Explore the vast range of titles available.

Objective This study aimed to evaluate the short‐term clinical outcomes of subxiphoid approach thoracoscopic surgery (SATS) versus lateral intercostal approach thoracoscopic surgery (LIATS) for anterior mediastinal tumors. Methods Clinical data from patients who underwent video‐assisted thoracoscopic surgery for anterior mediastinal tumors between April 1, 2020 and December 31, 2023 were analyzed. Patients were stratified into two cohorts according to the surgical approach used: the SATS group (n = 679) and the LIATS group (n = 461). Intraoperative and postoperative outcomes were compared between the two groups. Results A total of 1140 patients were included in the statistical analysis after screening and assessment. After propensity score matching, a total of 417 SATS patients were matched with 417 LIATS patients. In the analysis of the outcomes, the LIATS group had a shorter operation time than the SATS group (p < 0.001). There were no statistical differences in Numeric Rating Scale (NRS) pain scores on Postoperative Day 1 (p = 0.113), Day 2 (p = 0.189), or Day 3 (p = 0.462). Postoperative atelectasis was more common in the SATS group than in the LIATS group (p = 0.025). There were no perioperative deaths. Conclusions The SATS did not demonstrate significant improvements in postoperative pain compared with the LIATS. However, the LIATS was associated with shorter operative time in the overall cohort. In a matched study of 417 patients per group, LIATS for anterior mediastinal tumors resection had a significantly shorter operative time than SATS (75 ± 34 vs. 112 ± 43 min; p < 0.001), with no difference in postoperative pain.

Background In this study we aimed to assess the clinical outcomes of performing video‐assisted thoracic surgery (VATS) to treat primary mediastinal cysts (PMCs) and investigate the clinical factors which increase the difficulties associated with VATS. Methods The medical records of all consecutive PMC patients, who underwent surgical resection from April 2001 to July 2016, were reviewed and 282 patients were included. Clinical characteristics, imaging features, and surgical outcomes were analyzed. Follow‐up data were successfully obtained from 230 PMC patients by telephone or outpatient clinic annually. The latest follow‐up was July 2019. Results VATS was performed in 278 patients and four patients were converted into thoracotomy. The mean operation time and intraoperative bleeding were 102.4 ± 40.9 minutes (range 25–360 minutes) and 52.4 ± 75.1 mL (range 5–600 mL), respectively. The intra‐ and postoperative complication rates were 2.8 and 5.7%, respectively. Seven patients with bronchogenic cysts showed severe cyst adhesion to vital mediastinal structures and thus had incomplete resection. Multivariable logistic analysis revealed that a maximal cyst diameter greater than 5 cm was significantly associated with increased risks of operation time extension (OR = 2.106; 95% CI: 1.147–3.865, P = 0.016) and intraoperative blood loss increase (OR = 4.428; 95% CI: 1.243–16.489, P = 0.022). A total of 230 patients had follow‐up data. The median follow‐up time was 70 months (range, 36–210 months). No local recurrence was observed. Conclusions Surgical resection by VATS may be recommended for PMC management as a primary therapeutic strategy. Cysts with a maximum diameter greater than 5 cm or cysts adjacent to vital mediastinal structures can increase the surgical difficulties. Key points • Significant findings of the study A diameter >5 cm and adhesions significantly increased the risk of operation time extension together with increased blood loss. • What this study adds Cysts with a diameter >5 cm or those adjacent to vital mediastinal structures increased the potential for surgical difficulties. Surgical resection by VATS may be recommended for PMC management as a primary therapeutic strategy. The cysts with maximal diameter greater than 5 cm or the cysts that are adjacent to vital mediastinal structures can increase the surgical difficulties.

Background The majority of previous studies of the clinical outcome of video‐assisted thoracoscopic surgery (VATS) versus open lobectomy for pathological N2 non‐small cell lung cancer (pN2 NSCLC) have been single‐center experiences with small patient numbers. The aim of this study was therefore to investigate these procedures but in a large cohort of Chinese patients with pathological N2 NSCLC in real‐world conditions. Methods Patients who underwent lobectomy for pN2 NSCLC by either VATS or thoracotomy were retrospectively reviewed from 10 tertiary hospitals between January 2014 and September 2017. Perioperative outcomes and overall survival of the patients were analyzed. Cox regression analysis was performed to identify potential prognostic factors. Propensity‐score analysis was performed to reduce cofounding biases and compare the clinical outcomes between both groups. Results Among 2144 pN2 NSCLC, 1244 patients were managed by VATS and 900 by open procedure. A total of 305 (24.5%) and 344 patients died during VATS and the thoracotomy group during a median follow‐up of 16.7 and 15.6 months, respectively. VATS lobectomy patients had better overall survival when compared with those undergoing the open procedure (P < 0.0001). Multivariate COX regression analysis showed VATS lobectomy independently favored overall survival (HR = 0.75, 95% CI: 0.621–0.896, P = 0.0017). Better perioperative outcomes, including less blood loss, shorter drainage time and hospital stay, were also observed in patients undergoing VATS lobectomy (P < 0.05). After propensity‐score matching, 169 patients in each group were analyzed, and no survival difference were found between the two groups. Less blood loss was observed in the VATS group, but there was a longer operation time. Conclusions VATS lobectomy might be a feasible alternative to conventional open surgery for resectable pN2 NSCLC. Key points Significant findings of the study: VATS lobectomy has comparative OS in pN2 NSCLC versus open procedure in resectable patients. What this study adds: VATS lobectomy might be feasible for pN2 NSCLC. The present study aimed to investigate the clinical outcome of video‐assisted thoracoscopic surgery (VATS) versus open lobectomy for pathological N2 non‐small cell lung cancer (pN2 NSCLC) using a large cohort of Chinese patients in real world conditions. VATS lobectomy might be a feasible alternative for pN2 NSCLC.

Uniportal video‐assisted thoracic surgery (VATS) segmentectomy is a demanding technique but is safe and feasible in selected patients and confers favorable efficacy. It presents an acceptable alternative to conventional VATS. Lingulectomy is usually performed with left S4 + S5 segmentectomy. This report describes a case of uniportal VATS of left S4 anatomical segmentectomy alone.

Background In recent years, the field of minimally invasive thoracic surgery has experienced significant advancements driven by improvements in video-assisted thoracoscopic surgery (VATS) techniques and surgical instruments. These advances have given rise to uniportal VATS as a new area of exploration in minimally invasive thoracic surgery. This technique presents several potential advantages, including reduced access trauma, less postoperative pain, improved cosmesis, fewer complications, shorter hospital stays, and faster rehabilitation, ultimately leading to an improvement in patient quality of life. Purpose This article reviews the evolutionary history of minimally invasive thoracic surgery, highlights novel techniques, explores possible applications and obtained results, and discusses future prospects of uniportal VATS. Conclusion Experienced thoracic surgeons have demonstrated the capacity to perform uniportal VATS with a high level of safety and efficacy. Further studies are necessary to assess its long-term efficacy, address limitations, and enhance clinical decision-making for optimal treatment of thoracic conditions.

Robot-assisted thoracic surgery (RATS) has gained popularity for the treatment of lung cancer, but its quality outcome measures are still being evaluated. The purpose of this study was to compare the perioperative outcomes of lung cancer resection using RATS versus video-assisted thoracic surgery (VATS). To achieve this aim, we conducted a retrospective analysis of consecutive patients who underwent lung cancer surgery between July 2015 and December 2020. A propensity-matched analysis was performed based on patients’ performance status, forced expiratory volume in 1 s% of predicted, diffusing capacity of the lungs for carbon monoxide% of predicted, and surgical procedure (lobectomy or segmentectomy). Following propensity matching, a total of 613 patients were included in the analysis, of which 328 underwent RATS, and 285 underwent VATS, with satisfactory performance indicators. The results of the analysis indicated that RATS had a significantly longer operating time than VATS (132.4 ± 37.3 versus 122.4 ± 27.7 min; mean difference of 10 min 95% CI [confidence interval], 4.2 to 15.9 min; p = 0.001). On the other hand, VATS had a significantly higher estimated blood loss compared to RATS (169.7 ± 237.2 versus 82.2 ± 195.4 mL; mean difference of 87.5 mL; 95% CI, 48.1 to 126.8 mL; p < 0.001). However, there were no significant differences between the groups in terms of the duration of chest tubes, length of hospital stay, low- and high-grade complications, as well as readmissions and mortality within 30 days after surgery. Moreover, the number of dissected lymph-node stations was significantly higher with VATS than RATS (5.9 ± 1.5 versus 4.8 ± 2.2; mean difference of 1.2; 95% CI, 0.8 to 1.5; p = 0.001). Nonetheless, the percentage of patients who were upstaged after histopathological analysis of the resected lymph nodes was similar between the two groups. In conclusion, RATS and VATS yielded comparable results for most of the short-term outcomes assessed. Further research is needed to validate the implementation of RATS and identify its potential benefits over VATS.

Background The study aims to compare the safety and cost-effectiveness of low-cost video-assisted thoracoscopic surgery (VATS) lobectomy, utilizing the twining high-tension knot method, with regular stapler-based VATS lobectomy. Methods This retrospective cohort study included 102 patients who underwent VATS lobectomy at a single center between January 2013 and April 2020. Patients were divided into a regular group ( n  = 57) and a low-cost group ( n  = 45). Propensity score matching (1:1) balanced baseline characteristics between the groups (45 patients each). Clinical and cost outcomes were analyzed. Results The operative time (256.24 ± 87.45 min vs. 252.67 ± 73.46 min, p  = 0.834), intraoperative blood loss (102.89 ± 96.38 mL vs.138.44 ± 257.07 mL, p  = 0.39), and postoperative drainage tube indwelling time (3.04 ± 1.62 days vs. 4.02 ± 4.8 days, p  = 0.19) were comparable between the low-cost and regular groups. The length of hospital stay was significantly lower in low-cost VATS (5.91 ± 2.51) compared to regular VATS (8.47 ± 7.39) ( P  = 0.03). The low-cost group demonstrated significantly reduced intraoperative consumable expenses (11,830.09 ± 7,565.13 CNY vs. 25,965.42 ± 7,441.93 CNY, P  < 0.001) and total hospitalization costs (34,001.55 ± 12,649.06 CNY vs. 53,166.76 ± 10,966.48 CNY, P  < 0.001). Conclusions Low-cost VATS lobectomy, using the twining high-tension knot method, is as safe and effective as conventional stapler-based VATS lobectomy while significantly reducing costs. This innovative technique offers a practical, accessible alternative for minimally invasive thoracic surgery, particularly in resource-limited settings. Clinical trial registration number ChiCTR2100047430 in Chinese Clinical Trial Registry.

BackgroundPrevious studies have reported the feasibility and efficacy of thoracoscopic anatomical sublobar resection under three-dimensional computed tomography (3DCT) simulation; however, its long-term outcomes have not been clearly established in primary lung cancer. This study aimed to evaluate the long-term outcomes of this technique.MethodsWe retrospectively reviewed data from 112 consecutive patients with selected clinical stage IA non-small cell lung cancer (NSCLC) who underwent thoracoscopic anatomical sublobar resection from 2004 to 2014. This procedure was planned using preoperative 3DCT simulation to ensure sufficient surgical margins and enabled tailor-made surgery for each patient. Patients who had predominantly ground glass opacity lung cancers underwent anatomical sublobar resection as a curative-intent resection. Other patients who were high-risk candidates for lobectomy underwent anatomical sublobar resection as a compromised limited resection.ResultsOf the 112 cases, 82 had a curative-intent resection, while 30 had a compromised limited resection. Recurrence occurred in only 2 cases (1.8%), both of which were in the compromised limited group. A second primary lung cancer was observed in 5 cases (4.5%). Of the 5 patients, 4 underwent surgery for a second cancer and had no recurrence. The 5-year overall survival, lung cancer-specific overall survival, and recurrence-free survival rates were 92.5%, 100%, and 98.2%, respectively, for all cases; 97.6%, 100%, and 100%, respectively, in the curative-intent group; and 75.8%, 100% and 92.6%, respectively, in the compromised limited group.ConclusionsThoracoscopic anatomical sublobar resection under 3DCT simulation may be an acceptable alternative treatment in selected patients with NSCLC.Trial and clinical registryClinical registration number: IRB No. 2020-98 (Dated: 2020.6.30).

Background In adults with primary spontaneous pneumothorax (PSP), contralateral recurrence occurs in about 25–28% when there are asymptomatic blebs. How to treat contralateral recurrence of PSP in pediatric populations remains controversial. This study evaluated the outcomes of excising contralateral blebs to prevent recurrence in adolescents being operated on for PSP under the same anesthesia. Methods One hundred thirty-two male PSP patients under age 19 were surgically treated in a single institution between January 2008 and December 2016. Thoracoscopic blebectomies with pleurodesis were performed in all patients. The patients were categorized into those with contralateral blebs receiving one-stage bilateral surgeries (32 patients), those with contralateral blebs only receiving unilateral surgeries (40 patients), and those without contralateral blebs only receiving unilateral surgeries (60 patients). Perioperative details and outcomes were retrospectively analyzed. Results Significant differences in contralateral recurrence rate were found among the three groups (0%, 30%, and 1%, respectively; P  < 0.001). Multivariate analysis showed that being under 16.5 years old was a risk factor for overall recurrence (Hazard ratio [HR] 2.81, 95% confidence interval [CI] 1.08–7.30, P  = 0.034). Moreover, patients who had contralateral blebs and only received unilateral surgery were at greater risk of overall recurrence (HR 6.06, 95% CI 1.77–20.75, P  = 0.004). Kaplan–Meier analysis showed that contralateral and overall recurrence-free survival differed among the three groups ( P  < 0.0001, P  = 0.0002). Conclusions Although younger male PSP adolescents treated with surgery were more likely to have postoperative recurrences, the performance of simultaneous contralateral blebectomies in those receiving one-stage bilateral surgeries significantly reduced future contralateral recurrence without compromising patient safety.