Yunke Zhu

Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery

BackgroundThis study aims to introduce an optimized method named “non-grasping en bloc mediastinal lymph node dissection (MLND)” through video-assisted thoracoscopic surgery (VATS).MethodsBetween February 2009 and July 2013, 402 patients with clinical stage I non-small cell lung cancer (NSCLC) underwent “non-grasping en bloc MLND” conducted by one surgical team. Target lymph nodes (LNs) were exposed following non-grasping strategy with simple combination of a metal endoscopic suction and an electrocoagulation hook or an ultrasound scalpel. In addition, dissection was performed following a stylized three-dimensional process according to the anatomic features of each station. Clinical and pathological data were prospectively collected and retrospectively reviewed.ResultsThe postoperative morbidity and mortality were 17.4% (70/402) and 0.5% (2/402), respectively. The total number of LNs (N1 + N2) was 16.0 ± 5.9 (range of 5–52), while the number of N2 LNs was 9.5 ± 4.0 (range of 3–23). The incidences of postoperative upstaging from N0 to N1 and N2 disease were 7.7% and 12.2%, respectively.ConclusionsNon-grasping en bloc MLND enables en bloc dissection of mediastinal LNs with comparable morbidity and oncological efficacy while saving troubles of excessive interference of instruments and potential damage to the target LN.

Video‐assisted thoracoscopic surgery versus posterolateral thoracotomy lobectomy: A more patient‐friendly approach on postoperative pain, pulmonary function and shoulder function

We evaluated the physiological benefits following video‐assisted thoracoscopic surgery (VATS) lobectomy or posterolateral thoracotomy (PLT) lobectomy for lung cancer patients. One hundred and three patients were included in this study, who underwent either a VATS approach (n= 51) or a PLT approach (n= 52) lobectomy for clinical stage I lung cancer. Pain scores were measured preoperatively and on postoperative day (POD) one, three, seven, 30, and 90, by using a visual analog scale. Pulmonary function and shoulder function were measured preoperatively and on POD seven, 30 and 90 by using a portable spirometer and by the American Shoulder and Elbow Surgeons (ASES) standardized shoulder assessment form, respectively. Postoperative pain was experienced less in the VATS group than in the PLT group on POD one, three, seven, 30, and 90 (P= 0.060, 0.055, 0.000, 0.000, 0.000, respectively). Analgesic requirements were significantly less in the VATS group than in the PLT group during hospital stay (90.2 ± 60.8 mg vs. 119.2 ± 70.8 mg, P= 0.028). The pain score returned to the preoperative reference level on POD seven in the VATS group, but not until POD 30 in the PLT group. The recovery of forced vital capacity (FVC) was statistically better in the VATS group on POD seven, postoperative month (POM) one, and POM three (P= 0.000, 0.000, 0.002, respectively). The recovery of forced expiratory volume in 1 second (FEV1) was better in the VATS group, but the differences were not significant. The shoulder function in the VATS group was significantly well preserved on POD seven, 30 and 90, compared with the PLT group. Lobectomy by the VATS approach generates less pain, and preserves better pulmonary function and shoulder function in the early postoperative phase.

Chyle leakage in port incision after video-assisted thoracoscopic surgery: case report

A 26-year-old Asian male was found to have chyle leakage from the port incision after video-assisted thoracoscopic surgery (VATS) for excision of pulmonary bullae. The diagnosis was confirmed by oral intake of Sudan black and by lymphoscintigraphy. The leakage resolved after 5 days of restricted oral intake and total parenteral nutrition. No leakage recurred after return of oral intake. Possible explanations for the port incision chyle leakage are obstruction of the thoracic duct, which induced retrograde drainage of the lymphoid fluid, or an aberrant collateral branch of the thoracic duct in the chest wall.

Reconstruction of the pulmonary trunk via cardiopulmonary bypass in extended resection of locally advanced lung malignancies.

The aim of this retrospective study is to summarize our improvement of surgical procedures for radical resection of left hilar tumors involving the pulmonary trunk and determine its clinical feasibility.

Video-assisted thoracic surgery double sleeve lobectomy for non- small cell lung cancer: a report of seven cases

Background: Video-assisted thoracic surgery (VATS) double sleeve lobectomy has been rarely reported. We aimed to summarize the techniques and outcomes of this challenging procedure for non-small cell lung cancer (NSCLC) involving both the bronchus and pulmonary artery. Methods: From May 2012 to December 2016, seven patients were selected for VATS double sleeve lobectomy at our center, including four cases of left upper lobectomy and three cases of right upper lobectomy. Surgical procedures were performed with four ports for the first patient and three ports for the other patients. The “hollow out” process was designed for hilum dissection. The main pulmonary artery and interlobar artery were then blocked using two releasable atraumatic endoscopic Bulldog Clamps. Bronchovascular reconstruction was accomplished by the “two-needle-holder suturing technique” through directly watching a video monitor. Low-molecular heparin was subcutaneously administered during the first week after surgery. Results: The operations were uneventful. Surgical duration ranged from 250 to 480 min (median, 318 min) with blood loss between 30 to 200 mL (median, 200 mL). The average number of the dissected lymph nodes was 13 (range, 11–19). Two patients developed postoperative pneumonia with no mortalities. Prolonged air leak (>5 days) was observed in three patients. The median postoperative hospital stay was 15.5 days (range, 5–33 days). There were two cases of adenosquamous cell carcinoma and five cases of squamous cell carcinoma. One patient died of hemoptysis 50 days after surgery, and one died of metastatic lung cancer 2 years after surgery. The other five patients were alive without local recurrence at 4–58 months of follow-up. Conclusions: VATS bronchovascular double sleeve lobectomy is technically difficult but feasible for skilled thoracoscopic surgeons in experienced centers. More data are encouraged to assess the long-term outcomes of this new procedure.

Optimized thoracoport design for the thoracoscopic procedure during minimally invasive esophagectomy

Minimally invasive esophagectomy has several benefits as an effective alternative treatment for esophageal cancer. The three‐phase esophageal resection may be the most popular approach to esophagectomy. Numerous thoracoport designs are available for the thoracoscopic procedure. The present study aims to contribute a distinctive three‐port technique that is designed to minimize surgical trauma and facilitate operation during the thoracoscopic procedure. In this paper, we describe and demonstrate the details of the port design and each operation step. Based on our practical experience, the rational combination of the port design and instrument usage of the three‐port technique makes the thorascopic procedure more convenient.

Unusual cause of massive hemothorax: spontaneous rupture of nonfunctioning mediastinal paraganglioma

Mediastinal paraganglioma is a rare neurogenic tumor with a hypervascular feature. The spontaneous rupture of mediastinal paraganglioma is an unusual cause of massive hemothorax. Here we present a case of 39-year-old man with massive hemothorax due to the spontaneous rupture of a mediastinal paraganglioma. The man underwent successful resection of tumor and had an uneventful recovery. To our knowledge, this is the first reported case of spontaneous rupture of nonfunctioning mediastinal paraganglioma.

Simultaneous thoracoscopic resection for coexisting pulmonary and thymic lesions

BACKGROUND The management of synchronous thymic and pulmonary lesions remains a challenge due to the lack of case series and surgical guidelines. This study aims to retrospectively review our preliminary experience and results of performing simultaneous thoracoscopic resection of coexisting diseases of the lung and thymus. METHODS Simultaneous thoracoscopic resection was performed to remove coexisting thymic and pulmonary lesions in nine patients from August 2008 to November 2013. Patient demographics, preoperative assessment, surgical procedures and postoperative course of these patients were reviewed. RESULTS There were four female and five male patients between 43 and 70 years old (median age, 64 years). Each patient had thymic neoplasm and solitary pulmonary lesion on chest computed tomography (CT) scan. Four patients underwent thoracoscopic lobectomy and thymectomy. One patient had thoracoscopic bronchovascular sleeve lobectomy combined with thymic cyst resection (TCR). The other four patients received pulmonary wedge resection and thymectomy (n=3)/TCR (n=1). The operation lasted from 35-480 min (median, 110 min). Intra-operative blood loss was 20-380 mL (median, 120 mL). Two patients developed post-operative pneumonia without mortality. All the patients were discharged home within 9 days after surgery. Two patients died from metastatic lung cancer 14 months after surgery. CONCLUSIONS Simultaneous thoracoscopic resection of coexisting pulmonary and thymic lesions is safe and feasible in selected patients.