The feasibility of thoracoscopic-guided intercostal nerve block during uniportal video-assisted thoracoscopic lobectomy of the lung.

Background: Uniportal thoracoscopic surgery has become widely accepted for its favourable outcomes with regard to pain. However, post-operative pain is still a concern associated with thoracic surgery. The objective of this study was to evaluate the post-operative pain of patients undergoing uniportal video-assisted thoracoscopic surgery (VATS) lobectomies using an intra-operative intercostal nerve block. Methods: All consecutive patients undergoing uniportal VATS lobectomies between October 2018 and October 2019 were reviewed retrospectively. Twenty consecutive patients in Group A underwent uniportal VATS lobectomies without intra-operative intercostal nerve blocks. The other 20 consecutive patients in Group B underwent uniportal VATS lobectomies with intra-operative intercostal nerve blocks. Numeric Pain Rating Scale (NRS) scores were recorded at 1, 12 and 24 h postoperatively. The number of anti-inflammatory drugs (non-steroidal anti-inflammatory drug [NSAIDs]) consumed until the time of chest tube removal was also recorded. Results: There was no difference between the groups with regard to sex, age, chest tube duration, length of stay, operative time or laterality. There was a significant difference in post-operative NRS scores at 1 h (P < 0.001) and 12 h (P = 0.014) between the groups. The NSAID consumption was significantly lower in Group B than in Group A (P = 0.038). Conclusion: Intra-operative intercostal nerve blocks with bupivacaine provided immediate post-operative pain relief and reduced post-operative opioid consumption in patients who underwent uniportal VATS lobectomies.

Early results of modified aortic-valve sparing partial root replacement in acute type A aortic dissection with an intimal tear in the aortic sinuses.

We describe a modified aortic valve-sparing partial root replacement (AVSPRR) technique for acute type A aortic dissection with an intimal tear (IT) in the aortic sinus. This procedure consists of selective replacement of the sinus containing an IT with a rectangular patch. If an IT exists in any coronary sinus, the coronary button was reimplanted to the neo-sinus and an external wrapping of the noncoronary sinus was added. Modified AVSPRR may be considered a feasible short-term outcome, and may be considered as an option in selected patients.

Surgical outcomes of pulmonary mucoepidermoid carcinoma: a review of 23 cases.

BACKGROUND: The aim of the present study was to evaluate the oncologic characteristics of pulmonary mucoepidermoid carcinoma (PMEC) and the efficacy of surgical resections. MATERIALS AND METHODS: The surgery for PMEC was performed in 23 patients at Asan Medical Center from January 2000 to December 2010. They accounted for 0.8% of all surgically resected pulmonary neoplasm in the center. The medical records of these patients were reviewed retrospectively. RESULTS: This study group was composed of 13 males (56.5%) and 10 females (43.5%). Median age was 41 years (range, 10 to 75 years). Complete resection with systematic mediastinal lymph node dissection was performed in all patients. There were three postoperative complications: atelectasis in one patient and chylothorax in two patients. There was no postoperative mortality. The median follow-up duration was 68 months (range, 13 to 115 months). In one patient, recurrent disease was found 73 months after surgery. All patients were followed without mortality until the end of this study. The 5- and 8-year disease-free survival rates were 100 and 90.9%, respectively. CONCLUSION: Complete surgical resection with systematic lymph node dissection is an effective treatment for patients with PMEC and provides favorable prognosis.

Stanford type A aortic dissection secondary to infectious aortitis: a case report.

Nowadays, infectious aortitis has become a rare disease thanks to antibiotics, but remains life-threatening. We present a case of a patient with acupuncture-induced infectious aortitis leading to aortic dissection. Chest computed-tomogram scan revealed Stanford type A dissection with pericardial effusion. Under the impression of an impending rupture, emergent surgery was performed. During surgery, infectious aortitis was identified incidentally, so she underwent resection of the infected aorta including surrounding tissues. Then the ascending aorta and hemi-arch were replaced with a prosthetic graft as an in situ fashion. The resected tissue and blood cultures revealed Staphylococcus aureus, so prolonged antibiotherapy was prescribed.

Late simultaneous presentation of left ventricular pseudoaneurysm and tricuspid regurgitation after blunt chest trauma.

A 32-yr-old man developed progressive exertional dyspnea 4 yr after blunt chest trauma due to an automobile accident. Two-dimensional echocardiography and computed-tomographic coronary angiography demonstrated a large pseudoaneurysm of the left ventricle and severe tricuspid regurgitation. The patient underwent successful surgical exclusion of the pseudoaneurysm by endoaneurysmal patch closure and repair of the tricuspid valve regurgitation. To the best of our knowledge, this is the first case of these 2 different pathologies presenting late simultaneously after blunt chest trauma and successful surgical repairs in the published literature.

A pilot study of intraoperative intercostal nerve block during uniportal thoracoscopic wedge resection of the lung.

BACKGROUND AND AIMS: Uniportal thoracoscopic surgery has been reported to result in alleviating the postoperative pain when compared with traditional video-assisted thoracoscopic surgery (VATS). However, postoperative pain is still the main concerns associated with thoracic surgeries. The objective of this study is to evaluate the postoperative pain of patients undergoing uniportal VATS, especially wedge resection, with the use of intraoperative intercostal nerve block. METHODS: All consecutive patients undergoing the uniportal VATS wedge resection between January 2019 and March 2020 were reviewed retrospectively. Twenty consecutive patients in Group A underwent the uniportal VATS wedge resection without intraoperative intercostal nerve block. The other 20 consecutive patients in Group B underwent the uniportal VATS wedge resection with intraoperative intercostal nerve block. The numeric pain rating scale (NRS) scores were recorded at 1, 12, and 24 h, postoperatively. The number of opioid consumption was also recorded until the time to chest tube removal. RESULTS: There was no difference between groups with regard to sex, age, chest tube duration, length of stay, operative time, laterality time, and diagnosis. There was a significant difference in postoperative NRS scores at 1 h (P = 0.001) and 12 h (P = 0.022) between the groups. The opioid consumption was significantly in Group B lower than those in Group A (P = 0.025). CONCLUSION: The intraoperative intercostal nerve block with bupivacaine provided immediate postoperative pain relief with reducing the postoperative opioid consumption compared in patients who underwent uniportal VATS, especially wedge resection of the lung.

Isolated chest wall tuberculosis in immunocompetent patients.

Chest computed tomography scan demonstrated inflammatory lesion in and around the right sixth rib costochondral junction.

Subxiphoid single-port thymectomy without CO2 insufflation: Experience of a single center.

BACKGROUND: The subxiphoid single-port approach for thymectomy has advantages compared with conventional lateral transthoracic approaches. Most of centers use CO2 insufflation to secure an appropriate surgical field during subxiphoid thymectomy, which causes fighting between surgical instruments and restrictions on the types of surgical instruments. The objective of this study is to introduce an effective method to establish the subxiphoid approach without CO2 insufflation using a retractor and steel wire. METHODS: All consecutive 59 patients undergoing subxiphoid single-port thymectomy between August 2014 and August 2021 were reviewed retrospectively. RESULTS: We analyzed data of 59 patients (31 male and 28 female) with a median age of 59 years (range 50-68). Two (3.4%) patients presented postoperative complications. The conversion to a different approach was required in 4 (6.8%) cases. The median follow-up time was 23 months (range 10-41) and loco-regional recurrence was observed in one patient (1.7%). There were no intraoperative deaths and the postoperative mortality. No complications related to sternal wiring occurred. CONCLUSIONS: Subxiphoid single-port thymectomy without CO2 using a retractor and steel wire insufflation is a technically feasible method.

The Learning Curves of Uniportal Video-Assisted Thoracoscopic Surgery Lobectomy: A Single Center Experience.

Backgrounds: The aim of our study is to describe the learning curve for uniportal video-assisted thoracoscopic surgery (VATS) lobectomy from our single center's experience for adopting it because uniportal VATS is generally considered a technically difficult procedure. Methods: A retrospective review of all 164 consecutive patients who underwent uniportal VATS lobectomy between June 2015 and February 2020 was done. A cumulative summation (CUSUM) method was applied to evaluate the learning curves of the operation time. Results: Among the 164 patients, the CUSUM value inflected at the 31st case. Ninety-five consecutive patients underwent uniportal VATS upper lobectomy. The other 69 consecutive patients underwent uniportal VATS lower lobectomy. The operation time CUSUM learning curve analysis revealed that the curves descended from the 21st case in upper lobectomy group and the 12th case in lower lobectomy group. Conclusion: Operators are required to experience at least 21 cases for upper lobectomy and 12 cases for lower lobectomy until the operation time is stabilized.

Subxiphoid single-port thymectomy: six-year experience of a single center.

BACKGROUND: The subxiphoid single-port approach for thymectomy has several advantages compared with conventional lateral transthoracic approaches. However, perioperative outcomes of subxiphoid single-port thymectomy are still lacking. The objective of this study is to present our 6-year experience of subxiphoid single-port thymectomy, including our learning curve. METHODS: All consecutive 49 patients undergoing subxiphoid single-port thymectomy between August 2014 and September 2020 were reviewed retrospectively. RESULTS: We analyzed data of 49 patients (27 males and 22 females) with a median age of 58 years (range 49-68). Two patients presented postoperative complications. The conversion to a different approach was required in four cases. The median follow-up time was 17 months (range 3-35) and locoregional recurrence was observed in one patient. There were no intraoperative deaths and postoperative mortality. The operation time cumulative summation learning curve analysis revealed that the curves descended from the 24th case. CONCLUSIONS: The subxiphoid single-port approach for thymectomy is a safe and feasible modality with few complications.

Primary pulmonary diffuse large B-cell lymphoma in a young female patient.

Even if the patient is young or female, a primary pulmonary diffuse large B-cell lymphoma could be considered as a differential diagnosis of multifocal consolidation in the lung.

Cardiac tamponade due to ruptured cystic teratoma: report of two cases.

We report the rare two cases of cardiac tamponade due to ruptured cystic teratoma. In both cases, a chest computed tomography scan showed large cystic mass with large amount of pericardial effusion. Transthoracic echocardiogram revealed cardiac tamponade physiology. En bloc resection of the mass was performed and pathologic examination showed mature cystic teratoma. The postoperative course of patients was uneventful. A cystic mediastinal teratoma should be considered in the differential diagnosis of pericardial effusion.

Large infected pulmonary cyst mimicking empyema thoracis.

Infected pulmonary cyst could be misdiagnosed as empyema thoracis. Here, we report an infected pulmonary cyst in a middle-aged male patient. This report could serve as a reminder for differential diagnosis of infected pulmonary cyst, for which surgical approach would be more safe and effective method.

Successful Repair of Bronchoesophageal Fistula Through Uniportal Video-Assisted Thoracoscopic Surgery.

This report describes a case of successful repair of bronchoesophageal fistula through uniportal video-assisted thoracoscopic surgery. A 79-year-old female patient presented with persistent cough and aspiration pneumonia. Chest computed tomography and esophagography showed a bronchoesophageal fistula at right side wall of mid to lower esophagus. Esophagogastroduodenoscopy confirmed a fistula in the esophageal diverticulum. Surgical treatment was planned. The operation was performed through uniportal video-assisted thoracoscopic surgery. The patient was discharged 6 days postoperatively without any complication. No recurrence has been observed during 3 months follow-up in the outpatient clinic to date.

Single center experience of uniportal VATS anatomical lung resections: Mid-term oncological outcomes.

BACKGROUND: Uniportal video-assisted thoracoscopic surgery (VATS) anatomical lung resection has become widely accepted for its favorable outcomes with regard to pain. However, oncological outcomes, especially mid- or long-term outcomes, are still lacking. The objective of this study was to present our eight-year experience of uniportal VATS anatomical lung resection, including mid-term oncological outcomes. METHODS: All consecutive patients undergoing uniportal VATS anatomical lung resection between June 2012 and February 2020 were reviewed retrospectively. RESULTS: We analyzed data of 170 patients (100 male and 70 female), with a median age of 67 years. The median follow-up time was 21 months (range 11-41). The DFS of the entire cohort was 66.3 months. Stage-correlated DFS was 73.1 months for stage I, 42.6 months for stage II, 30.6 months for stage III and 12.5 months for stage IV. The OS of the entire court was 67 months. Stage-correlated OS was 75.6 months for stage I, 50.2 months for stage II, 31.7 months for stage III and 12.5 months for stage IV. CONCLUSIONS: Uniportal VATS anatomical lung resection for lung cancer can be performed with satisfactory mid-term histology- and stage-related outcomes, which is consistent with prior results of traditional VATS or thoracotomy.

Multiple small bowel metastasis of primary non-small cell lung cancer.

Gastrointestinal metastasis could be considered in the differential diagnosis of melena in the patient with NSCLC history.

Large pulmonary sclerosing pneumocytoma in a young female: A rare lung tumor.

We report a case of a 28-year-old female who presented with a solid mass lesion in the right middle lobe (RML). A chest computed tomography (CT) scan showed a 3.5 cm sized round and solid mass between the medial and lateral segment of the RML. The patient underwent a percutaneous lung biopsy with CT scan guidance and pathological examination showed pulmonary sclerosing pneumocytoma. RML lobectomy was performed for definitive treatment. Here, we describe this rare lung disease which presented as a large homogeneous lesion. Pulmonary sclerosing pneumocytoma should be considered in the differential diagnosis of solitary lung tumor, even if the patient is young.

Primary Pulmonary Undifferentiated Pleomorphic Sarcoma: A Rare Malignant Lung Tumor.

We report a case of a 56-year-old man with persistent right upper lobe cavitary mass. A chest computed tomography scan showed about 4-cm-sized mass with internal low attenuation and peripheral enhancement in right upper lobe apical segment. The lesion size increased over 1 month. Right upper lobectomy was performed with the intention to treat the lesion. Pathological examination showed primary pulmonary undifferentiated pleomorphic sarcoma. We describe this rare lung disease to remind that primary pulmonary undifferentiated pleomorphic sarcoma could be the differential diagnosis of pulmonary cavitary mass lesions.

Esophageal Neuroendocrine Carcinoma With Focal Squamous Cell Carcinoma Component.

This study was about a 70-year-old man with progressive dysphagia. Esophagogastroduodenoscopy showed a 1.2-cm circumferential ulcerative mass at the level of 23 cm from the upper incisors in the upper esophagus. The mass was first diagnosed as a poorly differentiated squamous cell carcinoma. McKeown esophagogastrectomy was performed with intention to treat the lesion. The pathological examination showed an esophageal neuroendocrine carcinoma that was mixed with squamous cell carcinoma component. In this report, we present a unique case of the extremely rare esophageal neoplasm, an esophageal neuroendocrine carcinoma with squamous cell carcinoma component.