Sumihiko Nawata

Cost Analysis for Thoracoscopy: Thoracoscopic Wedge Resection and Lobectomy

We reviewed our experience with video-assisted thoracic surgeyr (VATS) in our most recent 80 patients for the purpose of cost analysis. The costs incurred in the patients undergoing a VATS wedge resection for nodules (n=30) and a VATS lobectomy for lung cancer (n=10) were compared with the costs in similar patients undergoing a wedge resection (n=20) and lobectomy (n=20) using open techniques. The disposable instrument costs were US

Disadvantages of Muscle-Sparing Thoracotomy in Patients with Lung Cancer

1071 higher for a VATS wedge resection; however, the operative time was shorter (0.99h for VATS versus 1.75h for the open procedure). The length of hospital stay was also shorter after a VATS wedge resection (10.4 days for VATS versus 16.8 days for the open procedure), thus resulting in lower total hospital charge in the VATS group. The disposable instrument costs were

Chest wall implantation of lung cancer at the drainage tube site: Report of a case

3190 higher for a VATS lobectomy, and the operative time was longer (5.56 h for VATS versus 4.25 h for the open procedure). The length of hospital stay was similar in both groups (25.2 days for VATS versus 27.7 days for the open procedure), thus resulting in a higher total hospital charge in the VATS lobectomy group. The cost of a VATS wedge resection for removing peripheral nodules is competitive with that of open techniques, but the cost of a VATS lobectomy is higher than that for an open lobectomy.

Combined Thoracoscopic Lung Resection and Laser Ablation for Lung Cancer with Pulmonary Emphysema: Report of a Case

At our institute patients with lung cancer had traditionally undergone lobectomy with mediastinal lymph node dissection using a standard posterolateral approach. The considerable morbidity associated with the standard posterolateral thoracotomy led us to investigate an alternative muscle-sparing approach. A prospective, randomized study of 30 patients with primary lung cancer (stage I or II) was performed to compare the following: operative field size, number of dissected lymph nodes, surgery time, postoperative pain, shoulder range of motion, and pulmonary function test results between patients who underwent either standard thoracotomy (SP group, n = 15) or the muscle-sparing thoracotomy (MS group, n = 15). The procedure should provide enough operative field size to access the mediastinum. Compared with the standard posterior thoracotomy, the muscle-sparing thoracotomy supplied a smaller operative field (218 ± 31 versus 165 ± 41 cm2) and required more surgery time (87 ± 13 minutes) than the standard posterior thoracotomy (66 ± 12 minutes). There were no significant differences in the number of dissected mediastinal lymph nodes. During the early postoperative days, pain and restriction of shoulder flexion were significantly less in the MS group than in the SP group. There were no significant differences in pulmonary function between the two groups. In terms of the operative field there is a marked disadvantage with the muscle-sparing incision compared with standard thoracotomy. The operative field is significantly smaller than with a standard thoracotomy, requiring more time to dissect the mediastinum; however, the pain is less and shoulder range of motion is superior to what is seen after standard thoracotomy during the early postoperative period. We conclude that there is no overall advantage to using the muscle-sparing incision in patients with lung cancer.

Clinicopathological studies on thymoma

We report herein the case of a 70-year-old man in whom a chest wall implantation of adenocarcinoma of the lung at the drainage tube site was found 4 months after a right lower lobectomy with mediastinal lymph node dissection had been performed for adenocarcinoma of the right lower lobe. The lesion was successfully treated by tumor extirpation. We believe that tumor seeding to the chest wall occurred at the time of thoracotomy. To prevent such tumor seeding, the pleural cavity should be washed out routinely with a massive volume of physiological saline solution prior to closure of the chest wall.

Increased pulmonary hypertension after thoracoscopic volume reduction surgery for pulmonary emphysema : a case report

We report herein the case of the 71-year-old man with lung cancer and pulmonary emphysema requiring supplementary oxygen at 21/min by nasal cannula for whom thoracoscopic wedge resection of an adenocarcinoma in his left lower lobe was successfully performed. During the same procedure, thoracoscopic laser ablation of pulmonary bullae was also carried out. There were no postoperative complications, and the patient is currently well 12 months following surgery without any evidence of local or regional recurrence, or distant metastasis. His severe dyspnea on exertion improved, and he no longer requires supplementary oxygen.