BACKGROUND Uniportal full-endoscopy(UFE)technique has been continuously developed and applied for treating lumbar spinal stenosis.However,achieving effective decompression outcome of using the UFE technique remains te...BACKGROUND Uniportal full-endoscopy(UFE)technique has been continuously developed and applied for treating lumbar spinal stenosis.However,achieving effective decompression outcome of using the UFE technique remains technically demanding and uncertain.Previously,we have proposed the biportal full-endoscopy(BFE)technique to integrate the respective advantages of both UFE and unilateral biportal endoscopy technique.There is limited published data on the comparison of clinical outcomes between biportal and UFE techniques in lumbar spinal stenosis with bilateral symptoms.AIM To contrast the clinical outcomes between biportal and UFE techniques for treating lumbar spinal stenosis with bilateral symptoms.METHODS This study retrospectively examined 100 patients diagnosed with lumbar spinal stenosis and bilateral symptoms.Among them,52 cases were part of group A(BFE technique group),and 48 cases belonged to group B(UFE technique group).The visual analogue scale(VAS),Oswestry Disability Index(ODI),and modified Macnab criteria were used to evaluate the clinical outcomes.RESULTS Group A had significantly shorter operation time than group B.Both groups experienced substantial relief in lower back and lower extremity pain on the severe side at postoperative 3 days,3 months,and 12 months.Group A had notably lower VAS scores for mild side lower extremity pain at postoperative 3 months and 12 months compared to group B.Group A's ODI scores were significantly lower at postoperative 3 months and 12 months,whereas group B's scores did not significantly differ from preoperative values.Group A's ODI scores were significantly lower than group B's at postoperative 3 months and 12 months.Group A had a significantly higher excellent and good response rate(94.23%)compared to group B(81.25%)at postoperative 12 months based on the modified Macnab scale outcomes.CONCLUSION The BFE technique offers multiple benefits,including reduced trauma and quicker recovery as a minimally invasive surgery,and enhanced decompression efficiency over the UFE technique when treating lumbar spinal stenosis with bilateral symptoms.展开更多
Objectives:Mitochondrial Ca^(2+)uniporter(MCU)provides a Ca^(2+)influx pathway from the cytosol into the mitochondrial matrix and a moderate mitochondrial Ca^(2+)rise stimulates ATP production and cell growth.MCU is h...Objectives:Mitochondrial Ca^(2+)uniporter(MCU)provides a Ca^(2+)influx pathway from the cytosol into the mitochondrial matrix and a moderate mitochondrial Ca^(2+)rise stimulates ATP production and cell growth.MCU is highly expressed in various cancer cells including breast cancer cells,thereby increasing the capacity of mitochondrial Ca^(2+)uptake,ATP production,and cancer cell proliferation.The objective of this study was to examine MCU inhibition as an anti-cancer mechanism.Methods:The effects of MCU-i4,a newly developed MCU inhibitor,on cell viability,apoptosis,cytosolic Ca^(2+),mitochondrial Ca^(2+)and potential,glycolytic rate,generation of ATP,and reactive oxygen species,were examined in breast cancer BT474 cells.Results:MCU-i4 caused apoptotic cell death,and it decreased and increased,respectively,mitochondrial and cytosolic Ca^(2+)concentration.Inhibition of MCU by MCU-i4 revealed that cytosolic Ca^(2+)elevation resulted from endoplasmic reticulum(ER)Ca^(2+)release via inositol 1,4,5-trisphosphate receptors(IP3R)and ryanodine receptors(RYR).Unexpectedly,MCU-i4 enhanced glycolysis and ATP production;it also triggered a large production of reactive oxygen species(ROS)and mitochondrial membrane potential collapse.Conclusion:Cytotoxic mechanisms of MCU-i4 in cancer cells involved enhanced glycolysis and heightened formation of ATP and ROS.It is conventionally believed that cancer cell death could be caused by inhibition of glycolysis.Our observations suggest cancer cell death could also be induced by increased glycolytic metabolism.展开更多
Thanks to the recent improvements in video-assisted thoracoscopic techniques （VATS） and anesthetic procedures, a great deal of complex lung resections can be performed avoiding open surgery. The experience gained th...Thanks to the recent improvements in video-assisted thoracoscopic techniques （VATS） and anesthetic procedures, a great deal of complex lung resections can be performed avoiding open surgery. The experience gained through VATS techniques, enhancement of the surgical instruments ,improvement of high definition cameras and avoidance of intubated general anesthesia have been the greatest advances to minimize the trauma to the patient. Uniportal VATS for major resections has become a revolution in the treatment of lung pathologies since initially described 4 years ago. The huge number of surgical videos posted on specialized websites, live surgery events and experimental courses has contributed to the rapid learning of uniportal major thoracoscopic surgery during the last years. The future of the thoracic surgery is based on evolution of surgical procedures and anesthetic techniques to try to reduce the trauma to the patient. Further development of new technologies probably will focus on sealing devices for all vessels and fissure, refined staplers and instruments, improvements in 3D systems or wireless cameras, and robotic surgery. As thoracoscopic techniques continue to evolve exponentially, we can see the emergence of new approaches in the anesthetical and the perioperative management of these patients. Advances in anesthesia include lobectomies performed without the employment of general anesthesia, through maintaining spontaneous ventilation, and with minimally sedated patients. Uniportal VATS resections under spontaneous ventilation probably represent the least invasive approach to operate lung cancer.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
To investigate the influence of the mitochondrial calcium uniporter on the mitochondrial permeability transition pore, the present study observed mitochondrial morphology in cortical neurons isolated from adult rats u...To investigate the influence of the mitochondrial calcium uniporter on the mitochondrial permeability transition pore, the present study observed mitochondrial morphology in cortical neurons isolated from adult rats using transmission electron microscopy, and confirmed the morphology and activity of isolated mitochondria by detecting succinic dehydrogenase and monoamine oxidase, two mitochondrial enzymes. Isolated mitochondria were treated with either ruthenium red, an inhibitor of the uniporter, spermine, an activator of the uniporter, or in combination with cyclosporin A, an inhibitor of the mitochondrial permeability transition pore. Results showed that ruthenium red inhibited CaCl2-induced mitochondrial permeability transition pore opening, spermine enhanced opening, and cyclosporin A attenuated the effects of spermine. Results demonstrated that the mitochondrial calcium uniporter plays a role in regulating the mitochondrial permeability transition pore in mitochondria isolated from the rat brain cortex.展开更多
The present study investigated the effects of the mitochondrial calcium uniporter inhibitor ruthenium red and the agonist spermine on cerebral edema in rats with cerebral ischemia reperfusion injury. Left middle cereb...The present study investigated the effects of the mitochondrial calcium uniporter inhibitor ruthenium red and the agonist spermine on cerebral edema in rats with cerebral ischemia reperfusion injury. Left middle cerebral artery occlusion （MCAO） was induced in rats using the suture method. Following 24 hours of ischemic reperfusion, neurological function scores of rats with MCAO, and rats pretreated with ruthenium red and spermine were significantly lower, however, water content of brain tissue, aquaporin 4 expression and immunoglobulin G （IgG） exudation were significantly higher than those of sham-operated rats. Compared with MCAO rats and spermine-treated rats, neurological function scores were considerably higher, and brain tissue water content, aquaporin 4 expression and IgG exudation decreased in ruthenium red-treated rats. These findings suggest that preventive application of the mitochondrial calcium uniporter inhibitor ruthenium red can significantly decrease aquaporin 4 and IgG expression, influence the permeability of the blood brain barrier, and thereby decrease the extent of cerebral edema.展开更多
Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the tre...Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included;all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay.展开更多
We aimed to describe a method for repositioning of right middle lobar torsion by using a 3-cm uniportal video-assisted thoracoscopic surgery(VATS) approach. Middle lobe torsion occurred after right upper and lower lob...We aimed to describe a method for repositioning of right middle lobar torsion by using a 3-cm uniportal video-assisted thoracoscopic surgery(VATS) approach. Middle lobe torsion occurred after right upper and lower lobectomy in a 74-year-old man. Immediate re-exploratory thoracotomy using the 3-cm uniportal VATS approach was performed. The torsion was corrected, and the lobe was anchored to the anterior chest wall with Prolene stitches. The patient recovered well postoperatively with daily improvements in chest radiographic findings. Follow-up examination was performed using fiberbronchoscopy, which revealed an unobstructed right middle lobe bronchus and sticky yellow sputum. Follow-up chest computed tomography was performed 3 months after the primary surgery and revealed increased expansion of the right middle lobe. We repositioned the right middle lobe successfully by using the 3-cm uniportal VATS approach, but more cases are needed to confirm the feasibility of the approach. Lobectomy remains the primary treatment option for such cases.展开更多
BACKGROUND Mediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor.In this report,we describe a rare case of giant mature teratoma located primarily in the anterior med...BACKGROUND Mediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor.In this report,we describe a rare case of giant mature teratoma located primarily in the anterior mediastinum and causing partial atelectasis of the upper and middle lobes of the right lung,as well as extrinsic compression of the right atrium.CASE SUMMARY A 31-year-old male with a giant mediastinal mature teratoma presented with progressive exertional dyspnea and chest pain for 1 mo.Computed tomography of the chest indicated the diagnosis of anterior mediastinal teratoma.The patient underwent right uniportal anterior approach video-assisted thoracoscopic surgery(VATS).En bloc resection of the giant teratoma,wedge resection of the upper and middle lobes of the right lung,resection of the thymus and partial excision of the pericardium were successfully performed.The pathological diagnosis revealed a mature cystic teratoma with foreign-body reaction that was closely related to the right lung,atrium dextrum,superior vena cava and ascending aorta.An atrophic thymic tissue was also discovered at the external teratoma surface.The patient was discharged on postoperative day 7.CONCLUSION This is the first report of the use of uniportal VATS for complete resection of a teratoma in combination with wedge resection of the right upper and middle lung lobes and partial resection of the pericardium.展开更多
BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE...BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE SUMMARY A 39-year-old woman presented with a growing solitary pulmonary nodule measuring 2.0 cm in the right upper lobe(RUL)of the lung.The patient underwent a RUL anterior segmentectomy using uniportal video-assisted thoracoscopy.A preliminary tissue diagnosis indicated malignancy;however,it was later revised to an IMTs.Due to the absence of a minor fissure between the right upper and middle lobes,an alternative resection approach was necessary.Therefore,we utilized indocyanine green injection to aid in delineating the intersegmental plane.Following an uneventful recovery,the patient was discharged on the third postoperative day.Thereafter,annual chest tomography scans were scheduled to monitor for potential local recurrence.CONCLUSION This case underscores the challenges in diagnosing and managing IMTs,showing the importance of accurate pathologic assessments and tailored surgical strategies.展开更多
Introduction: Uniportal Video-Assisted Thoracic Surgery (U-VATS) has appeared as a promising, minimally invasive approach for thoracic oncology, offering benefits such as reduced trauma, shorter recovery times, and lo...Introduction: Uniportal Video-Assisted Thoracic Surgery (U-VATS) has appeared as a promising, minimally invasive approach for thoracic oncology, offering benefits such as reduced trauma, shorter recovery times, and lower complication rates. However, its adoption in resource-limited settings faces challenges, primarily due to limited access to specialized equipment, training, and infrastructure. Methods: This retrospective study evaluated the outcomes of 138 oncologic patients who underwent U-VATS between 2020 and 2024 at two centers in the Dominican Republic. Patients included those with primary lung cancer, pulmonary metastases, or masses requiring diagnostic biopsy. Data was extracted from patient records including epidemiological variables and clinical variables, treatments, and complications. A descriptive analysis was performed to summarize the data. Frequencies and percentages were calculated to report demographic and clinical characteristics, types of procedures, and postoperative outcomes. Results: The study population was predominantly middle-aged, with a near-equal gender distribution. Most patients underwent lung biopsies (63%), followed by lobectomies (22.5%) and metastasectomies (14.5%). The overall complication rate was low, with only 2.1% experiencing wound infections or atelectasis. The majority (87%) were discharged within 24 hours. These findings underscore U-VATS as a safe and effective choice for thoracic oncology in this setting. Conclusions: U-VATS shows promising outcomes in oncologic patients in the Dominican Republic, proving its feasibility and safety in a resource-limited environment. However, widespread adoption requires investment in infrastructure, training, and insurance coverage. Phased implementation, public-private partnerships, and cost-benefit analyses could support broader accessibility and integration of U-VATS, potentially improving patient outcomes and reducing healthcare costs in similar settings.展开更多
Background Video-assisted thoracoscopic sympathectomy had replaced open surgery. The aim of this study was to compare the outcomes of using a single port and two ports to perform video-assisted thoracoscopic sympathec...Background Video-assisted thoracoscopic sympathectomy had replaced open surgery. The aim of this study was to compare the outcomes of using a single port and two ports to perform video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis. Methods Between April 2006 and February 2008, 20 cases underwent video-assisted thoracoscopic sympathectomy through one port （uniportal group） and 25 cases through two ports （biportal group）. The variables including the operating time, hospital stay, pain scores, postoperative complications, incidence of symptom recurrence and patient satisfaction were compared. The mean postoperative follow-up period was 11.5 months （range, 3-25 months）. Results The hands of all patients were warm and dry after operation. No conversion to open surgery was necessary, and no operative mortality was recorded in either group. The mean inpatient pain scores were significantly higher in the biportal group （1.2±0.6） than that in the uniportal group （0.8±0.5, P=0.025）. For the first three weeks after operation, four out of 20 （20%） patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 （32%） cases in the biportal group （P=0.366）. Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics. Our mean operative time （bilateral sympathectomy） in the uniportal group （（39.5±10.0） minutes） was shorter than that in biportal group （（49.7±10.6） minutes, P=0.02）. There were no significant differences between two groups in terms of the mean hospital stay, compensatory sweating, and patient satisfaction. Two patients in the biportal group and three in the uniportal group experienced a unilateral pneumothorax. None of them required chest drainage. No patient experienced Homer＇s syndrome, and no recurrent symptoms were observed in either groups Conclusions Both uniportal and biportal video-assisted thoracoscopic sympathectomy are effective, safe, and minimally invasive for palmar hyperhidrosis. Comparing with the biportal approach, the uniportal approach causes less postoperative pain and less operative time, and is a more reasonable procedure in treatment of palmar hyperhidrosis.展开更多
Background： Both uniportal and triportal thoracoscopic lobectomy and sublobectomy are feasible for early-stage non-small cell lung cancer （NSCLC）. The aim of this study was to compare the perioperative outcomes of ...Background： Both uniportal and triportal thoracoscopic lobectomy and sublobectomy are feasible for early-stage non-small cell lung cancer （NSCLC）. The aim of this study was to compare the perioperative outcomes of uniportal and triportal thoracoscopic Iobectomy and sublobectomy for early-stage NSCLC. Methods： A total of 405 patients with lung lesions underwent thoracoscopic lobectomy or sublobectomy through a uniportal or triportal procedure in approximately 7-month period （From November 2014 to May 2015）. A propensity-matched analysis, incorporating preoperative variables, was used to compare the short-term outcomes of patients who received uniportal or triportal thoracoscopic lobectomy and sublobectomy. Results： Fifty-eight patients underwent uniportal and 347 patients underwent triportal pulmonary resection. The conversion rate for uniportal and triportal procedure was 3.4% （2/58） and 2.3% （8/347）, respectively. The complication rate for uniportal and triportal procedure was 10.3% and 9.5%, respectively. There was no perioperative death in either group. Most patients had early-stage NSCLC in both groups （uniportal： 45/47, 96%; triportal： 313/343, 91%）. Propensity score-matching analysis demonstrated no significant differences in operation time, intraoperative blood loss, numbers of dissected lymph nodes, number of stations of lymph node dissected, duration of chest tube, and complication rate between uniportal and triportal group for early-stage NSCLC. However, the duration of postoperative hospitalization was longer in the uniportal group （6.83 ± 4.17 vs. 5.42 ± 1.86 d, P = 0.036） compared with the triportal group. Conclusions： Uniportal thoracoscopic lobectomy and sublobectomy is safe and feasible, with comparable short-term outcomes with triportal thoracoscopic pulmonary resection. Uniportal lobectomy and sublobectomy lead to similar cure rate as triportal Iobectomy and sublobectomy for early NSCLC.展开更多
Lung major resections involving bronchovascular reconstruction pose a surgical challenge due to their technical complexity and frequency.The traditional techniques to perform vascular or bronchial reconstructions thro...Lung major resections involving bronchovascular reconstruction pose a surgical challenge due to their technical complexity and frequency.The traditional techniques to perform vascular or bronchial reconstructions through multiportal video-assisted thoracoscopic surgery(VATS)approach can be applied also by uniportal VATS approach.Nevertheless,specific tools have already been developed in order to facilitate these procedures through uniportal VATS approach increasing comfort and workspace through the single port utility.These procedures must be performed just in very highly uniportal VATS trained teams and it is recommended that teams who perform these techniques previously have completed the advanced learning curve for lung major resections through uniportal VATS approach.The aim of this paper is to describe the major key points for performing most frequent bronchovascular reconstructions through uniportal VATS approach in a safe and feasible way.Operative technique is step by step described in order to safely perform most common uniportal VATS left/right side lung major bronchovascular resections and reconstructions.Specific tip and tricks are detailed in order to facilitate vascular control,bronchovascular reconstructions and unexpected bleeding control through uniportal VATS approach.展开更多
基金Supported by National Natural Science Foundation of China,No.82202694Clinical Research Innovation Plan of Shanghai General Hospital,No.CTCCR-2021C10.
文摘BACKGROUND Uniportal full-endoscopy(UFE)technique has been continuously developed and applied for treating lumbar spinal stenosis.However,achieving effective decompression outcome of using the UFE technique remains technically demanding and uncertain.Previously,we have proposed the biportal full-endoscopy(BFE)technique to integrate the respective advantages of both UFE and unilateral biportal endoscopy technique.There is limited published data on the comparison of clinical outcomes between biportal and UFE techniques in lumbar spinal stenosis with bilateral symptoms.AIM To contrast the clinical outcomes between biportal and UFE techniques for treating lumbar spinal stenosis with bilateral symptoms.METHODS This study retrospectively examined 100 patients diagnosed with lumbar spinal stenosis and bilateral symptoms.Among them,52 cases were part of group A(BFE technique group),and 48 cases belonged to group B(UFE technique group).The visual analogue scale(VAS),Oswestry Disability Index(ODI),and modified Macnab criteria were used to evaluate the clinical outcomes.RESULTS Group A had significantly shorter operation time than group B.Both groups experienced substantial relief in lower back and lower extremity pain on the severe side at postoperative 3 days,3 months,and 12 months.Group A had notably lower VAS scores for mild side lower extremity pain at postoperative 3 months and 12 months compared to group B.Group A's ODI scores were significantly lower at postoperative 3 months and 12 months,whereas group B's scores did not significantly differ from preoperative values.Group A's ODI scores were significantly lower than group B's at postoperative 3 months and 12 months.Group A had a significantly higher excellent and good response rate(94.23%)compared to group B(81.25%)at postoperative 12 months based on the modified Macnab scale outcomes.CONCLUSION The BFE technique offers multiple benefits,including reduced trauma and quicker recovery as a minimally invasive surgery,and enhanced decompression efficiency over the UFE technique when treating lumbar spinal stenosis with bilateral symptoms.
基金China Medical University and China Medical University Hospital,Taiwan for providing fundings(CMU111-S-20,CMU112-S-59,DMR-112-067)ECS thanks An Nan Hospital for support(ANHRF112-04).
文摘Objectives:Mitochondrial Ca^(2+)uniporter(MCU)provides a Ca^(2+)influx pathway from the cytosol into the mitochondrial matrix and a moderate mitochondrial Ca^(2+)rise stimulates ATP production and cell growth.MCU is highly expressed in various cancer cells including breast cancer cells,thereby increasing the capacity of mitochondrial Ca^(2+)uptake,ATP production,and cancer cell proliferation.The objective of this study was to examine MCU inhibition as an anti-cancer mechanism.Methods:The effects of MCU-i4,a newly developed MCU inhibitor,on cell viability,apoptosis,cytosolic Ca^(2+),mitochondrial Ca^(2+)and potential,glycolytic rate,generation of ATP,and reactive oxygen species,were examined in breast cancer BT474 cells.Results:MCU-i4 caused apoptotic cell death,and it decreased and increased,respectively,mitochondrial and cytosolic Ca^(2+)concentration.Inhibition of MCU by MCU-i4 revealed that cytosolic Ca^(2+)elevation resulted from endoplasmic reticulum(ER)Ca^(2+)release via inositol 1,4,5-trisphosphate receptors(IP3R)and ryanodine receptors(RYR).Unexpectedly,MCU-i4 enhanced glycolysis and ATP production;it also triggered a large production of reactive oxygen species(ROS)and mitochondrial membrane potential collapse.Conclusion:Cytotoxic mechanisms of MCU-i4 in cancer cells involved enhanced glycolysis and heightened formation of ATP and ROS.It is conventionally believed that cancer cell death could be caused by inhibition of glycolysis.Our observations suggest cancer cell death could also be induced by increased glycolytic metabolism.
文摘Thanks to the recent improvements in video-assisted thoracoscopic techniques （VATS） and anesthetic procedures, a great deal of complex lung resections can be performed avoiding open surgery. The experience gained through VATS techniques, enhancement of the surgical instruments ,improvement of high definition cameras and avoidance of intubated general anesthesia have been the greatest advances to minimize the trauma to the patient. Uniportal VATS for major resections has become a revolution in the treatment of lung pathologies since initially described 4 years ago. The huge number of surgical videos posted on specialized websites, live surgery events and experimental courses has contributed to the rapid learning of uniportal major thoracoscopic surgery during the last years. The future of the thoracic surgery is based on evolution of surgical procedures and anesthetic techniques to try to reduce the trauma to the patient. Further development of new technologies probably will focus on sealing devices for all vessels and fissure, refined staplers and instruments, improvements in 3D systems or wireless cameras, and robotic surgery. As thoracoscopic techniques continue to evolve exponentially, we can see the emergence of new approaches in the anesthetical and the perioperative management of these patients. Advances in anesthesia include lobectomies performed without the employment of general anesthesia, through maintaining spontaneous ventilation, and with minimally sedated patients. Uniportal VATS resections under spontaneous ventilation probably represent the least invasive approach to operate lung cancer.
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.
基金supported by the National Natural Science Foundation of China, No. 30972855/C160203Natural Science Foundation of Shandong Province No. ZR2009CM062
文摘To investigate the influence of the mitochondrial calcium uniporter on the mitochondrial permeability transition pore, the present study observed mitochondrial morphology in cortical neurons isolated from adult rats using transmission electron microscopy, and confirmed the morphology and activity of isolated mitochondria by detecting succinic dehydrogenase and monoamine oxidase, two mitochondrial enzymes. Isolated mitochondria were treated with either ruthenium red, an inhibitor of the uniporter, spermine, an activator of the uniporter, or in combination with cyclosporin A, an inhibitor of the mitochondrial permeability transition pore. Results showed that ruthenium red inhibited CaCl2-induced mitochondrial permeability transition pore opening, spermine enhanced opening, and cyclosporin A attenuated the effects of spermine. Results demonstrated that the mitochondrial calcium uniporter plays a role in regulating the mitochondrial permeability transition pore in mitochondria isolated from the rat brain cortex.
基金the National Natural Science Foundation of China, No. 30972855/C160203
文摘The present study investigated the effects of the mitochondrial calcium uniporter inhibitor ruthenium red and the agonist spermine on cerebral edema in rats with cerebral ischemia reperfusion injury. Left middle cerebral artery occlusion （MCAO） was induced in rats using the suture method. Following 24 hours of ischemic reperfusion, neurological function scores of rats with MCAO, and rats pretreated with ruthenium red and spermine were significantly lower, however, water content of brain tissue, aquaporin 4 expression and immunoglobulin G （IgG） exudation were significantly higher than those of sham-operated rats. Compared with MCAO rats and spermine-treated rats, neurological function scores were considerably higher, and brain tissue water content, aquaporin 4 expression and IgG exudation decreased in ruthenium red-treated rats. These findings suggest that preventive application of the mitochondrial calcium uniporter inhibitor ruthenium red can significantly decrease aquaporin 4 and IgG expression, influence the permeability of the blood brain barrier, and thereby decrease the extent of cerebral edema.
文摘Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included;all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay.
文摘We aimed to describe a method for repositioning of right middle lobar torsion by using a 3-cm uniportal video-assisted thoracoscopic surgery(VATS) approach. Middle lobe torsion occurred after right upper and lower lobectomy in a 74-year-old man. Immediate re-exploratory thoracotomy using the 3-cm uniportal VATS approach was performed. The torsion was corrected, and the lobe was anchored to the anterior chest wall with Prolene stitches. The patient recovered well postoperatively with daily improvements in chest radiographic findings. Follow-up examination was performed using fiberbronchoscopy, which revealed an unobstructed right middle lobe bronchus and sticky yellow sputum. Follow-up chest computed tomography was performed 3 months after the primary surgery and revealed increased expansion of the right middle lobe. We repositioned the right middle lobe successfully by using the 3-cm uniportal VATS approach, but more cases are needed to confirm the feasibility of the approach. Lobectomy remains the primary treatment option for such cases.
文摘BACKGROUND Mediastinal mature teratoma is the most common histological type of primary extragonadal germ cell tumor.In this report,we describe a rare case of giant mature teratoma located primarily in the anterior mediastinum and causing partial atelectasis of the upper and middle lobes of the right lung,as well as extrinsic compression of the right atrium.CASE SUMMARY A 31-year-old male with a giant mediastinal mature teratoma presented with progressive exertional dyspnea and chest pain for 1 mo.Computed tomography of the chest indicated the diagnosis of anterior mediastinal teratoma.The patient underwent right uniportal anterior approach video-assisted thoracoscopic surgery(VATS).En bloc resection of the giant teratoma,wedge resection of the upper and middle lobes of the right lung,resection of the thymus and partial excision of the pericardium were successfully performed.The pathological diagnosis revealed a mature cystic teratoma with foreign-body reaction that was closely related to the right lung,atrium dextrum,superior vena cava and ascending aorta.An atrophic thymic tissue was also discovered at the external teratoma surface.The patient was discharged on postoperative day 7.CONCLUSION This is the first report of the use of uniportal VATS for complete resection of a teratoma in combination with wedge resection of the right upper and middle lung lobes and partial resection of the pericardium.
文摘BACKGROUND Inflammatory myofibroblastic tumors(IMTs)are exceptionally rare neoplasms with intermediate malignant potential.Surgery is the accepted treatment option,aiming for complete resection with clear margins.CASE SUMMARY A 39-year-old woman presented with a growing solitary pulmonary nodule measuring 2.0 cm in the right upper lobe(RUL)of the lung.The patient underwent a RUL anterior segmentectomy using uniportal video-assisted thoracoscopy.A preliminary tissue diagnosis indicated malignancy;however,it was later revised to an IMTs.Due to the absence of a minor fissure between the right upper and middle lobes,an alternative resection approach was necessary.Therefore,we utilized indocyanine green injection to aid in delineating the intersegmental plane.Following an uneventful recovery,the patient was discharged on the third postoperative day.Thereafter,annual chest tomography scans were scheduled to monitor for potential local recurrence.CONCLUSION This case underscores the challenges in diagnosing and managing IMTs,showing the importance of accurate pathologic assessments and tailored surgical strategies.
文摘Introduction: Uniportal Video-Assisted Thoracic Surgery (U-VATS) has appeared as a promising, minimally invasive approach for thoracic oncology, offering benefits such as reduced trauma, shorter recovery times, and lower complication rates. However, its adoption in resource-limited settings faces challenges, primarily due to limited access to specialized equipment, training, and infrastructure. Methods: This retrospective study evaluated the outcomes of 138 oncologic patients who underwent U-VATS between 2020 and 2024 at two centers in the Dominican Republic. Patients included those with primary lung cancer, pulmonary metastases, or masses requiring diagnostic biopsy. Data was extracted from patient records including epidemiological variables and clinical variables, treatments, and complications. A descriptive analysis was performed to summarize the data. Frequencies and percentages were calculated to report demographic and clinical characteristics, types of procedures, and postoperative outcomes. Results: The study population was predominantly middle-aged, with a near-equal gender distribution. Most patients underwent lung biopsies (63%), followed by lobectomies (22.5%) and metastasectomies (14.5%). The overall complication rate was low, with only 2.1% experiencing wound infections or atelectasis. The majority (87%) were discharged within 24 hours. These findings underscore U-VATS as a safe and effective choice for thoracic oncology in this setting. Conclusions: U-VATS shows promising outcomes in oncologic patients in the Dominican Republic, proving its feasibility and safety in a resource-limited environment. However, widespread adoption requires investment in infrastructure, training, and insurance coverage. Phased implementation, public-private partnerships, and cost-benefit analyses could support broader accessibility and integration of U-VATS, potentially improving patient outcomes and reducing healthcare costs in similar settings.
文摘Background Video-assisted thoracoscopic sympathectomy had replaced open surgery. The aim of this study was to compare the outcomes of using a single port and two ports to perform video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis. Methods Between April 2006 and February 2008, 20 cases underwent video-assisted thoracoscopic sympathectomy through one port （uniportal group） and 25 cases through two ports （biportal group）. The variables including the operating time, hospital stay, pain scores, postoperative complications, incidence of symptom recurrence and patient satisfaction were compared. The mean postoperative follow-up period was 11.5 months （range, 3-25 months）. Results The hands of all patients were warm and dry after operation. No conversion to open surgery was necessary, and no operative mortality was recorded in either group. The mean inpatient pain scores were significantly higher in the biportal group （1.2±0.6） than that in the uniportal group （0.8±0.5, P=0.025）. For the first three weeks after operation, four out of 20 （20%） patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 （32%） cases in the biportal group （P=0.366）. Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics. Our mean operative time （bilateral sympathectomy） in the uniportal group （（39.5±10.0） minutes） was shorter than that in biportal group （（49.7±10.6） minutes, P=0.02）. There were no significant differences between two groups in terms of the mean hospital stay, compensatory sweating, and patient satisfaction. Two patients in the biportal group and three in the uniportal group experienced a unilateral pneumothorax. None of them required chest drainage. No patient experienced Homer＇s syndrome, and no recurrent symptoms were observed in either groups Conclusions Both uniportal and biportal video-assisted thoracoscopic sympathectomy are effective, safe, and minimally invasive for palmar hyperhidrosis. Comparing with the biportal approach, the uniportal approach causes less postoperative pain and less operative time, and is a more reasonable procedure in treatment of palmar hyperhidrosis.
文摘Background： Both uniportal and triportal thoracoscopic lobectomy and sublobectomy are feasible for early-stage non-small cell lung cancer （NSCLC）. The aim of this study was to compare the perioperative outcomes of uniportal and triportal thoracoscopic Iobectomy and sublobectomy for early-stage NSCLC. Methods： A total of 405 patients with lung lesions underwent thoracoscopic lobectomy or sublobectomy through a uniportal or triportal procedure in approximately 7-month period （From November 2014 to May 2015）. A propensity-matched analysis, incorporating preoperative variables, was used to compare the short-term outcomes of patients who received uniportal or triportal thoracoscopic lobectomy and sublobectomy. Results： Fifty-eight patients underwent uniportal and 347 patients underwent triportal pulmonary resection. The conversion rate for uniportal and triportal procedure was 3.4% （2/58） and 2.3% （8/347）, respectively. The complication rate for uniportal and triportal procedure was 10.3% and 9.5%, respectively. There was no perioperative death in either group. Most patients had early-stage NSCLC in both groups （uniportal： 45/47, 96%; triportal： 313/343, 91%）. Propensity score-matching analysis demonstrated no significant differences in operation time, intraoperative blood loss, numbers of dissected lymph nodes, number of stations of lymph node dissected, duration of chest tube, and complication rate between uniportal and triportal group for early-stage NSCLC. However, the duration of postoperative hospitalization was longer in the uniportal group （6.83 ± 4.17 vs. 5.42 ± 1.86 d, P = 0.036） compared with the triportal group. Conclusions： Uniportal thoracoscopic lobectomy and sublobectomy is safe and feasible, with comparable short-term outcomes with triportal thoracoscopic pulmonary resection. Uniportal lobectomy and sublobectomy lead to similar cure rate as triportal Iobectomy and sublobectomy for early NSCLC.
文摘Lung major resections involving bronchovascular reconstruction pose a surgical challenge due to their technical complexity and frequency.The traditional techniques to perform vascular or bronchial reconstructions through multiportal video-assisted thoracoscopic surgery(VATS)approach can be applied also by uniportal VATS approach.Nevertheless,specific tools have already been developed in order to facilitate these procedures through uniportal VATS approach increasing comfort and workspace through the single port utility.These procedures must be performed just in very highly uniportal VATS trained teams and it is recommended that teams who perform these techniques previously have completed the advanced learning curve for lung major resections through uniportal VATS approach.The aim of this paper is to describe the major key points for performing most frequent bronchovascular reconstructions through uniportal VATS approach in a safe and feasible way.Operative technique is step by step described in order to safely perform most common uniportal VATS left/right side lung major bronchovascular resections and reconstructions.Specific tip and tricks are detailed in order to facilitate vascular control,bronchovascular reconstructions and unexpected bleeding control through uniportal VATS approach.
