计算机辅助手术系统在胸腔镜肺结节切除术中的应用

目的:分析计算机辅助手术(CAS)系统在胸腔镜肺结节肺段切除术中的应用效果.方法:回顾分析2018年1月1日至2021年10月1日以肺结节入院行胸腔镜肺段切除术患者的临床资料,将患者分为实验组(n=96,应用CAS系统术前评估)与对照组(n=92,未应用CAS系统术前评估).对比分析两组手术效果.结果:两组年龄、性别、...     

Computed tomography-fluoroscopy guided injection of cyanoacrylate to mark a pulmonary nodule for thoracoscopic resection

Background: There have been several reports regarding aids to localize small and/or deeply situated peripheral pulmonary lesions thoracoscopically. However, we have found that they were not always reliable and have attempted to use a cyanoacrylate adhesive as an alternative.Method: We injected 0.1～0.2 ml of Histoacryl® (n-butyl-2-cyanoacrylate) blue through a 22 gauge long needle to the lung parenchyma immediately beneath the pleural surface that was nearest to the target nodule. Following local anesthesia of the thoracic wall, we inserted the needle tip to the desired position under CT-fluoroscopic guidance. After retracting the syringe piston to confirm that no blood was aspirated, we injected the adhesive and immediately removed the needle.Results: The adhesive polymerized immediately after its injection into the lung parenchyma to form a hard nodule. There was no complication except mild pneumothorax and slight pain at the puncture site. The adhesive nodule measured 1.0～1.5 cm in diameter and was hard enough to be easily located thoracoscopically in all the 8 patients/9 nodules studied. The nodule was also recognizable by its blue color visible under the pleura.Conclusion: CT-fluoroscopy guided injection of Histoacryl® blue provided a reliable marker for the localization of pulmonary nodules, especially in those patients with severe anthracosis in the pulmonary parenchyma.     

肺部小结节胸腔镜术前CT引导下硬化剂定位的临床应用价值

目的 探讨肺部小结节胸腔镜术前CT引导下注射硬化剂定位的临床应用价值.方法 2010年12月至2012年1月,27例患者,检出29枚孤立性肺结节,胸腔镜术前在CT引导下注射硬化剂(医用胶)定位后成功行胸胸腔镜下肺楔形切除术.结果 CT引导下注射医用胶定位成功率100％.定位时间(6.87±6.75)min,定位后无严重并发症,29枚小结节均成功定位后行胸腔镜下肺楔形切除术,无中转开胸于术,手术后均经病理确诊.结论 CT引导下注射硬化剂(医用胶)定位方法安全、可行,效果可靠.     

Complications of thoracoscopic pulmonary resection

Thoracoscopic strategies are becoming increasingly utilized in the management of patients with thoracic disease processes, including primary pulmonary malignancy, secondary pulmonary malignancy, granulomatous lung disease, and pleural processes. Although minimally invasive approaches have been demonstrated to improve outcomes and reduce complications, as compared to the conventional approach, the prevention, early recognition, and effective management of complications after thoracoscopic pulmonary resection are still critical factors in optimizing outcomes.     

Computed tomography-fluoroscopy guided injection of cyanoacrylate to mark a pulmonary nodule for thoracoscopic resection.

BACKGROUND: There have been several reports regarding aids to localize small and/or deeply situated peripheral pulmonary lesions thoracoscopically. However, we have found that they were not always reliable and have attempted to use a cyanoacrylate adhesive as an alternative. METHOD: We injected 0.1-0.2 ml of Histoacryl (n-butyl-2-cyanoacrylate) blue through a 22 gauge long needle to the lung parenchyma immediately beneath the pleural surface that was nearest to the target nodule. Following local anesthesia of the thoracic wall, we inserted the needle tip to the desired position under CT-fluoroscopic guidance. After retracting the syringe piston to confirm that no blood was aspirated, we injected the adhesive and immediately removed the needle. RESULTS: The adhesive polymerized immediately after its injection into the lung parenchyma to form a hard nodule. There was no complication except mild pneumothorax and slight pain at the puncture site. The adhesive nodule measured 1.0-1.5 cm in diameter and was hard enough to be easily located thoracoscopically in all the 8 patients/9 nodules studied. The nodule was also recognizable by its blue color visible under the pleura. CONCLUSION: CT-fluoroscopy guided injection of Histoacryl blue provided a reliable marker for the localization of pulmonary nodules, especially in those patients with severe anthracosis in the pulmonary parenchyma.     

Video-assisted thoracoscopic solitary pulmonary nodule resection after CT-guided hookwire localization: 43 cases report and literature review

Background  

Peripheral subpleural solitary pulmonary nodules can be visualized and resected easily at thoracoscopy, but it is very difficult to localize deep nonpalpable pulmonary nodules that lie in lung parenchyma. The purpose of this article was to study the effectiveness of video-assisted thoracoscopic solitary pulmonary nodules resection after computed tomography (CT)-guided hookwire localization and to review the literature related to solitary pulmonary nodule diagnosis and treatment.     

Video-assisted thoracoscopic resection for intralobar pulmonary sequestration

Video-assisted thoracoscopic treatment of intralobar pulmonary sequestration in an obese (120 kg, body mass index 42) young man is described. Two aberrant arteries originating from the descending thoracic aorta were transected with a vascular stapler, and a left lower lobectomy was successfully performed thoracoscopically. Three-dimensional chest computed tomography was used to identify the aberrant vessels. Video-assisted thoracoscopic lobectomy is useful and minimally invasive for treating pulmonary sequestration, especially in obese patients.     

Video-assisted thoracoscopic wedge resection for pulmonary sequestration

A 60-year-old woman underwent a video-assisted thoracoscopic wedge resection of intralobar pulmonary sequestration instead of a lobotomy because the lesion was localized in the right basal segment. Preoperative 3-dimensional computed tomography was useful for identifying an aberrant artery arising from the thoracic aorta and distributing to the lesion. A successful outcome more than 4 years after the surgery indicates that a wedge resection under video-assisted thoracoscopy may prove to be a therapeutic option for localized pulmonary sequestration.     

局部麻醉下电视胸腔镜肺切除术的探讨

目的 研究局麻下电视胸腔镜肺切除术的可行性。方法 自2000年2月至12月,对8例患(周围型肺小结节病变6例,间质性肺病2例)在局麻下实施电视胸腔镜手术。结果 1例因胸腔内致密粘连转行全麻开胸手术,其余均在局麻下完成肿物切除。术中病理诊断为结核3例,转移癌及炎性假瘤各1例,肺间质纤维化2例。手术时间40～200min。无术后并发症和死亡。手术花费平均5400元。结论 局麻下经胸腔镜进行肺部分切除术可行。该方法对麻醉要求低、经济、微创。     

Sublobar resection for the subcentimeter pulmonary nodule

Several studies have demonstrated an increased local recurrence rate with sublobar resection (SR) when compared with lobar resection for the treatment of non-small-cell lung cancer (NSCLC). Therefore, lobectomy has remained the gold standard therapy for NSCLC with lesser resection reserved as a compromise operation for high-risk patients. The increased identification of small NSCLC tumors by CT scan is leading many surgeons to question the appropriateness of lobectomy for these tumors. There has been increasing interest by many surgeons to use SR as intentional therapy for patients with small peripheral NSCLC. This article reviews the recent literature and evidence supporting intentional SR for NSCLC. Although lobectomy should continue to be regarded as the procedure of choice for NSCLC, we believe that a subset of patients with favorable characteristics may be appropriately treated with intentional SR as long as good assessment of nodal involvement is made. Future investigation is required to better define when SR is appropriate.     

胸腔镜与常规开胸切除孤立性肺结节的比较

目的 比较电视胸腔镜手术(Video—assisted thoraeoscopic surgery，VATS)与常规开胸手术切除孤立性肺结节(Soli-tary pulmonary nodule，SPN)的临床效果。方法 回顾分析65例SPN施行肺楔形切除术的临床资料，其中20例行VATS(VATS组)，45例常规开胸手术(开胸组)。结果 所有病例均顺利完成肺楔形切除术。VATS组的手术时间(t=-5．326，P=0．000)、留置胸腔引流管时间(t=-4．935，P=0．000)和术后住院时间(t=-4．995，P=0．000)比开胸组明显缩短。而失血量明显减少(t=-18．633，P=0．000)。两组SPN性质(X^2=2．251，P=0．945)，住院总费用(t=-0．169，P=0．866)无统计学差异。两组无手术死亡，无术中、术后严重并发症发生。结论 电视胸腔镜下肺楔形切除术是诊治SPN的有效方法，具有手术时间短、出血少、恢复时间短等优点，不增加住院费用和术中、术后并发症。     

Therapeutic video-assisted thoracoscopic surgical resection of colorectal pulmonary metastases

Objective: Careful patient selection is vital when video-assisted thoracoscopic surgical (VATS) therapeutic pulmonary metastasectomy of colorectal carcinoma is considered. Complete resection of all metastatic disease remains a vital concept. We reviewed our VATS experience for therapeutic metastasectomy of peripheral colorectal pulmonary metastases. Methods: Over 90 months, therapeutic VATS metastasectomy was accomplished upon 80 patients with colorectal metastases. Thin cut computed tomography (CT) was central in identifying lesions. The mean interval from primary carcinoma to VATS resection was 41 months (1–156 months; median, 33). A solitary lesion was resected in 60 patients and multiple (2–7) lesions resected in 20 patients. Statistics were obtained using the Student's t-test. Results: No operative mortality or major postoperative complications occurred. The hospital stay was 4.5±2.2 days (range, 1–13). All lesions were resected by VATS, with four conversions to thoracotomy to improve the margins. The mean survival of patients with one lesion was 34.8 months compared with 26.5 months for patients with multiple lesions (P=0.37). The mean survival was 20.5 months when metastases occurred <3 years vs. 28.1 months for >3 years from primary carcinoma resection (P=0.20). Twenty-five (31%) patients are disease free; with a mean interval of 38.7 (3–84; median, 35) months. Sixty-nine percent (55/80) of patients developed a recurrence: 6/80 (8%) local; 19/80 (24%) regional (same hemithorax away from resection); and 30/80 (38%) distant. The overall survival at 1 year was 81.2%, 48.4% at 3 years and 30.8% at 5 years. Conclusions: Therapeutic VATS resection of colorectal metastases appears efficacious. Preoperative CT can identify peripheral colorectal metastases amenable to VATS. Conversion to thoracotomy is indicated when none of the lesions identified by CT are found or when clear surgical margins are jeopardized.     

A strategy for thoracoscopic resection of small pulmonary nodules

BACKGROUND: Preoperative procedures are often necessary to localize pulmonary nodules during thoracoscopic resection in order to reduce the necessity of resorting to thoracotomy. The aim of this report is to describe the strategy we developed to limit preoperative techniques without reducing the thoracoscopic success rate of localization.METHODS: Between January 2000 and December 2003, 183 patients underwent video thoracoscopic resection of small pulmonary nodules. The patients were divided into two groups on the basis of the radiological features of the nodule. The subjects in group 1 were operated on directly, and endothoracic ultrasonography was performed when necessary. The subjects in group 2 underwent preoperative radionuclide labeling of the nodule. RESULTS: In group 1, 112 out of 119 nodules (94%) were localized. Twenty-five out of 32 lesions, neither visible nor palpable, were found by endothoracic ultrasonography. In group 2, we localized 62 out of 64 nodules (97%). CONCLUSIONS: Currently, we cannot completely avoid preoperative labeling techniques for thoracoscopic resection of small pulmonary nodules. However, correct patient selection may limit this necessity, without an increased conversion rate to thoracotomy, if endothoracic ultrasonography is available.     

Laser application enables awake thoracoscopic resection of pulmonary nodules with minimal access

Background  

Thoracoscopic resection of indeterminate pulmonary nodules is most commonly performed through three trocars using an endoscopic stapler. We assessed the safety, feasibility, and results of laser resection via minimal access under only local anesthesia.     

Management of the solitary pulmonary nodule: directed resection

The primary goals in management of a solitary pulmonary nodule are: 1) early detection and treatment of lung cancer at a curable stage; 2) avoidance of unnecessary surgery for benign lesions; 3) efficient, economic use of resources in distinguishing between benign and malignant lesions. Management depends on the nature of the nodule, the nature of the patient, and the approach of the physician or surgeon who assumes responsibility for further evaluation and treatment of the solitary pulmonary nodule. By combining appropriate diagnostic studies, and close personal attention, unnecessary excision of benign nodules can be kept to a minimum, patient anxiety allayed and excision of cancers undertaken with appropriate staging and without compromise of outcome.     

Planned pulmonary resection for metastatic pulmonary tumor with video-assisted thoracoscopic surgery using multidetector row angiography

Purpose  

For video-assisted thoracic surgery (VATS) on metastatic pulmonary tumors, wedge resection using an endo-stapler is the standard procedure in many institutions. However, this procedure can miss lesions or compromise surgical margins, particularly with small, deep lesions. The planned pulmonary resection in this study is a surgical method for pulmonary resection aimed at a previously assigned pulmonary area. We determine the pulmonary area for anatomical or nonanatomical resection before surgery on the basis of tumor location in relation to the anatomical distribution of pulmonary vessels.     

VATS intraoperative tattooing to facilitate solitary pulmonary nodule resection

Introduction  

Video-assisted thoracic surgery (VATS) has become routine and widely accepted for the removal of solitary pulmonary nodules of unknown etiology. Thoracosopic techniques continue to evolve with better instruments, robotic applications, and increased patient acceptance and awareness.