Guobing Xu

Preliminary results of single-port versus triple-port complete thoracoscopic lobectomy for non-small cell lung cancer

OBJECTIVE To compare the feasibility and safety of single-port vs. triple-port complete thoracoscopic lobectomy for non-small cell lung cancer (NSCLC). METHODS A retrospective study was conducted on 82 patients with NSCLC who underwent complete thoracoscopic lobectomy from August 2014 to October 2014 in Department of Thoracic Surgery, Fujian Medical University Union Hospital. There were 33 cases in single-port complete thoracoscopic lobectomy group (single-port group) and the other 49 ones in triple-port complete thoracoscopic lobectomy group (triple-port group). Total lymph node harvest, mediastinal lymph node harvest, dissection of mediastinal lymph node groups, operation time, intraoperative blood loss, chest drainage duration, postoperative hospital stay, postoperative one-day pain visual analogue scale (POP-VAS), and the complications were thoroughly compared between the two groups. RESULTS There were no significant differences in total lymph node harvest, mediastinal lymph node harvest, dissection of mediastinal lymph node groups, intraoperative blood loss, chest drainage duration, postoperative hospital stay, and complications between the two groups (P>0.05). However, the operation time of single-port group was significantly longer than that of triple-port group (181.3±27.5 vs. 149.5±30.9 min, P<0.05). POP-VAS in single-port group was significantly lower than that in triple-port group (3.6±0.7 vs. 5.5±1.0, P<0.05). CONCLUSIONS For NSCLC, the feasibility and safety of single-port complete thoracoscopic lobectomy is similar to triple-port complete thoracoscopic lobectomy. Compared with triple-port complete thoracoscopic lobectomy, the operation time of single-port complete thoracoscopic lobectomy is longer, but its postoperative pain is gentler. As the experience accumulating, single-port complete thoracoscopic lobectomy should be popularized with its merits of minimal invasiveness.

Complete video-assisted thoracoscopic surgery upper left bronchial sleeve lobectomy

This video demonstrates a case undergoing complete video-assisted thoracoscopic surgery (VATS) upper left bronchial sleeve lobectomy. The 18-year-old female patient was admitted for recurrent cough and intermittent hemoptysis for one month. Chest CT scan showed a neoplasm in the left main bronchus and the left upper lobe bronchus. Bronchoscopic biopsy indicated mucinous epithelial cancer. Based on the chest CT findings, the left lower lung was not affected. To preserve normal lung tissue and minimize the loss of lung function, we decided to perform this surgical procedure. A three-port technique was conducted, in which the hypoplastic oblique fissure, the left upper pulmonary vein, and the upper lobe branch of the left pulmonary artery were initially treated under complete VATS. Bronchial sleeve lobectomy of the upper lobe of the left lung was finally carried out. The key to success was the end-to-end anastomosis between the left main bronchus and the lower left bronchus under thoracoscope. The deep location of the operative field partly hidden under the left pulmonary artery trunk during bronchial anastomosis made it even more difficult to operate thoracoscopically. To improve exposure of the operative field, we managed to raise the left main bronchus by passing two 1-0 silk sutures, respectively ligated with both sides of the posterior wall of the left main bronchus, through the anterior and posterior chest walls using a crochet needle. Similarly, a 1-0 silk suture was advanced through the posterior chest wall with a crochet needle to lift the trunk of the left pulmonary artery. In this way, a widely open, exposed field was achieved. Postoperative recovery was smooth. Chest X-ray showed good expansion of the left lung. Bronchoscopy indicated a patent anastomosis. The patient was discharged after two weeks. In conclusion, complete VATS bronchial sleeve lobectomy is a minimally invasive approach for thorough removal of tumor lesions while sparing as most normal lung tissue as possible, which avoids pneumonectomy and satisfies the psychological and physiological needs of patients.

Single-port video-assisted thoracoscopic surgery lung resection: experiences in Fujian Medical University Union Hospital

Video-assisted thoracoscopic surgery (VATS) is currently a better choice than thoracotomy for lung resection, and then single-port VATS has been increasingly applied in clinical settings with the improvements in both endoscopic instruments and surgical skills. Our center began to perform single-port VATS lobectomy in May 2014 and had performed all sort of lung resection in 168 patients till December 2014, including wedge resection, routine lobectomy, sleeve lobectomy, segmentectomy and pneumonectomy. All these procedures were successfully performed without any severe complication. We believe the single-port VATS lung resection is a safe and feasible procedure after surgery practice.

Modified bronchial anastomosis in video-assisted thoracoscopic sleeve lobectomy: a report of 32 cases.

BACKGROUND Bronchial anastomosis is a key technical challenge in sleeve lobectomy, especially when using the video-assisted thoracoscopic surgery (VATS) approach. A retrospective study was conducted to evaluate the feasibility and safety of a modified bronchial anastomosis technique developed by the authors at Fujian Union Hospital. METHODS From October 2010 to October 2015, we performed 32 cases of VATS sleeve lobectomy through a three-port or single-port approach. All bronchial anastomoses were performed using modified bronchial anastomosis technique: the bronchial anastomosis was begun with an initial stitch on the posterior wall, and the bilateral quarters of the circumference were continuously sutured. The other two bilateral quarters were then similarly sutured, and the last knot was made outside the bronchial lumen. RESULTS All cases were completed uneventfully. No perioperative deaths or serious complications occurred. The mean operative time, bronchial anastomosis time, and blood loss volume were 271.8±67.5, 37.6±12.0 min, and 177.5±102.9 mL, respectively. The mean follow-up time was 21.0±11.7 months, and the follow-up rate was 96.9% (31/32). An electronic bronchoscope scan was performed 6 months after surgery, and a fine healing stoma was detected in all cases. No anastomotic fistula, anastomotic stenosis, or other serious postoperative anastomotic complications occurred until the end of follow-up. CONCLUSIONS Modified bronchial anastomosis technique applied in bronchial anastomosis was safe and feasible in three-port and single-port VATS sleeve lobectomy with good short-term and long-term therapeutic results. Adequate management of the operative process and implementation of a skilled bronchial anastomosis technique could help to reduce the difficulty of VATS sleeve lobectomy.

Thoracic surgery: single-port video-assisted thoracoscopic lobectomy

Single-port video-assisted thoracoscopic surgery (VATS) has been increasingly applied in clinical settings in the past two years along with the improvements in both endoscopic instruments and surgical skills. Our center began to perform single-port VATS lobectomy in May 2014 and had performed this procedure in 121 patients till January 2015. The surgical incision (3.5-4.5 cm in length) was created in the 4(th) or 5(th) intercostal space at the anterior axillary line at the diseased side. The operator standed at the abdominal side of the patient and operated using the endoscopic instruments only. The surgical steps of single-port VATS lobectomy were same as those of the triple-port VATS lobectomy. There was no fixed mode in handling the three major structures of the pulmonary lobes, and the resection sequence can be scheduled based on the development status of pulmonary fissures and on the difficulties in dissecting the relevant structures. We believe the single-port VATS lobectomy is a safe and feasible procedure and warrants further clinical applications after finishing these surgeries.

IQQA-3D imaging interpretation and analysis system-guided single-port video-assisted thoracic surgery for anatomical sub-segmentectomy (LS 1+2 a+b)

Gradual improvements in health awareness and expanded physical examinations have resulted in more frequent discovery of pulmonary nodules, especially those of ground-glass opacity. In turn, diagnosis of early lung cancer is increasingly common. Surgeons have found that these early lung cancers may be safely removed via segmentectomy or sub-segmentectomy instead of lobectomy. However, the hilum structure of lung segments is complicated, and the many variations increase the challenge of performing segmental or subsegmental resection.

Recommendations for camera-holding during single-port video-assisted thoracoscopic lobectomy for non-small cell lung cancer

Background: To summarize experience in coordinating the camera during single-port video-assisted thoracoscopic (VAT) lobectomy. Methods: Between May 2014 and June 2016 the author participated in 82 consecutive single-port VAT lobectomies as the camera holder. The peri-operative data were collected, the operative coordinating experience, and solutions to technical difficulties are summarized based on the characteristics of the single-port VAT technique. Results: All cases were completed uneventfully. The study cohort consisted of 35 males and 47 females with an average age of 59.0±10.5 y. The tumor was located in the right upper lobe in 26 patients, the right middle lobe in 4 patients, the right lower lobe in 16 patients, the left upper lobe in 21 patients, the left lower lobe in 7 patients, and a combination of lobes in 8 patients. The average tumor diameter was 2.0±1.2 cm. The average operative time and blood loss were 178.6±41.0 min and 84.0±95.7 mL, respectively. The post-operative pathologic results were as follows: (IA) n=56; (IB) n=13; (IIA) n=1; (IIB) n=4; and (IIIA) n=8. The average number and stations of lymph nodes dissected were 16.8±8.2 and 5.7±1.9, respectively. Conclusions: In addition to the skillful manipulation of the surgeon, excellent coordination and rapid reactions of the camera holder are important for the successful completion of single-port VAT lobectomy.

Video-assisted thoracoscopic extended thymectomy using the subxiphoid approach

Minimally invasive thoracoscopic surgery has become an inevitable trend in the treatment of anterior mediastinal tumors and other thoracic diseases. Many surgical approaches may be used for video-assisted thoracoscopic surgery (VATS) thymectomy. Some researchers have proven that that VATS thymectomy using the subxiphoid approach is technically safe and feasible. Compared with the transthoracic approach, the subxiphoid approach is considered to provide a better view of the bilateral pleural cavities and to cause relatively less pain; it is thus considered a less invasive surgical approach. In this article, we summarize our experience with various incision designs, specific surgical procedures, and key operative manipulations that are crucial for successful performance of subxiphoid VATS extended thymectomy.

Initial experience of single-port video-assisted thoracoscopic surgery sleeve lobectomy and systematic mediastinal lymphadenectomy for non-small-cell lung cancer

BACKGROUND In this study, we evaluate the feasibility and safety of single-port video-assisted thoracoscopic surgery (VATS) sleeve lobectomy (SL) and systematic mediastinal lymphadenectomy and summarize our surgical experience. METHODS From October 2014 to December 2015, eight cases of single-port VATS SL [seven male patients and one female patient, median age 56.0 (range, 38-63) years] were performed by a single group of surgeons in Fujian Medical University Fujian Union Hospital. The median tumor size was 2.7 cm. Types of resection included four right upper, one right lower, and three left upper sleeve lobectomies. Systematic mediastinal lymphadenectomy was performed in all patients. A modified anastomosis technique developed by the author (Chens technique) was applied for bronchial anastomosis. Postoperative outcome and short-term follow-up data were recorded and analyzed. RESULTS All eight operations were completed uneventfully with no conversion to thoracotomy or reoperation required. No perioperative death was observed. Major results (medians or percentages) were as follows: operative duration, 234.5 [185-345] min; bronchial anastomosis duration, 38.0 [30-43] min; blood loss, 65.0 [50-200] mL; number of lymph node dissected, 22.5 [18-37]. The postoperative complication rate was 37.5% (three of eight cases, including two pulmonary infections and one atrial fibrillation). All patients recovered and were discharged uneventfully with symptomatic therapy. Pathology showed squamous cell carcinoma in seven patients and adenocarcinoma in one patient; two patients were in TNM stage IB, three in stage IIA, one in stage IIB, and two in stage IIIA. The mean follow-up was 7.5 [2-15] months. There were no tumor recurrences or bronchial anastomotic complications. CONCLUSIONS Single-port VATS SL and mediastinal lymphadenectomy are safe and feasible. Improvements in operating procedures can help facilitate single-port VATS. The application of Chens technique in bronchial anastomosis is easy and reliable and shows a satisfactory short-term clinical outcome.