Single-port thoracoscopic intrathoracic rib resection: a case description
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ABSTRACT:
SUBMITTER: Wang C
PROVIDER: S-EPMC9816731 | biostudies-literature | 2022 Oct
REPOSITORIES: biostudies-literature
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Project description:First rib resection is a surgical treatment for decompressing the neurovascular structures in thoracic outlet syndrome (TOS). Historically, extrathoracic approaches have used a posterior, supraclavicular, or transaxillary incision to remove the first rib. In this report, we demonstrate video-assisted thoracoscopic surgery for intrathoracic first rib resection (VATS-IFRR).Between 2009 and 2014, eight patients underwent VATS-IFRR for TOS. Surgery was performed through two 5-mm ports and one 10-mm port. Endoscopic graspers, a hook-type electrocautery probe, a long peapod intervertebral disc rongeur, and Kerrison punches were used. The types of disease, operative times, chest tube indwelling days, lengths of hospital stay after operation, perioperative complications, postoperative pain scale ratings, and postoperative symptom recurrence rates at provocation tests were reviewed. The surgical outcomes were compared to published outcomes of extrathoracic approaches and other VATS approaches.The eight patients (3 right ribs, 5 left ribs) exhibited neurogenic (1 patient), combined type (2 patients), arterial (4 patients), and venous type (1 patient) TOS. The mean operative time was 190 (range 155-310) minutes. No mortalities or major complications occurred. The mean chest tube indwelling duration was 6 (range 3-10) days, and the mean postoperative hospital stay was 9 (range 4-21) days. The mean immediate postoperative pain numeric rating scale (NRS) score was 2.7/10 (range 2-4). No recurrence was observed during follow-up (median 25.5 months, range 10-64 months) in any patient.VATS-IFRR was safe and had several advantages. Thus, VATS-IFRR is a minimally invasive surgical option suitable for treating selective cases of TOS.
| S-EPMC5542955 | biostudies-other
Project description:Single-port thoracoscopic surgery has widened the current minimally invasive surgical techniques toward more less invasive procedures in terms of reducing the number of incisions. However, the current status of oncologic outcome with this technique is not well known for lung cancer surgery. The purpose of this study is to evaluate the oncologic outcomes in early stage lung cancer for impact of the survival outcomes with our experience of conversion to a single-port approach from the conventional three-port approach.Retrospective data of patients who underwent thoracoscopic major lung resection for non-small cell lung cancer between January 2006 and June 2015 were analyzed. Patients' characteristics, perioperative outcomes, pathologic result, and postoperative follow-up data of thoracoscopic surgery were reviewed and surgical outcomes were compared between conventional three-port (n = 168), two-port (n = 68), and single-port thoracoscopic surgery (n = 203).Of the 203 single-port thoracoscopic surgeries, we performed 167 single-port thoracoscopic lobectomy and mediastinal lymph node dissections. During the learning period of each thoracoscopic approach, the mean operation time for single-port thoracoscopic surgery (189±62 min) was not significantly different from those of two-port (175±46 min) and three-port (195±75 min) thoracoscopic lobectomy (p = 0.165). Perioperative outcomes including drain indwelling time (p <0.001), complication (p = 0.185) and conversion event (p = 0.911) were not worsened during learning period with two-port. Midterm survival (p = 0.753) and recurrence free survival (p = 0.656) of single port thoracoscopic lobectomy showed acceptable results compared with two- and three-port approach.Single-port thoracoscopic surgery is safe and a feasible option for major lung resection in lung malignancy and this approach following experiences of two-port approach may yield similar oncologic results to those of conventional multi-port approach during thoracoscopic lobectomy.
| S-EPMC5685603 | biostudies-literature
Project description:IntroductionPain is still severe after single-port video-assisted thoracoscopic (SPVAT) lung wedge resection. We observed the effect of single-injection thoracic paravertebral block (TPB) via the intrathoracic approach for analgesia after SPVAT lung wedge resection.MethodsSixty patients undergoing SPVAT lung wedge resection were randomly divided into a control group and an observation group. All patients underwent TPB via the intrathoracic approach at the T4 level with a scalp needle before closing the chest. The patients in the observation group received 20 ml 0.375% ropivacaine at the T4 level, and the patients in the control group received 20 ml of 0.9% saline. A patient-controlled intravenous analgesic (PCIA) pump with sufentanil was attached to all patients after surgery. The sufentanil consumption and number of PCIA presses in the first 24 h after surgery were recorded. The visual analogue scale (VAS) scores (during rest and coughing) were recorded at 6 h, 12 h, 24 h, and 36 h after surgery. The incidence of adverse reactions after surgery were recorded.ResultsThe sufentanil consumption in the observation group was significantly lower than that in the control group (34.2 ± 1.9 µg vs. 52.3 ± 2.3 µg; P < 0.001). The VAS score at 6, 12, and 24 h after surgery, the incidence of adverse reactions after surgery in the observation group were significantly lower than those in the control group (all P < 0.05). The number of PCIA presses in the observation group was significantly lower than that in the control group [0 (0-0) times vs. 3 (2-4) times, P < 0.001].ConclusionsSingle-injection TPB via the intrathoracic approach under thoracoscopic direct vision is easy to perform and can effectively alleviate postoperative pain after SPVAT lung wedge resection, with fewer adverse reactions.Trial registrationChiCTR2000034726.
| S-EPMC8119565 | biostudies-literature
Project description:Thoracic outlet syndrome (TOS) is a rare condition resulting from the compression of the brachial plexus and/or the subclavian vessels in the thoracic outlet (TO). Neurogenic TOS (NTOS) is the most common form in up to 95% of the cases, while venous TOS (VTOS) occurs in 3-5% and arterial TOS (ATOS) in 1-2% of the cases. Patients may suffer from the pathologic coexistence of arterio-venous compression in the TO called arterio-venous TOS (AVTOS) with an overlap of clinical symptoms. While imaging studies such as computed tomography (CT)-angiography, magnetic resonance imaging (MRI)-angiography and duplex sonography are helpful to detect the underlying condition in vascular pathologies, electrodiagnostic testing is necessary to distinguish NTOS from other peripheral neuropathies. Subclavian vein (SV)-compression in the TO can result in venous thrombosis, called Paget-Schroetter syndrome (PSS), named after the discoverers of the disease. Besides oral anticoagulation in cases with venous upper extremity thrombosis and multimodal conservative treatment in the management of NTOS, surgical decompression is the current standard of care for TOS. Surgical decompression aims to remove structures compressing the brachial plexus or the subclavian vasculature in the TO. In NTOS, when conservative management has failed, surgical resection of the 1st or a cervical rib is often combined with scalenectomy and brachial plexus neurolysis. Minimally invasive techniques have replaced traditionally open supra-, infraclavicular or transaxillary approaches with excellent results and minimal morbidity. Video-assisted thoracoscopic surgery (VATS) was described to offer better visualization, shorter length of stay (LOS) and less neurovascular injuries attributable to less traction applied. Robotic-assisted thoracoscopic surgery (RATS) moreover, further improved magnification, angulation of the surgical instruments in narrow anatomical spaces and the comfort for the operating surgeon. Uniportal RATS (uRATS) has lately been applied for 1st rib resection. The aim of this surgical technique manual is to describe and illustrate a RATS 1st rib resection with its advantages over traditionally open approaches step by step.
| S-EPMC11565304 | biostudies-literature
Project description:BackgroundThe morbidity and mortality of lung cancer have always ranked first among malignant tumors (MTs). Previous studies have shown that neoadjuvant chemotherapy can improve the 5-year survival rate of patients with non-small cell lung cancer (NSCLC), but the benefit is limited. Studies have proven that neoadjuvant immunotherapy combined with chemotherapy has unique advantages in prolonging patient survival, reducing distant recurrence, and inducing antitumor immunity. However, its impact remains to be more comprehensively investigated.Case descriptionA 59-year-old male who was admitted to the hospital with a primary complaint of repeated cough and expectoration for 6 months. Preoperative assessment showed right upper lung squamous cell carcinoma with multiple hilar and mediastinal lymph node metastasis, and the clinical stage was cT2aN2M0 stage (IIIA). After three cycles of pembrolizumab + carboplatin + paclitaxel therapy were administered, the reexamination of the tumor was evaluated as partial response (PR), and a sleeve lobectomy of the right upper lung was performed under single-port thoracoscopic surgery. The operation proceeded smoothly without conversion to thoracotomy, and R0 resection was successfully achieved. Postoperative pathological stage was ypT1bN0M0 stage IA, and postoperative pathological remission was evaluated as major pathological response (MPR). After the operation, three cycles of immunotherapy combined with chemotherapy were completed, which was followed by maintenance therapy with pembrolizumab monotherapy for 1 year, and no signs of tumor recurrence and metastasis have been found in follow-up thus far.ConclusionsThrough this case, we believe that for locally advanced NSCLC sleeve lobectomy after neoadjuvant therapy may be a safe and feasible treatment option, can avoid pneumonectomy, protect the lung function of patients, and still ensure the R0 resection rate. Moreover, it may does not significantly increase the difficulty of surgical operation or reduce safety. However, further research is needed to confirm our conclusion. And then, neoadjuvant therapy in the perioperative period may induce a series of side effects or adverse reactions, and thus greater attention should be paid to its timely management.
| S-EPMC10938100 | biostudies-literature
Project description:IntroductionVideo-assisted thoracoscopic sleeve lobectomy is safe and feasible for lung cancer. We describe a case of video-assisted thoracoscopic sleeve lobectomy via a novel single intercostal space (SIC) three-port approach.ConclusionsThis case demonstrates that a SIC three-port thoracoscopic approach is effective in sleeve lobectomy, and possesses potential advantages in perioperative pain management and rehabilitation.
| S-EPMC5502186 | biostudies-literature
Project description:Sleeve lobectomy has solidified its position as a preferred alternative to pneumonectomy due to its significant advantage in preserving lung function, whereas right lower lobe sleeve lobectomy remains relatively uncommon because of the higher technical challenge. With the development of minimally invasive technology and experience acquired over the years, robot-assisted thoracoscopic surgery (RATS) has shown progress and distinct advantages compared to the traditional thoracotomy and video-assisted thoracoscopic surgery (VATS) approach. Owing to its 3D vision, bendable wrist joints, and tremor filtration capabilities, this surgical technique exhibits great advantages in complex thoracic operations demanding for reconstructive procedures compared to traditional thoracoscopic surgery. The Davinci Xi system has been employed in a substantial number of sleeve resections via a single-port approach. However, the Davinci Xi system was first designed for multi-port thoracic surgery, which poses challenges for adaptation to single-port surgery. Additionally, the newer Davinci SP system, with its 2.5 cm port diameter, cannot be inserted through an intercostal incision and can only be utilized for lung surgery via a subcostal incision, thus restricting its application in complex lung surgeries such as sleeve resection. Here we present a case report on a right lower sleeve lobectomy utilizing the innovative Shurui single-port robotic system which exhibits several advantages in the realm of lung surgery compared to traditional procedures.
| S-EPMC11635244 | biostudies-literature
Project description:Despite the advances in video-assisted thoracoscopic surgery (VATS), vascular reconstruction of the pulmonary artery (PA) is still infrequently performed by thoracic surgeons because of the technical difficulties and the increased operative risk during thoracoscopy. The few published reports have been performed by using 3-4 incisions. We present the first report of a pulmonary artery reconstruction procedure performed by a single-incision VATS technique. A 73-year old male patient was operated on by the thoracoscopic approach through a single 4-cm incision with no rib spreading. The postoperative recovery was uneventful.
| S-EPMC3805214 | biostudies-literature
Project description:BackgroundAimed to assess clinical effect of three-port inflatable robot-assisted thoracoscopic surgery in mediastinal tumor resection by comparing results of the robot group with the video group.MethodsRetrospectively analyze 179 patients diagnosed with anterior mediastinal tumor from May 2017 to August 2021. Two groups were divided according to the surgical approach, including 92 cases in the RATS group and 87 cases in the VATS group. The results were analyzed between two groups with variables of age, sex, BMI, tumor size, and diagnosis. Perioperative clinical data was gathered to compare.ResultThere were no significant differences between the 2 groups with regards to demographic data and clinical features. There were no significant differences inoperative time and duration of chest tube via RATS vs. VATS. The intraoperative blood loss was statistically significantly different among the RATS and VATS groups (75.9 ± 39.6 vs. 97.4 ± 35.8 ml p = 0.042). The postoperative stay of patients in RATS group were significantly shorter than that in VATS group (2.3 ± 1.0 vs. 3.4 ± 1.4 day p = 0.035), CONCLUSION: Three-port inflatable robot-assisted thoracoscopic surgery for mediastinal tumor is feasible and reliable it is more advantageous, and it provides the surgeon with advice on treatment choice.
| S-EPMC10962077 | biostudies-literature
Project description:Background: Intrathoracic ribs are very rare congenital anomalies, and often discovered incidentally on chest X-ray. Since its first description by Lutz in 1947, approximately 50 cases have been reported in the literature till date. The aim is to review the all reported intrathoracic ribs, summarize their clinical features, and propose a potential classification. Methods: All relevant literatures were searched and reviewed. The terms include intrathoracic rib, intrathoracic bifid rib, trans-thoracic rib and intrathoracic rib anomaly. We have summarized the first finding events, origination, distribution, related anomalies and imaging features of intrathoracic rib, and propose an updated classification. Results: The patients' age at initial finding was from six weeks to 79 years old. Of all, sixty percent was less than 30 years old. There was no difference in gender. Most of them were reported by authors in western countries (85.3%, 58/68), and incidental findings by radiologist and respiratory physician. The intrathoracic rib occurs more frequently on the right side, and is usually single and unilateral. According to the new classification, type I and II was account for 45.6% and 35.3%, respectively. Conclusion: Intrathoracic rib is rare findings in clinical practice. It is useful that radiologists or clinician are familiarized with the imaging appearances of these malformations. These anomalies reflect some disturbances during the embryo development, leading us to propose a potential classification that could contribute to a better understanding of this rib anomaly.
| S-EPMC8579300 | biostudies-literature