenterology,Jawaharlal Institute of Postgraduate Medical Education and Research,Puducherry.Nineteen patients aged 18 to 70 years with slight male preponderance,undergoing elective thoracoscopic esophagectomy for esophageal carcinoma were included in this observational study from June 2021 to June 2023.Pre and post dissection pleural cavity lavage was done with 200 mL saline and the fluid was subjected to cytologic and immunocytological examination.The cytology and immunocytological examination report was interpreted as positive for malignant cells or negative for malignant cells.Immunocytological examination was done and evaluated for presence or absence of tumor markers cytokeratin 7 and p40 signifying presence or absence of tumor spillage.RESULTS Rate of pre dissection fluid was negative for the malignant cell by cytological and immunocytological analysis in all cases indicating no micrometastasis in our group of patients.Rate of post dissection fluid was negative for the malignant cell by cytological and immunocytological analysis in all cases indicating no incidence of tumor spillage post-surgery in our patients.No significant association was found between age,gender,body mass index,site of lesion,histological type,neoadjuvant therapy and tumor-nodes-metastasis staging with pre and post dissection pleural fluid cytological and immunohistochemical analysis in our study.CONCLUSION This study assessed the incidence of micrometastasis and tumor spillage following minimal invasive esophagectomy could not find any tumor cells in both pre and post dissection samples.
基金Supported by Zhejiang Provincial Traditional Chinese Medicine Science and Technology Plan Project,No.2023ZL424.
文摘BACKGROUND Although thoracotomy has been the conventional treatment for patients with early esophageal cancer(EEC),its drawbacks underscore the demand for more effective therapeutic strategies to improve surgical outcomes.AIM To comprehensively analyze the effect of totally thoracoscopic esophagectomy(TTE)on postoperative complications and serum inflammatory factors in patients diagnosed with EEC.METHODS A total of 113 patients with EEC,who were admitted to our hospital between September 2022 and December 2024,were recruited for this study.Specifically,55 patients were assigned to the control group and underwent conventional surgical procedures,whereas 58 patients formed the research group and underwent TTE.Subsequently,a series of comparisons and analyses were conducted between the two groups.These comparisons included surgery-related parameters,such as incision length,operation duration,and the number and extent of lymph node dissection;postoperative complications,namely,empyema,pulmonary infection,incision infection,anastomotic fistula,and delayed gastric emptying;postoperative pain,which was quantitatively evaluated by the Numerical Rating Scale;postoperative hospitalization duration;serum inflammatory factors,including interleukin(IL)-6,IL-8,and tumor necrosis factor-α;and stress response-associated indicators,such as C-reactive protein,cortisol,and adrenaline.RESULTS Statistical data demonstrated that compared with the control group,the research group exhibited substantially shorter incision length and postoperative hospitalization duration.The two groups had comparable number and extent of lymph node dissection.Notably,both the overall incidence of postoperative complications and the Numerical Rating Scale score on postoperative day 3 were remarkably lower in the research group.Although the levels of IL-6,IL-8,tumor necrosis factor-α,C-reactive protein,cortisol,and adrenaline in the research group increased statistically postoperatively,they were still considerably lower than those in the control group.CONCLUSION In patients with EEC,TTE not only reduces the risk of postoperative complications but also effectively alleviates the body’s inflammatory and stress responses associated with surgery.
基金supported by the National High Level Hospital Clinical Research Funding(80102022501).
文摘Objective:To comparatively analyze the readability and information quality of the educational materials for patients undergoing thoracoscopic lobectomy in both Chinese and English versions generated by three mainstream Large Language Models(LLMS),namely DeepSeek,Grok-3 and ChatGPT,Provide evidence-based basis for the clinical selection of AI-assisted educational tools.Method:A cross-sectional study design was adopted,with“education for patients undergoing thoracoscopic lobectomy”as the core requirement.Standardized Chinese and English prompts were designed to drive each of the three models to generate 3 independent educational materials(a total of 18,9 in Chinese and 9 in English).The readability was evaluated using the internationally recognized readability assessment tools(English:Flesch-Kincaid Grade Level,FKGL;Flesch Reading Ease,FRE;Chinese:average sentence length),and the DISCERN scale was used to evaluate the quality of information.The diff erences among the three models were compared by the Kruskal-Wallis H test,the diff erences between the Chinese and English versions were analyzed by the paired sample t-test,and the reliability of the raters was tested by the intraclass correlation coeffi cient(ICC).Result:1.Readability:In the English version,DeepSeek V3 had the highest FRE score(80.36±1.18)and the lowest FKGL score(4.83±0.12),which was significantly better than ChatGPT-o3(FRE:67.36±0.74,FKGL:)(6.56±0.36)and Grok3(FRE:45.67±1.65,FKGL:11.93±0.17)(P<0.05);Among the Chinese versions,Grok3 had the shortest average sentence length(17.74±1.02 characters),which was signifi cantly better than ChatGPT-o3(27.81±1.47 characters)and DeepSeek V3(26.75±1.18 characters)(P<0.05).2.Information quality:The reliability of the raters was excellent(ICC=0.92,95%CI:0.925-0.998,P<0.001);The DISCERN total scores of the Chinese and English versions of the three models were all at the“good-excellent”level(59.00-71.17 points).Among them,the total scores of the Chinese and English versions of ChatGPT-o3 were the highest(English:71.17±1.17,Chinese:70.50±0.55),and Grok3 was the lowest(English:(63.17±0.94,Chinese:59.00±0.89)),and the diff erence between groups was statistically significant(P<0.05).Conclusion:Among the educational materials for thoracoscopic lobectomy generated by the three LLMS,the English version of DeepSeeking V3 has the best readability,the Chinese version of Grok3 has outstanding reading fl uency,and the comprehensive performance of the Chinese and English versions of ChatGPT-o3 is balanced.The Chinese version still needs to be optimized in terms of terminology consistency and information details.When applying it in clinical practice,the model should be selected in combination with language requirements,and the content generated by AI should be professionally reviewed.
基金This research was funded by the Natural Science Foundation of Guangdong Province(2023A1515012501)Guangzhou Municipal Science and Technology Planning Project(2023B03J1254)Congenital Heart Disease Medical Talent Cultivation and Education Fund(2023QT0009).
文摘Background:Totally thoracoscopic surgery(TTS)and right lateral thoracotomy(RLT)are both extensively utilized in the surgical repair for atrial septal defect(ASD).However,RLT is generally considered in low-weight pediatric patients as a result of restricted surgical exposure.This study aims to introduce an RLT approach for ASD repair in adults and compare its clinical outcomes with TTS.Methods:We conducted a retrospective analysis of the clinical data of 23 adult patients who underwent ASD repair at Guangdong Provincial People’s Hospital between June and October 2024.Patients were divided into two groups based on the surgical approach they adopted:group totally thoracoscopic surgery(TTS,n=12)and group right lateral thoracotomy(RLT,n=11).All individuals finished a follow-up three months after surgery.Operative parameters,postoperative courses,echocardiographic measurements and laboratory investigations were compared between the two groups.Results:The total surgical duration was significantly longer in group RLT compared with group TTS[(234.00±47.93)min vs.(175.17±52.36)min,p=0.011].Group RLT exhibited a significantly higher respiratory index(RI)at<6 h postoperatively(1.00±0.58 vs.0.30±0.37,p=0.01)and significantly lower levels of soluble suppression of tumorigenicity 2(sST2)[(136.61±43.12)ng/mL vs.(199.08±33.56)ng/mL,p=0.037]and cardiac troponin(cTnT)[(277.04±89.85)pg/mL vs.(343.30±482.40)pg/mL,p=0.047]at 12-24 h postoperatively.Echocardiographic measurements showed no significant differences between two groups,except for a more pronounced reduction in left atrial(LA)size at discharge in group TTS[(5.00±3.64)mm vs.(0.09±4.44)mm,p=0.008].Conversely,group RLT demonstrated a less significant decrease in glutamyl transpeptidase(GGT)[(1.00±6.00)U/L vs.(5.25±3.86)U/L,p=0.026]but a more significant decrease in blood urea nitrogen(BUN)[(1.81±1.10)mg/dL vs.(0.81±1.07)mg/dL,p=0.038].Conclusions:RLT for ASD repair in adults demonstrated comparable clinical outcomes to TTS in terms of postoperative recovery and cardiac function and also produced fewer scars than TTS.Our study proved the feasibility,safety and cosmetic effects of uniport RLT for ASD repair in adults when compared with TTS.
文摘BACKGROUND Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer(LC).This is achieved using either a thoracic paravertebral block(TPVB)or sufentanil(SUF)-based multimodal analgesia.However,the efficacy and impact of their combined use on postoperative pain and postoperative cognitive dysfunction(POCD)remain unclear.AIM To explore the analgesic effect and the influence on POCD of TPVB combined with SUF-based multimodal analgesia in patients undergoing thoracoscopic radical resection for LC to help optimize postoperative pain management and improve patient outcomes.METHODS This retrospective analysis included 107 patients undergoing thoracoscopic radical resection for LC at The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital between May 2021 and January 2023.Patients receiving SUF-based multimodal analgesia(n=50)and patients receiving TPVB+SUF-based multimodal analgesia(n=57)were assigned to the control group and TPVB group,respectively.We compared the Ramsay Sedation Scale and visual analog scale(VAS)scores at rest and with cough between the two groups at 2,12,and 24 h after surgery.Serum levels of epinephrine(E),angio-tensin Ⅱ(Ang Ⅱ),norepinephrine(NE),superoxide dismutase(SOD),vascular endothelial growth factor(VEGF),transforming growth factor-β1(TGF-β1),tumor necrosis factor-α(TNF-α),and S-100 calcium-binding proteinβ(S-100β)were measured before and 24 h after surgery.The Mini-Mental State Examination(MMSE)was administered 1 day before surgery and at 3 and 5 days after surgery,and the occurrence of POCD was monitored for 5 days after surgery.Adverse reactions were also recorded.RESULTS There were no significant time point,between-group,and interaction effects in Ramsay sedation scores between the two groups(P>0.05).Significantly,there were notable time point effects,between-group differences,and interaction effects observed in VAS scores both at rest and with cough(P<0.05).The VAS scores at rest and with cough at 12 and 24 h after surgery were lower than those at 2 h after surgery and gradually decreased as postoperative time increased(P<0.05).The TPVB group had lower VAS scores than the control group at 2,12,and 24 h after surgery(P<0.05).The MMSE scores at postoperative days 1 and 3 were markedly higher in the TPVB group than in the control group(P<0.05).The incidence of POCD was significantly lower in the TPVB group than in the control group within 5 days after surgery(P<0.05).Both groups had elevated serum E,Ang Ⅱ,and NE and decreased serum SOD levels at 24 h after surgery compared with the preoperative levels,with better indices in the TPVB group(P<0.05).Marked elevations in serum levels of VEGF,TGF-β1,TNF-α,and S-100β were observed in both groups at 24 h after surgery,with lower levels in the TPVB group than in the control group(P<0.05).CONCLUSION TPVB combined with SUF-based multimodal analgesia further relieves pain in patients undergoing thoracoscopic radical surgery for LC,enhances analgesic effects,reduces postoperative stress response,and inhibits postoperative increases in serum VEGF,TGF-β1,TNF-α,and S-100β levels.This scheme also reduced POCD and had a high safety profile.
基金The 13th Five-Year Key Project for Traditional Chinese Medicine of Zhejiang Province,No.2A11951.
文摘BACKGROUND Pericardial rupture caused by blunt chest trauma is rare in clinical practice.Because of its atypical clinical symptoms,and because surgeons are often unfamiliar with the clinical and radiological manifestations of the injury,preoperative diagnosis is difficult;it is easily misdiagnosed and causes serious consequences.CASE SUMMARY A 60-year-old man,previously healthy,was transported to the emergency room after falling from a great height.Upon arrival,his vital signs were stable.Electrocardiography and echocardiography were performed,and there was no sign of cardiac injury or ischemia.Chest and abdomen computerized tomography revealed pneumopericardium,hemopneumothorax,lung contusion,multiple rib fractures on the right side(Figure 1),and right scapula and clavicle fractures.He was admitted to the inpatient department for further observation after tube thoracostomy.The next day,the patient suddenly experienced rapid arrhythmia(the ventricular rate reached 150-180 beats/min)when turning onto his right side,accompanied by a blood pressure drop to 70/45 mm Hg and a chief complaint of palpitation.Thoracoscopy was performed urgently,and a large vertical tear(8 cm×6 cm)was found in the pericardium.The defect was successfully repaired using a heart Dacron patch.His postoperative condition was uneventful without any fluctuations in vital signs,and he was transferred to the orthopedics department for further surgery on postoperative day 8.CONCLUSION Although the possibility of pericardial rupture combined with cardiac hernia is extremely low,it is one of the causes of cardiogenic shock following blunt trauma.Therefore,clinicians need to be more familiar with its characteristic manifestations and maintain a high degree of vigilance against such injuries to avoid disastrous consequences.
基金Supported by China Medical University Hospital(No.DMR-107-063).
文摘BACKGROUND Pneumocephalus is a rare complication presenting in the postoperative period of a thoracoscopic operation.We report a case in which tension pneumocephalus occurred after thoracoscopic resection as well as the subsequent approach of surgical management.CASE SUMMARY A 66-year-old man who received thoracoscopic resection to remove an intrathoracic,posterior mediastinal,dumbbell-shaped,pathology-proven neurogenic tumor.The patient then reported experiencing progressively severe headaches,especially when in an upright position.A brain computed tomography scan at a local hospital disclosed extensive pneumocephalus.Revision surgery for resection of the pseudomeningocele and repair of the cerebrospinal fluid leakage was thus arranged for the patient.During the operation,we traced the cerebrospinal fluid leakage and found that it might have derived from incomplete endoscopic clipping around the tumor stump near the dural sac at the T3 level.After that,we wrapped and sealed all the possible origins of the leakage with autologous fat,tissue glue,gelfoam,and duraseal layer by layer.The patient recovered well,and the computed tomography images showed resolution of the pneumocephalus.CONCLUSION This report and literature review indicated that the risk of developing a tension pneumocephalus cannot be ignored and should be monitored carefully after thoracoscopic tumor resection.
文摘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.
文摘Objective: to investigate the effect of right mammary duct esophageal cancer surgery on lung function and medical history. Methods: from February 2018 to March 2019, 80 patients with esophageal cancer underwent surgical resection were randomly selected for clinical data. They were divided into control group (n = 40) and follow-up group (n = 40). They selected clinical routine surgery for breast cancer, upper and lower esophageal cancer, and thoracic prism observation group for esophageal cancer radical surgery. The indexes of the two groups were compared, and the changes of pulmonary function parameters before and after surgery (FEV1, FEV1/FVG, and PEF) were analyzed. Bottom line: Compared with the control group, the operation indexes (operation time, leakage time, hospitalization time, hemorrhage) were significantly reduced (n < 0.05);The lung function indexes of the two groups before and after the operation treatment (n> 0.05) were significantly different from each other. After the treatment, the lung function indexes of the observation group were significantly better than those of the control group (n <0.05). Conclusion: compared with the traditional thoracotomy, the right endoscopic surgery for esophageal cancer has the advantages of fewer traumas, less pain, significantly improved operation performance, less influence on lung function and high clinical application cost.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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.
文摘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
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.
