Comparison of Sleeve Lobectomy for Lung Cancer Using Mini-Thoracotomy and an Optimized Robot-Assisted Technique.

Objective: To evaluate the clinical significance of an optimized approach to improve surgical field visualization and simplify anastomosis techniques using robotic-assisted sleeve lobectomy for lung or bronchial carcinoma. Method: A total of 26 consecutive patients who underwent sleeve lobectomy between January 2017 and April 2020 were enrolled in the study. The cohort included 11 cases of robotic-assisted surgery (RAS group) and 15 cases of mini-thoracotomy (MT group). RAS was performed via an exclusive optimized approach utilizing the "3 to 4-6 to 8/9" four-port technique. Retrieved demographical and clinical data included operation time, anastomosis time, blood loss, chest drainage time and volume, postoperative pain scores, complications, white blood cell (WBC) levels, and duration of hospital stay and follow-up. Results: No cases of perioperative death were recorded. Compared to MT group, the RAS group had a similar anastomosis time (30.82 ± 6.08 vs 33.20 ± 7.73 min, respectively, p > 0.05) and shorter operation time (189.73 ± 36.41 vs 225.33 ± 38.19 min, respectively, p < 0.05). The RAS group had lower pain scores (4.23 ± 0.26 vs 4.91 ± 0.51, p < 0.05), lower levels of WBC (p < 0.05), and no anastomotic complications postoperatively. The RAS and MT groups demonstrated a successful bronchus reconstruction with low risk of angulation (1/11 vs 1/15, p > 0.05) and satisfactory disease-free survival (eight cases, 72.73% and 12 cases, 80%, respectively). Conclusion: The optimized approach to RA sleeve lobectomy is convenient and efficient and provides satisfactory clinical outcomes. Further study with a large sample size and evaluation of long-term survival are warranted. Key points: (i) we present a novel, convenient, and efficient approach for robotic-assisted sleeve lobectomy, ie, "3 to 4-6 to 8/9" four-port technique. The optimized approach for RA sleeve lobectomy is convenient and efficient and provides satisfactory clinical outcomes; (ii) details for the "3 to 4-6 to 8/9" four-port method: the assistant port was located at the fourth intercostal space. The 1-cm camera port was inserted at the sixth intercostal space in the posterior axillary line. The 0.5-cm da Vinci ports of the instrument arms were placed at the third intercostal space in the anterior axillary line and the eighth or ninth intercostal space in the posterior axillary line. The patient cart was inserted from the back of the patient's head and shoulders at 75° to the longitudinal line.

Application of CBL combined with clinical pathway in thoracic surgery practice teaching / 中华医学教育探索杂志

Objective:To explore the feasibility and application value of case-based learning (CBL) combined with clinical pathway in thoracic surgery practice teaching.Methods:A total of 30 clinical undergraduate students who practiced from January 2018 to August 2018 were selected and randomly divided into the traditional group and the research group. The traditional group used traditional teaching mode, while the research group adopted the CBL combined with clinical pathway teaching. The scores of theoretical examination and practice skills assessment and the case analysis ability of the two groups were compared at the time of department. In addition, the evaluation of the teaching effect of the two groups of teachers and students was observed through anonymous questionnaires. SPSS 21.0 was used for t-test and Chi-square test. Results:The scores of the students in the research group were better than those in the traditional group, including score of theoretical examination [(88.20±4.02) vs. (80.76±4.62), P<0.001], score of practice skills assessment [(90.80±2.16) vs. (84.80±3.07), P<0.001] and case analysis ability [(89.80±3.34) vs. (81.86±4.31), P<0.001]. The differences were statistically significant. At the same time, the questionnaire showed that the research group was superior to the traditional group in improving students' learning interest, clinical skills, case analysis ability, clinical communication ability, theoretical knowledge understanding and clinical thinking ability, with a statistically significant difference ( P<0.05). While the two groups had no statistically significant difference in students' satisfaction with teachers ( P=0.083). Conclusion:The CBL method combined with clinical pathway teaching method can improve the teaching effect of thoracic surgery practice, which is worth popularizing.

Clinical efficacy of thoracoscopy-assisted modified Nuss procedure in children with pectus excavatum: A retrospective analysis in a single center / 中国胸心血管外科临床杂志

@#Objective    To explore the clinical efficacy of thoracoscopy-assisted modified Nuss procedure for pectus excavatum (PE) in children. Methods    The clinical data of patients with PE who underwent thoracoscopy-assisted modified Nuss procedure from October 2013 to October 2020 in Daping Hospital were retrospectively analyzed. Results    A total of 86 patients were collected, including 79 males and 7 females with a mean age of 14.03±3.36 years. The operations were performed successfully in all patients without intraoperative cardiac vascular injury or perioperative death. The mean operation time was 87.30±33.45 min, bleeding volume was 19.94±14.60 mL, and the postoperative hospitalization stay time was 6.89±2.59 d. Early postoperative complications included 2 patients of pneumothorax, 2 patients of wound fat liquefaction and infection, 2 patients of bar flipping and displacement. One patient had bar displacement 1 year after the surgery. The total complication rate was 8.14%. All patients were followed up for 3-42 months. The bars were taken out about 36 months after the surgery. According to the evaluation criteria of orthopedic effect, 68 (79.07%) patients were excellent, 10 (11.63%) patients were good, 5 (5.81%) patients were moderate and 3 (3.49%) patients were poor. Conclusion    Minimally invasive and individualized shaping via the Nuss procedure for PE children is safe and convenient, with satisfied effect. It is worthy of popularization in the clinic.

Application of robot-assisted lung basal segmentectomy: A retrospective study / 中国胸心血管外科临床杂志

@#Objective    To summarize the experience of robot-assisted lung basal segmentectomy, and analyze the clinical application value of intersegmental tunneling and pulmonary ligament approach for S9 and/or S10 segmentectomy. Methods    The clinical data of 78 patients who underwent robotic lung basal segmentectomy in our hospital between January 2020 to May 2022 were retrospectively reviewed. There were 32 males and 46 females with a median age of 50 (33-72) years. The patients who underwent S9 and/or S10 segmentectomy were divided into a single-direction group (pulmonary ligament approach, n=19) and a bi-direction group (intersegmental tunneling, n=19) according to different approaches, and the perioperative outcomes between the two groups were compared. Results    All patients successfully completed the operation, without conversion to thoracotomy and lobectomy, serious complications, or perioperative death. The median operation time was 100 (40-185) min, the blood loss was 50 (10-210) mL, and the median number of dissected lymph nodes was 3 (1-14). There were 4 (5.1%) patients with postoperative air leakage, and 4 (5.1%) patients with hydropneumothorax. No patient showed localized atelectasis or lung congestion at 6 months after the operation. Further analysis showed that there was no significant difference in the operation time, blood loss, thoracic drainage time, complications or postoperative hospital stay between the single-direction and bi-direction groups (P>0.05). However, the number of dissected lymph nodes of the bi-direction group was more than that of the single-direction group [6 (1-13) vs. 5 (1-9), P=0.040]. Conclusion    The robotic lung basal segmentectomy for pulmonary nodules is safe and effective. The  perioperative results of robotic S9 and/or S10 complex segmentectomy using intersegmental tunneling and pulmonary ligament approach are similar.

Robotic versus thoracoscopic lung segmentectomy: a case control study / 中华胸心血管外科杂志

Objective:To summarize the experience of robotic and thoracoscopic segmentectomy in Daping Hospital, Army Medical University, and comparison analysis the clinical application value for early-stage lung cancer.Methods:A retrospective cohort study was conducted to continuously enroll 190 patients, 100 who received robotic(33 males and 67 females, median age of 51 years)and 90 who received VATS(34 males and 56 females, median age of 54 years), who underwent segmentectomy between June 2018 and October 2019. Perioperative outcomes(the operation time, intraoperative blood loss, postoperative thoracic drainage volume and time, pain score, complications, postoperative hospital stay and survival and mortality) were compared.Results:All the patients successfully completed the surgery and recovered from hospital, with no perioperative death.The baseline characteristics(sex, age, clinical symptoms, smoking status, underlying disease, tumor size, pathological type) and type of segmentectomy were comparable. There was significant difference in operative time[120(interquartile range, IQR 60-225)min vs. 155( IQR 75-330)min, P<0.001], blood loss[30( IQR 20-400) ml vs. 100( IQR 20-1 600) ml, P<0.001] between the robotic and VATS groups, respectively. But there was no significant difference in postoperative thoracic drainagevolume[4( IQR 1-15) days vs. 4( IQR 2-29) days, P=0.547], postoperative thoracic time[755( IQR 200-3 980)ml vs. 815( IQR 280-3 920)ml, P=0.902], pain score[2.33( IQR 0.88-4.75) points vs. 3.13( IQR 0.95-5.29)points, P=0.199], complications[7.4%(14/190) vs. 6.3%(12/190), P=0.303], postoperative hospital stay[7( IQR 3-19) days vs. 6( IQR 4-21) days, P=0.405] , number of lymph nodes[(4.83±3.18) vs.(6.15±4.1), P=0.255] between the robotic and VATS groups, respectively. The follow-up time was 6.5( IQR 1-26) months in the two groups, without recurrence, metastasis or death. Conclusion:Robotic lung segmentectomy is safe and feasible. This approach might lead to a better in operative time and blood loss. The short-term efficacy is similar with thoracoscopy, and the long-term efficacy needs further follow-up time.

Clinical analysis of robot-assisted lobectomy through anterior approach in 180 patients / 中国胸心血管外科临床杂志

@#Objective    To evaluate the feasibility and clinical value of robot-assisted lobectomy through anterior approach. Methods    We retrospectively analyzed the clinical data of 180 patients who underwent robot-assisted lobectomy through anterior approach in our hospital between April 2017 and February 2018. There were 97 males and 83 females, aged 59.5 (32.0-83.0) years. The clinical effects were analyzed. Results    One patient was transferred to thoracotomy due to tumor invasion of adjacent blood vessels and injury to the blood vessels, and there was no perioperative death. There were 8.5 (1.0-35.0) dissected lymph nodes for each patient. The median operation time was 120 (50-360) min, including robot Docking time 5 (1-23) min and robot operation time 65 (7-270) min. The median blood loss was 50 (5-1 500) mL, 132 (73.3%) patients had malignant tumors and median drainage time was 5 (2-30) d. The mean postoperative pain score was 3.4±0.7 points and the postoperative hospital time was 8 (2-32) d. At the median follow-up of 24 months, 11 patients developed recurrence and metastasis, and 3 died. Conclusion    Robot-assisted lobectomy through anterior approach is a safe and convenient operation method, which is worthy of clinical application.

Clinical application of three-dimensional computed tomography bronchography and angiography in robotic lung segmentectomy / 中国胸心血管外科临床杂志

@#Objective    To explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in robotic lung segmentectomy. Methods    A non-randomized control study was performed and continuously enrolled 122 patients who underwent robotic lung segmentectomy in our hospital from January 2019 to January 2020. 3D-CTBA was performed before operations in 53 patients [a 3D-CTBA group, including 18 males, 35 females, with a median age of 52 (26-69) years] and not performed in the other 69 patients [a traditional group, including 23 males, 46 females, with a median age of 48 (30-76) years]. The clinical data of the patients were compared between the two groups. Results    All the patients were successfully completed the surgery and recovered from hospital, with no perioperative death. The baseline characteristics of the patients were not significantly different between the two groups (P>0.05). No significant difference was found in the operative time [120 (70-185) min vs. 120 (45-225) min, P=0.801], blood loss [50 (20-300) mL vs. 30 (20-400) mL, P=0.778], complications rate (17.0% vs. 11.6%, P=0.162), postoperative hospital stay [7 (4-19) d vs. 7 (3-20) d, P=0.388] between the two groups. In the 3D-CTBA group, 5 (9.4%) patients did not find nodules after segmentectomy, and only 1 (1.9%) of them needed lobectomy, but in the traditional group, 8 (11.6%) patients did not find nodules and had to carry out lobectomy, the difference was statistically significant (P<0.05). The follow-up time was 10 (1-26) months, and during this period, there was no recurrence, metastasis or death in the two groups. Conclusion    3D-CTBA is helpful for accurate localization of nodules and reasonable surgical planning before operations, and reducing wrong resections in segmentectomy, without increasing the operation time, blood loss and complications. It is safe and effective in anatomical lung segmentectomy.

Application of Electromagnetic Navigation Bronchoscopic Biopsy Combined with Massage Staining in Diagnosis and Treatment of Peripheral Pulmonary Lesion / 中国肺癌杂志

BACKGROUND@#Electromagnetic navigation bronchoscopy (ENB) has become the latest minimally invasive diagnostic and therapeutic technique due to its characteristics, e.g., non-invasion, accuracy, real-time positioning. In this study, we investigated the application of ENB biopsy combined with Massage staining in the diagnosis and treatment of peripheral pulmonary lesions (PPL).@*METHODS@#The clinical data of 15 PPL patients undergoing ENB biopsy plus Massage staining between August 2017 and January 2018 were retrospectively reviewed. Among them, there were 12 male and 3 female, and the mean age was (51.3±2.1) years old.@*RESULTS@#The diameter of PPLs ranged from 6 mm to 36 mm (mean: 14.0 mm). The successful biopsy rate was 66.7%. All patients successfully underwent Massage staining. The distance between the centers of staining and lesion was (1.0±0.4) cm, and the diameter of staining was (2.8±0.6) cm. The mean operation time was (26.7±5.3 ) min, and the mean blood loss during surgery was (3.3±1.5) mL. There was no pneumothorax, hemothorax and pulmonary vascular injury during the procedure.@*CONCLUSIONS@#The ENB biopsy plus Massage staining technique caused very few complications, and provided high precision, which warrants further application.

The application of detecting BCAR1 (+)-circulating tumor cells in postoperative monitoring of early stage lung adenocarcinoma / 中华胸心血管外科杂志

Objective To explore the clinical significance regarding monitoring circulating tumor cells in early stage lung adenocarcinoma.Methods From November 2015 to January 2018,48 patients with stage Ⅰ lung adenocarcinoma were included in the study.BCAR1 expression in CTCs in peripheral blood were detected by using CanPatrolTM and RNA in situ hybridization detection.Results Among the 48 cases,CTCs and BCAR1 (+)-CTCs were detected in 41 cases(85.4％) and 30 cases(62.5％),respectively.Number of BCAR1 (+)-CTCs seemed to be significantly positively related to that of CTCs.BCAR1 (+)-CTCs were more likely to appear in the M-CTCS and E&M-CTCS.BCAR1 (+)-CTCs remarkably increased in three relapsed cases.Furthermore,there were 19 stable cases who had postoperative CTCs data:(1) in 12 patients,either CTCs or BCAR1 (+)-CTCs were significantly reduced or remained stable;(2) in 7 cases,CTCs increased,but BCAR1 (+)-CTCs remained stable in 2 cases,reduced in 1 case,and the other 4 cases underwent close follow-up.Conclusion Evaluation of BCAR1 (+)-CTCs possibly can be contributive to prediction of early lung adenocarcinoma recurrence or metastasis.

Strategies to shorten the duration of mechanical ventilation in patients with post-thymectomy myasthenic crisis / 中华胸心血管外科杂志

Objective To identify the clinical and demographical features that may impact the duration of mechanical ventilation(DMV) in the patients with post-thymectomy myasthenic crisis(PTMC).Methods Reviewed the patients who had PTMC from June 2008 to November 2015.Cox proportional hazard regression analysis was used to identify potential prognostic factors that may impact DMV and long-term survival,respectively.One-way ANOVA analysis was used to compare the four groups with continuous variates.Statistical powers were calculated by using XLSTAT.Results In total,seventy patients with PTMC were enrolled.Alcoholic abuse,high MGFA classification and Clavien-Dindo classification were the critical factors that remarkably delayed early extubation.Postoperative lung infection(PLI) as sole complication did not prolong DMV as compared to those without any complication,however,PLI with other more severe complications requiring at least pharmacological treatment seemed to remarkably prolong DMV,as compared to those without any complication.Conclusion Preoperative abstinence,proper treatment of MG and postoperative complications can decrease the incidence of PTMC,shorten the use of ventilator time and improve the prognosis of patients.