Prospective case-control study on pain intensity after the use of promethazine in patients undergoing videothoracoscopy.

Objective: Effective and secure pain management following video-assisted thoracoscopic surgery (VATS) is crucial for rapid postoperative recovery. This study evaluated analgesic and sedative effects of sufentanil and promethazine in patient-controlled intravenous analgesia (PCIA) post-thoracic surgery, along with potential adverse reactions. Methods: In this prospective, randomized, controlled, double-blind, clinical study, 60 patients (American Society of Anesthesiologists status I-III) undergoing VATS were enrolled. The patients were randomized into experimental (Group P) or control (Group C) groups. PCIA was administered post-general anesthesia using a double-blind method. Group P received sufentanil (3 µg/kg) + promethazine (1 mg/kg) + 0.9% sodium chloride solution (100 mL total), while Group C received sufentanil (3 µg/kg) + 0.9% sodium chloride solution (100 mL total). PCIA settings included a 1-mL bolus and 15-min locking time. The primary outcomes were the visual analog scale (VAS) at rest and during coughing and sedation (Ramsay) scores at 6, 12, 24, and 48 h. The secondary outcomes were rescue drug use rate, hemodynamic parameters (mean arterial pressure and heart rate), percutaneous oxygen saturation, respiratory rate, and occurrence of adverse reactions. Results: Group P exhibited lower resting and coughing VAS scores at 6, 12, 24, and 48 h, plus decreased incidence of nausea and vomiting within 48 h post-surgery compared with Group C (p < 0.05). No significant differences were observed in pruritus, sedation (Ramsay) scores, mean arterial pressure, heart rate, oxygen saturation, or respiratory rate between the two groups (p > 0.05). Discussion: The combination of sufentanil and promethazine for postoperative intravenous analgesia could effectively reduce adverse effects such as nausea and vomiting, contributing to postoperative pain relief.

Analgesic Efficacy of Single-Shot Erector Spinae Block in Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Retrospective Cohort Study.

Introduction Video-assisted thoracic surgery (VATS) is a minimally invasive surgical technique though effective analgesia remains a challenge. Erector spinae plane block (ESPB) has gained popularity due to its ease and safety of placement. In this study, we evaluated the analgesic efficacy of ESPB in patients undergoing VATS through a propensity score-matched retrospective cohort study. The primary outcome is the total opioid use in the first 12 postoperative hours. Methods We used binomial logistic regression to model whether patients received ESPB as a function of age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, and surgery type to generate a propensity score for each patient for matching. Results After screening 286 patients, 55 patients each in the ESPB and no-block groups were matched. ESPB was associated with a 1.2 mg (95% CI: -2.2 to -0.2) reduction in opioid use in IV hydromorphone equivalents when compared to no block. However, there was no reduction in the 12-hour pain score area under the curve or incidence of complications between the two groups. Conclusions ESPB was associated with a modest reduction in total opioid consumption although not a difference in pain score. While its analgesic efficacy may be limited, ESPB could be considered a component of multi-modal analgesia in VATS.

Continuous Serratus Anterior Versus Erector Spinae Plane Block Catheters for Postoperative Pain Management Following Video-Assisted Thoracoscopic Surgery: A Retrospective Study.

INTRODUCTION: Optimal pain management following video-assisted thoracoscopic surgery (VATS) is key to promoting efficient recovery while minimizing the incidence of postoperative complications. Regional anesthesia can help achieve greater pain control, fostering enhanced recovery and increased patient satisfaction, though debate remains over the most effective technique for VATS. This study sought to compare the analgesic efficacy of two continuous regional anesthetic techniques commonly used for VATS, the serratus anterior plane block (SAPB or CSAPB) and the erector spinae plane block (ESPB or CESPB). This study also sought to identify the clinical benefits of regional anesthesia (CSAPB or CESPB) versus no regional anesthesia in the setting of VATS. METHODS: A retrospective study was conducted, including 397 adult patients who underwent VATS and received multimodal analgesia. Postoperative outcomes were compared among patients who received CSAPB versus those who received CESPB; these outcomes were also compared between patients who received either regional anesthesia technique (CSAPB or CESPB, block group) and patients who did not receive regional anesthesia (non-block group). Co-primary outcomes included opioid consumption during hospital admission (presented as morphine milligram equivalents) and pain (minimum, maximum, and average numeric pain scale scores) in the first 72 postoperative hours. Secondary postoperative outcomes included post-anesthesia care unit (PACU) length of stay, time from procedure end to discharge, time to first opioid medication, ambulation distance on day one, medication use, and incidence of surgical or block-related complications. All data were retrospectively obtained from patients' electronic medical records. RESULTS: Comparing regional anesthesia techniques, patients who received CESPB reported lower pain with activity postoperatively than patients who received CSAPB (3.6 vs. 4.2, p=0.009). There were no other significant differences in postoperative outcomes between these groups. Comparing the block and non-block groups, the block group exhibited a higher overall comorbidity burden than the non-block group (p=0.001). Even so, the block group reported less postoperative pain at rest and with activity than the non-block group (mean: 3.6 vs. 4.1, p=0.012; mean 3.8 vs. 4.4, p=0.012). PACU stay and time to discharge were longer in the block group than non-block group (3.3 vs. 2.6 hours, p=0.004 and 3.1 vs. 2.9 days, p=0.012, respectively). However, the block group ambulated a significantly longer distance than the non-block group on the first postoperative day (median: 181.1 m vs. 73.2 m, p<0.001). The block group more often received acetaminophen and/or aspirin and gabapentinoids than the non-block group (94.5% vs. 75.0%, p<0.001 and 84.8% vs. 62.0%, p<0.001, respectively). CONCLUSION: Both CESPB and CSAPB are effective regional anesthesia techniques for VATS postoperative pain management with clear clinical benefits over no regional anesthesia. A direct comparison of the analgesic efficacy of CESPB versus CSAPB indicated that CESPB is more effective than CSAPB in terms of pain control. These findings are consistent with existing literature and most recent practice recommendations.

A retrospective analysis of simultaneous bilateral uniportal thoracoscopic surgeries for multiple primary bilateral pulmonary nodules.

BACKGROUND: There are no standard treatment options for bilateral multiple pulmonary nodules requiring resection. This study aimed to summarize the experience of simultaneous bilateral uniportal video-assisted thoracoscopic surgery for the treatment of bilateral multiple primary pulmonary nodules. METHODS: The clinical data of 65 cases of simultaneous bilateral uniportal thoracoscopic surgery for bilateral multiple primary pulmonary nodules treated were retrospectively analyzed. These cases were treated within The Ninth Medical Center of PLA General Hospital between January 2018 and November 2020. Parameters related to the surgery, perioperative aspects, surgical techniques, pathology results, and postoperative complications were examined. RESULTS: All surgeries were conducted through uniportal video-assisted thoracoscopic surgery, with no instances of intraoperative conversion to thoracotomy. Fifty-three patients further underwent CT-guided Hookwire localization for the localization of pulmonary nodules. A total of 189 nodules were resected using multiple surgical procedures, with a malignancy rate of 86.2%. The average operation time was 226 ± 77.4 min, the average thoracic drainage duration was 3.1 ± 1.5 days, the average 24 h pleural drainage was 385.9 ± 157.4 mL, the average postoperative hospital stay was 8.6 ± 2.4 days, and the average blood loss was 77.2 ± 33.8 mL. Post-surgery, all patients were transferred to the ward safely within 12 h. 15.38% of patients have prolonged drainage time, and 12.31% of patients experience complications such as lung infection, arrhythmia, and venous thrombosis. CONCLUSION: The selected cases undergoing simultaneous bilateral uniportal video-assisted thoracoscopic surgery for the management of bilateral multiple primary pulmonary nodules demonstrated favorable outcomes. Our observations indicate the safety and feasibility of this procedure, providing an individualized and precise treatment approach for affected patients.

Video-Assisted Thoracoscopic Surgery (VATS) in Pregnant Patient With Tuberculosis: A Case Report.

Diagnosis of tuberculosis (TB) in pregnancy may be challenging. Recommended diagnostic tests often are not sensitive, and additional diagnostic procedures are necessary to confirm disease. Symptoms of TB in pregnancy are often atypical and difficult to diagnose in the early stages of the disease. Obstetric complications of TB include spontaneous abortion, preterm labor, low birth weight, and increased neonatal mortality. In pregnant patients, empyema is one of the complications of tuberculous pneumonia, and video-assisted thoracoscopic surgery (VATS) is the recommended surgical treatment. We present the case of a pregnant patient in the 20th week of gestation who was hospitalized due to suspected TB. Serological, microbiological, and molecular tests specific to TB were negative. Radiological tests confirmed pneumonia with pleural effusion. Due to the development of empyema, VATS debridement was indicated. VATS pleural biopsy confirmed the diagnosis of TB.

Right Thoracoscopic Excision of an Esophageal Bronchogenic Cyst.

Bronchogenic cysts, first described in 1859, are rare congenital cystic malformations of the respiratory tract, with an incidence of one per 42,000-68,000 hospital admissions in one hospital series. They comprise 10-15% of mediastinal tumors and between 50% and 60% of mediastinal cystic lesions. Its clinical diagnosis is often challenging due to the absence of distinct imaging features. This case report focuses on the case of a 51-year-old female who initially received a misdiagnosis of esophageal leiomyoma. Subsequently, during exploration in the operating theater, right thoracoscopy revealed the presence of an esophageal bronchogenic cyst.

Thoracic Endometriosis Masquerading As Recurrent Hemothorax.

Extragenital endometriosis is not a common occurrence. Its diagnosis is often delayed, which leads to further complications and recurrent hospitalizations. In this report, we present a case of a 37-year-old African American female diagnosed with thoracic endometriosis who initially presented with a two-week duration of progressive shortness of breath. The diagnosis of this patient posed a dilemma as there was initial suspicion of ovarian cancer and Meig's syndrome, which can have similar presentations.

Contemporary Video-Assisted Thoracoscopic Lobectomy for Early-Stage Lung Cancer.

The treatment of non-small cell lung cancer (NSCLC) has evolved tremendously in recent decades as innovations in medical therapies advanced concomitantly with minimally invasive surgical techniques. Despite early skepticism regarding its benefits, video-assisted thoracoscopic surgery (VATS) techniques for the surgical resection of early-stage NSCLC have now become the standard of care. After being the subject of many studies since its inception, VATS has been shown to cause less postoperative pain, have shorter recovery time, and have fewer overall complications when compared to conventional open approaches. Furthermore, some studies have shown it to have comparable oncological outcomes, though more higher evidence studies are needed. Newer technologies and improved surgical instruments, advancements in nodule localization techniques, and improved preoperative staging procedures have allowed for the development of newer, less invasive techniques such as uniportal VATS and parenchymal-sparing sublobar resections, which might further improve postoperative rates of complications in specific cases. These minimally invasive approaches have allowed surgeons to offer surgery to high-risk patients and those who would otherwise not tolerate conventional thoracotomy, though some relative contraindications still exist. This review aims to describe the evolution of VATS lobectomy, current techniques, its indications, contraindications, preoperative testing, benefits, and outcomes in patients with stage I and II NSCLC.

Intraoperative nitrous oxide inhalation to prevent chronic postsurgical pain in video-assisted thoracoscopic surgery: a prospective observational cohort study.

Background: Chronic postsurgical pain (CPSP) is a significant detriment to postsurgical recovery. Previous studies have shown that nitrous oxide (N2O) may produce long-term analgesia and may benefit the prevention of CPSP in Chinese patients. We tested the hypothesis that N2O is a protective factor against chronic pain after video-assisted thoracoscopic surgery (VATS). Methods: Two groups of patients with and without N2O inhalation during VATS in Peking Union Medical College Hospital were recruited. Perioperative information was documented, and postsurgical pain was followed up by telephone. The primary outcome was the presence of CPSP at 6 months postoperatively. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated using a multivariate logistic regression model adjusted for relevant confounding factors. Results: A total of 833 patients were eligible, among whom 33.6% were male and 66.4% were female, with an average age of 56.3±11.1 years. A total of 387 (46.5%) patients reported incision-related pain at 6 months after surgery, and 160 (40.0%) out of 400 patients with N2O inhalation during surgery and 227 (52.4%) out of 433 patients without N2O inhalation during surgery developed CPSP. After adjusting for confounding factors, N2O inhalation during surgery was associated with lower odds of CPSP (OR =0.654; 95% CI: 0.480-0.890; P=0.007). Conclusions: N2O inhalation during surgery was associated with lower odds of CPSP in VATS patients, and N2O may benefit the prevention of chronic pain after thoracoscopic surgery.

Evaluating three-dimensional lung reconstructions for thoracoscopic lung resections using open-source software: a pilot study.

Background: Preoperative three-dimensional (3D) lung reconstructions can reduce intraoperative blood loss, conversion rate, and operation duration. These 3D reconstructions are predominantly provided by commercial expensive products, hence we aimed to assess the usability and performance of preoperative 3D lung reconstructions created with open-source software. Methods: Patients were invited to participate in this prospective pilot study if they were planned for uniportal video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy between January and February 2023. Participants were excluded if a two-dimensional (2D) late-arterial-phase computed tomography (CT) scan contained motion artifacts, another surgical procedure was performed, or the surgery was canceled. After informed consent was obtained, 3D lung reconstructions were constructed using open-source 3D Slicer software. The system usability score (SUS) questionnaire assessed the usability of these reconstructions, whilst performance was evaluated based on anatomical validity compared to prior 2D CT assessment as well as operative findings. Descriptive statistics were reported. Results: Thirteen patients were included, of whom one underwent a segmentectomy. Eighty-three percent of the 3D lung reconstructions scored above average (SUS >68). Compared to 2D CT scans, 38% of lung nodule segmental locations were detected more accurately through 3D lung reconstructions. Furthermore, 3D lung reconstructions revealed anatomical variations in 62%, which were not recognized on 2D CT scans, and provided surgeons with insights that would change the procedure and/or transection planes in 62%. One 3D lung reconstruction failed to demonstrate an intraoperative recognized segmental pulmonary artery (A6) branch. Conclusions: Three-dimensional lung reconstructions created with open-source software were usable and effective for uniportal VATS anatomical resections. Trial Registration: ClinicalTrials.gov/NCT06132607.

Perioperative Challenges: Analysis of Surgical Complications in Screening Lung Carcinoma Patient.

Introduction In September 2020, the Institute for Pulmonary Diseases of Vojvodina (IPBV) started a lung cancer screening program using low-dose computed tomography (LDCT). Video-assisted thoracic surgery (VATS) lobectomy is the most effective treatment for early-stage lung cancer. However, the frequency of postoperative complications in VATS anatomical lung resections among patients enrolled in the screening program has not been adequately studied. This study aims to compare the frequency of surgical complications and length of hospital stay between patients enrolled in the screening program and a control group. Methods Retrospective, observational, monocentric, non-randomized study was conducted at the IPBV in Sremska Kamenica. The study included patients with a confirmed diagnosis of lung cancer who underwent anatomic pulmonary resection with mediastinal lymphadenectomy for therapeutic purposes. The patients were divided into two groups: the first group consisted of 34 patients who participated in the lung carcinoma screening program, while the second control group consisted of 102 patients. Over the past three years, all patients identified with nodules suspicious of malignancy during the screening program were sequentially enrolled in the screening group. For the control group, patients were selected based on a matching process to ensure valid statistical comparisons with the screening group. They were matched in a 3:1 ratio with patients from the screening group based on criteria including gender, disease stage, pathohistological type of cancer, tumor, node, and metastasis (TNM) stage of the disease, and degree of surgical resection. Patients were monitored for demographic parameters, smoking status, presence of comorbidities and prior oncological diseases, pulmonary function parameters, level of pre-operational risk, the number of lymph nodes removed by biopsies, spread through alveolar spaces (STAS), and the occurrence of complications after surgery (infection, bleeding, air leak, presence of adhesions), re-drainage, and length of hospital stay. Results The patients in the screening group had a higher incidence of infections, bleeding, prolonged air leak, and required re-drainage after surgery compared to the control group. Patients from the screening program with a high operative risk, prolonged air leak, and pleural adhesions had a statistically significant higher hospital stay longer than the control group. Conclusions This research emphasizes the importance of screening programs for detecting lung cancer in the early stages. However, it also highlights the need for further research to reduce surgical complications and improve therapeutic interventions for patients in the screening program.

IgG4-related pleural disease diagnosed by thoracoscopic pleural biopsy: A case report.

Here we report a rare case of immunoglobulin G4 (IgG4)-related pleural disease diagnosed using a thoracoscopic pleural biopsy. A 66-year-old man was admitted to our hospital with right-dominant bilateral pleural effusions and gradually worsening dyspnoea. Chest radiographs revealed right-dominant pleural effusions, while chest computed tomography showed bilateral pleural effusions without parenchymal lesions. Although the bilateral pleural effusions were exudative with an increased number of lymphocytes, the definitive diagnosis was initially elusive. High IgG4 levels in the serum and pleural effusions were observed. A pathological evaluation of a right pleural biopsy specimen collected via video-assisted thoracoscopic surgery showed fibrosis-associated lymphoplasmacytic infiltration, 45-60 IgG4-positive plasma cells per high-power field, and an IgG4/immunoglobulin G ratio of 40%. Consequently, the patient was diagnosed with IgG4-related pleural disease. The bilateral pleural effusions improved after corticosteroid therapy.

Incidence and risk factors for recurrent primary spontaneous pneumothorax after video-assisted thoracoscopic surgery: a systematic review and meta-analysis.

Background: The incidence and risk factors for recurrent primary spontaneous pneumothorax (PSP) after video-assisted thoracoscopic surgery (VATS) remain controversial. A systematic review and meta-analysis were conducted to determine the incidence and risk factors for recurrence of PSP after VATS. Methods: A systematic search of PubMed, Web of Science, Embase, and Cochrane Library databases was conducted to identify studies that reported the rate and risk factors for recurrence of PSP after VATS published up to December 2023. The pooled recurrence rate and odds ratio (OR) with 95% confidence interval (CI) were calculated using a random-effects model. In addition, risk factors were similarly included in the meta-analysis, and sources of heterogeneity were explored using meta-regression analysis. Results: A total of 72 studies involving 23,531 patients were included in the meta-analysis of recurrence. The pooled recurrence rate of PSP after VATS was 10% (95% CI: 8-12%). Male sex (OR: 0.61; 95% CI: 0.41-0.92; P=0.02), younger age [mean difference (MD): -2.01; 95% CI: -2.57 to -1.45; P<0.001), lower weight (MD: -1.57; 95% CI: -3.03 to -0.11; P=0.04), lower body mass index (BMI) (MD: -0.73; 95% CI: -1.08 to 0.37; P<0.001), and history of contralateral pneumothorax (OR: 2.46; 95% CI: 1.56-3.87; P<0.001) were associated with recurrent PSP, whereas height, smoking history, affected side, stapling line reinforcement, and pleurodesis were not associated with recurrent PSP after VATS. Conclusions: The recurrence rate of PSP after VATS remains high. Healthcare professionals should focus on factors, including sex, age, weight, BMI, and history of contralateral pneumothorax, that may influence recurrence.

The Enigma of Recurrent Lung Abscess: Management and Outcomes in a School-Aged Child With a Review of Literature.

Pediatric lung abscess is a rare and poorly studied disease entity. In the past, prolonged courses of intravenous (IV) antibiotics have been successfully used; however, with the advent of interventional radiology, the main therapeutic approach is through percutaneous placement of pigtail catheters with ultrasound and computed tomography (CT) direction, where available. The pathogen yield identified from fluid samples of the abscess has dramatically increased owing to the greater invasive measures, such as aspiration and drainage, as well as enhanced microbiological diagnostic methods, which also include polymerase chain reaction testing. In our case report, in 2012 when the patient was two years old, she was diagnosed with pulmonary Koch's and underwent anti-Koch's therapy, category 2. High-resolution CT of the chest revealed a large lobulated cavitary lesion with an air-fluid level suggestive of a right lung abscess. After initial therapy with IV antibiotics for three weeks and a negative tuberculosis work-up, she underwent right limited lateral thoracotomy and drainage with decortication of the right lung abscess (LA) in 2019 via a left endobronchial tube with a bronchial blocker (general endobronchial anesthesia). All samples sent for histopathologic examination after surgery yielded negative results, and she was discharged after a course of injectable antibiotics for 21 days. She remained almost symptom-free for the next four years. Thereafter, she presented with a right LA recurrence due to a thick-walled cavitary lesion, with a severely damaged right lower lung lobe resulting in right lower lobectomy under single-lung ventilation (double-lumen endotracheal tube No. 26 Fr.). Culture results should guide management, particularly for immunocompromised patients, as the LA may be attributed to complications arising from underlying conditions. Primary lung abscesses (PLA) in children are typically caused by Staphylococcus aureus, Streptococcal species, and Klebsiella pneumoniae. Compared to adults, children with PLA and secondary lung abscesses have a meaningfully greater rate of recovery.

Comparative outcomes of video-assisted thoracoscopic surgery versus open surgery for bronchogenic cysts in adults: a retrospective cohort study.

Background: Open thoracotomy has been the traditional surgical approach for patients with bronchogenic cysts (BCs). This study aimed to evaluate the safety and efficacy of video-assisted thoracoscopic surgery (VATS) compared to open surgery for the treatment of BCs in adults. Methods: This single-institution, retrospective cohort study included 117 consecutive adult patients who underwent VATS (group A) or open surgery (group B) for BC resection between February 2019 and January 2023. Data regarding clinical history, operation duration, length of hospital stay, 30-day mortality, and recurrence during follow-up were collected and analyzed. Results: Of the total cohort, 103 (88.0%) patients underwent VATS, while 14 (12.0%) patients underwent open surgery. Patients' age in group B were much older than group A (P=0.014), and no significant differences in other demographic and baseline clinical characteristics were observed between the groups. The VATS group had shorter median operation duration (96 vs. 149.5 min, P<0.001) and shorter mean length of hospital stay (5.0±5.5 vs. 8.6±4.0 days, P<0.001). One death occurred in the open surgery group. During a median follow-up of 34 (interquartile range, 20.8-42.5) months, no instances of BC recurrence were observed in either group. Conclusions: Compared to open surgery, VATS is also a safe and efficacious approach for treating BCs in adults. What's more, VATS offered shorter operative times and hospital stays. Considering the minimally invasive, VATS may be a better choice in most patients with bronchial cysts.

Early chest tube removal within 6 hours after thoracic surgery results in improved postoperative prognosis and no adverse effects.

Background: Advances in minimally invasive surgery and drainage systems have caused earlier chest-tube-removal. This retrospective study aimed to assess the safety of early chest tube removal using the institution's new criteria 6 hours after thoracic surgery. Methods: Elective thoracic surgery patients from 2017 to 2023 were reviewed for meeting or not meeting the newer institutional requirement for early chest tube removal; (I) no air leak detected under the digital drainage device observation; (II) no fluid drainage of ≥100 mL/h; (III) no ≥3 combined risks [male, chronic obstructive pulmonary disease (COPD), body mass index (BMI) of <18.5 kg/m2, severe pleural adhesion, upper lobe lobectomy, or left upper division segmentectomy]. The incidence of adverse events, including chest tube replacement, subcutaneous tube placement, and postoperative thoracentesis, were investigated for 1 month postoperatively. Perioperative outcomes and factors involved in conventional chest tube removal were also assessed. Results: Of the 942 patient charts reviewed, 244 (25.9%) met the criteria for chest tube removal within 6 hours postoperatively. This patient group did not experience adverse events. They also demonstrated shorter postoperative hospital stay (4 vs. 6 days, P<0.001), and lesser postoperative complications (7.4% vs. 25.6%, P<0.001) compared to those for whom early chest tube removal was not done. A correlation with thoracotomy, COPD, and steroid and/or immunosuppressant use was observed for patients in the conventional chest tube removal group. Conclusions: Early chest tube removal after 6 postoperative hours was deemed safe for a selected group of patients who met the criteria for early chest tube removal. This study would support the potential expansion of our early removal criteria.

Pleural Epithelioid Hemangioendothelioma: An Ultrarare Cause for Recurrent Pleural Effusion Managed With Trametinib and Pazopanib.

Epithelioid hemangioendothelioma (EHE) is an extremely rare sarcoma of vascular origin. Primary pleural involvement is extremely under-reported and tends to have a more aggressive course. We report a case of pleural EHE in a Caucasian female in her 50s with a two-month history of dyspnea and chest pain. Investigations, including video-assisted thoracoscopy, revealed extensive pleural scarring and inflammation. Management with trametinib and pazopanib led to a stable disease course, reduction in the frequency of pleural effusion recurrence, and improvement in cancer-related pain.

Suction versus non-suction drainage strategy after uniportal thoracoscopic lung surgery: a prospective cohort study.

Background: The postoperative outcomes of suction drainage versus non-suction drainage after uniportal video-assisted thoracoscopic surgery (UniVATS) come with little consensus. This study aimed to prospectively compare the postoperative outcomes of suction drainage versus non-suction drainage in patients who underwent UniVATS. Methods: Between October 2022 and January 2023, patients undergoing UniVATS were prospectively enrolled. The choice of drainage strategy (suction or non-suction) was at the surgeon's discretion. The primary outcome was chest tube duration, with secondary outcomes including postoperative drainage volume, pain scores, postoperative complications, length of hospital stay, and hospitalization cost. Baseline characteristics and postoperative outcomes were compared. Univariable and multivariable analyses were used to identify risk factors for postoperative outcomes. Results: A total of 206 patients were enrolled in this study, with 103 patients in each group. Baseline characteristics were well-balanced. The chest tube duration did not significantly differ between the two groups. However, suction drainage exhibited a significantly lower total drainage volume compared to non-suction drainage (280.00 vs. 400.00 mL, P=0.03). Suction drainage was associated with a significantly shorter postoperative hospital stay (3.00 vs. 4.00 days, P<0.001) and lower pain score on the second postoperative day (POD). Multivariable analyses also confirmed that suction drainage was significantly correlated with a lower total drainage volume and a shorter postoperative hospital stay. Conclusions: These findings suggested that the suction drainage was superior to non-suction drainage in terms of postoperative drainage volume and length of hospital stay in patients undergoing UniVATS.

A simple and safe surgical technique for nonpalpable lung tumors: One-stop Solution for a nonpalpable lung tumor, Marking, Resection, and Confirmation of the surgical margin in a Hybrid operating room (OS-MRCH).

When performing thoracoscopic partial resections of nonpalpable lung tumors such as ground-glass opacities (GGOs) and small tumors, detecting the location of the lesion and assessing the resection margins can be challenging. We have developed a novel method to ease this difficulty, the One-stop Solution for a nonpalpable lung tumor, Marking, Resection, and Confirmation of the surgical margin in a Hybrid operating room (OS-MRCH), which uses a hybrid operating room wherein the operating table is seamlessly integrated with cone-beam computed tomography (CBCT). We performed the OS-MRCH method on 62 nodules including primary lung cancer presenting with GGO. Identification of the lesion and confirmation of the margin were performed in 58 of the cases, while nodules were detected in all. The frequency of computed tomography (CT) scans performed prior to resection was one time in 51 cases, two times in eight cases, and ≥3 times in three cases. Additional resection was performed in two cases. The median operative time was 85.0 minutes, and the median pathological margin was 11.0 mm. The key advantages of this method are that all surgical processes can be completed in a single session, specialized skill sets are not required, and it is feasible to perform in any facility equipped with a hybrid operating room. To overcome its disadvantages, such as longer operating time and limited patient positioning, we devised various methods for positioning patients and for CT imaging of the resected specimens. OS-MRCH is a simple, useful, and practical method for performing thoracoscopic partial resection of nonpalpable lung tumors.