Yi-Cheng Wu

Thoracoscopic Removal of Intrathoracic Neurogenic Tumors: A Combined Chinese Experience

ObjectiveTo review the surgical and clinical results of minimally invasive resection of intrathoracic neurogenic tumors using a video-assisted thoracoscopic technique. Summary Background DataThoracoscopy has emerged as a possible means for diagnosing and managing various intrathoracic disorders. Benign intrathoracic tumors often are ideal lesions for resection using a video-assisted technique. The authors report on their combined experience with the thoracoscopic resection of 143 intrathoracic neurogenic tumors. MethodsBetween March 1992 and February 1999, 143 patients with intrathoracic neurogenic tumors were diagnosed and underwent resection using video-assisted thoracoscopic techniques in three teaching centers. Case selection, surgical technique, and clinical results were reviewed. ResultsThe average age of the patients was 40.8 years; 57.3% were male. Thirty-eight patients (27%) had symptoms attributable to the masses. Seventy-two masses were neurofibromas, 33 were neurilemmomas, 7 were paragangliomas, and 31 were ganglioneuromas. All but seven tumors were located in the posterior mediastinum. The masses were on average 3.5 cm in greatest diameter. The mean surgical time was 40 minutes, and the average hospital stay was 4.1 days. There were no major postoperative complications or recurrences to date. Nine patients reported paresthesias over the chest wall during a mean follow-up of 29 months. ConclusionsResection of intrathoracic neurogenic tumors using a thoracoscopic technique based on standard surgical indications would seem to be appropriate. Most of these masses are benign and readily removed. For dumbbell tumors, a combined thoracic and neurosurgical approach is mandatory.

Inhibition of NF-kappa B activation can attenuate ischemia/reperfusion-induced contractility impairment via decreasing cardiomyocytic proinflammatory gene up-regulation and matrix metalloproteinase expression.

Following cardiopulmonary bypass (CPB) and cardiac global ischemia and reperfusion, proinflammatory genes are up-regulated, and nuclear factor (NF)-κB is involved in this regulation. We studied whether inactivation of NF-κB could decrease myocardial ischemia/reperfusion injury with cardioplegia during CPB, attenuate matrix metalloproteinase (MMP) activation, and prevent cardiac mechanical dysfunction. Rabbits received normal saline (group 1) or curcumin (70 and 7 μmol/kg in groups 2 and 3) injection 2 hours before CPB. Total CPB was initiated, and myocardial protection was delivered every 20 minutes for 60 minutes of cardiac arrest. Rabbits were weaned from CPB and reperfused for 4 hours before the hearts were harvested. Blood was sampled at various time points. Postoperative expression of myocardial mRNA levels of interleukin 6, monocyte chemoattractant protein-1, and tumor necrosis factor-α, postreperfusion plasma level of troponin I, and cardiac mechanical dysfunction were significantly decreased in the curcumin groups. The myocardial levels of activated MMP-2 and -9 were also significantly reduced compared with the control group. In conclusion, by inhibiting NF-κB activation, the up-regulation of cardiac proinflammatory genes can be ameliorated, and the activation of MMPs can be decreased during CPB, thereby lessening severity of cardiac mechanical dysfunction after global cardiac ischemia/reperfusion injury.

Single-port video-assisted thoracoscopic mediastinal tumour resection

OBJECTIVES To present the technique of single-port video-assisted thoracoscopic mediastinal tumour resection, which includes limited thymectomy, extended thymectomy, cyst excision and posterior mediastinal tumour excision, and the early results of resection with the use of this technique. METHODS Twenty-nine patients with mediastinal tumours were treated with single-port thoracoscopic mediastinal resection at Chung Gung Memorial Hospital between April 2014 and May 2015.The surgical intervention was performed through the fourth or fifth intercostal space at the anterior axillary line. A 5- or 10-mm 30° video camera and working instruments were employed simultaneously at this incision site throughout the surgery. The perioperative variables and outcomes were collected and analysed retrospectively. RESULTS Among the 29 cases included in the final analysis, 8 extended thymectomies, 5 limited thymectomies, 7 cyst excisions and 9 tumour excisions were performed successfully without the need for conversion. For the 29 patients who underwent single-port video-assisted thoracoscopic surgery (VATS), the mean operation time was 97.3 ± 31.2 min and the average blood loss was 34.1 ± 45.7 ml. The average length of the incision wound was 3.41 ± 0.76 cm and the average length of postoperative hospital stay was 3.75 ± 1.53 days. There were no mortalities, and mobility was achieved 30 days after surgery. CONCLUSIONS With regard to oncological concerns, the occurrence of postoperative myasthenia gravis or freedom from tumour recurrence is a paramount issue. Our cohort follow-up time was not long enough to address this, and more time and patients are needed for further evaluation. But our preliminary report showed that uniportal VATS for mediastinal tumour resection was a promising and safe technique with regard to short-term clinical outcome.

Minimally invasive approach for coronary artery bypass surgery

Forty-two patients, 33 male and 9 female, aged 35.7 to 81.6 years old (mean 62.7), were operated on for left main and/or triple vessel coronary artery disease by using minimally invasive cardiac surgical techniques. A myocardial infarction had occurred in 26 patients (61.9%). The left ventricular ejection fraction ranged from 17 to 83% (52+/-22). The surgeries were performed through left parasternal minithoracotomy (8 to 12 cm in length) under femoro-femoral or aorto-atrial cardiopulmonary bypass. The myocardium was protected by blood cardioplegic solution with the aorta crossclamped. Under direct vision, average 3.8 distal anastomoses were performed in each patient, with the saphenous vein grafts and the left internal thoracic arterial graft. The aortic crossclamp time was 62 to 137 min (80+/-15). The duration of cardiopulmonary bypass was 88 to 168 min (115+/-24). The postoperative course was uneventful in all patients. Follow-up (1.0 to 5.6 months, mean 2.9) was complete in all patients and there were no late deaths or angina. Coronary angiography of ten patients showed patent grafts. Our experience demonstrates that minimally invasive cardiac surgery during cardioplegic arrest is technically feasible and can be performed in coronary artery disease safely and effectively for complete revascularization.