ObjectiveTo investigate the clinical value of three-dimensional reconstruction of liver and resection of hepatocellular carcinoma with indocyanine green (ICG) fluorescence staining. MethodsClinical data of a patient with hepatocellular carcinoma admitted to the Department of Liver Surgery of West China Hospital of Sichuan University in May 2021 were retrospectively collected. In this patient, intrahepatic vascular reconstruction was performed by SYNAPSE 3D software of Japan before operation, and the portal vein and hepatic vein corresponding to the tumor were analyzed to simulate the resection range. Intraoperative ICG fluorescence staining was used to perform laparoscopic resection of segment Ⅳ of the liver.ResultsIn this patient, the fluorescence boundary on the liver surface was clear after staining, and the intrahepatic segment fluorescence interface could still be maintained in the hepatic parenchyma dissociation, and the resection of the liver segment was consistent with the preoperative three-dimensional reconstruction plan. The operation took 230 min in total, and the bleeding was about 200 mL. On the first day after the operation, blood biochemical test showed that the plasma albumin was slightly low, and no obvious abnormalities were observed in transaminase, bilirubin, etc. After the infusion of human albumin, the indexes returned to normal, and the patient recovered and was discharged on the fourth day after the operation. No complications occurred after the operation, and no tumor recurrence and metastasis were observed during follow-up period. Conclusion3D reconstruction and ICG fluorescence guidance are safe and feasible for the treatment of hepatocellular carcinoma after laparoscopic anatomic segment Ⅳ resection, and the positive staining method of ICG fluorescence segment is recommended.
Objective To assess the safety and clinical outcomes of segmentectomy in one- or two-staged video-assisted thoracoscopic surgery (VATS) for bilateral lung cancer. MethodsWe retrospectively enrolled 100 patients who underwent VATS segmentectomy for bilateral lung cancer at the Department of Thoracic Surgery of Peking Union Medical College Hospital from December 2013 to May 2022. We divided the patients into two groups: a one-stage group (52 patients), including 17 males and 35 females with a mean age of 55.17±11.09 years, and a two-stage group (48 patients), including 16 males and 32 females with a mean age of 59.88±11.48 years. We analyzed multiple intraoperative variables and postoperative outcomes. Results All 100 patients successfully completed bilateral VATS, and at least unilateral lung received anatomical segmentectomy. Patients in the one-stage group were younger (P=0.040), had lower rate of comorbidities (P=0.030), were less likely to have a family history of lung cancer (P=0.018), and had a shorter interval between diagnosis and surgery (P=0.000) compared with patients in the two-stage group. Wedge resection on the opposite side was more common in the one-stage group (P=0.000), while lobectomy was more common in the two-stage group. The time to emerge from anesthesia in the one-stage group was longer than that in the first and second operations of the two-stage group (P=0.000, P=0.002). Duration of surgery and anesthesia were similar between two groups (P>0.05). Total number of lymph node stations for sampling and dissection (P=0.041) and lymph nodes involved (P=0.026) were less in the one-stage group. Intraoperative airway management was similar between two groups (P>0.05). The one-stage group was associated with lower activities of daily living (ADL) scores. Conclusion Segmentectomy is safe in one- or two-staged VATS for bilateral lung cancer, including contralateral sublobectomy and lobectomy. Duration of surgery and perioperative complications are similar between two groups, but the one-stage group is associated with lower ADL scores. On the basis of comprehensive consideration in psychological factors, physical conditions and personal wishes of patients, one-staged sequential bilateral VATS can be the first choice.
ObjectiveTo explore the curative effect of precise hepatectomy techniques in hepatolithus. MethodsTotally 132 patients underwent precise hepatectomy and 52 patients underwent irregular hepatectomy were retrospectively analyzed, and the intraoperative and postoperative indexes such as operation time, blood loss, postoperative complications, hospitalization time, clearance rate of calculus, and cost of hospitalization were analyzed. ResultsCompared with the patients in irregular hepatectomy group, although the operative time was longer in precise hepatectomy group 〔(364.6±57.8) min vs. (292.9±44.7) min, Plt;0.001〕, but the patients in precise hepatectomy group had less blood loss 〔(558.3±90.6) ml vs. (726.7±88.7) ml, Plt;0.001〕, less postoperative complications (11.4% vs. 23.1%，P=0.004 3), and higher clearance rate of calculus (89.4% vs. 73.1%, P=0.005 5). Thus, the patients in precise hepatectomy group had shorter hospital stay 〔(22.9±4.4) d vs. (28.8±3.5) d, Plt;0.001〕 and less cost of hospitalization 〔(1.8±0.7)×104 yuan vs. (2.1±0.9)×104 yuan, P=0.016 5〕. Conclusion Precise hepatectomy is better than irregular hepatectomy in treatment for hepatolithus.
ObjectiveTo investigate the clinical application value of laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein.MethodsClinical data of 8 patients who underwent laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein in Xinqiao Hospital from May 2017 to December 2019 were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative complications, and hospitalization duration were observed.ResultsAll patients were confirmed by pathology, the postoperative pathological results showed that: hepatocellular carcinoma was found in 6 patients, mixed hepatocellular carcinoma and cholangiocarcinoma was found in 2 patients. All patients completed the operation successfully without conversion to open surgery. The median operation time was 220 min (190-240 min), median blood loss was 230 mL (200-280 mL), and blood transfusion was not needed. The postoperative median hospital stay was 8 d (7–12 d). All the patients recovered well without severe complications. Eight patients were followed up for 10.5 to 31.7 months, with a median follow-up time of 16.9 months. During the follow-up period, none of them developed hemorrhage, bile leakage, and other complications. There was no reoperation or perioperative mortality during the follow-up.ConclusionsThe method of laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein is safe and effective. This method can shorten the operation time, improve the safety, and reduce the difficulty of operation.
Abstract： Objective To evaluate the safety and efficacy of total thoracoscopic anatomic pulmonary segmentectomy for the treatment of early-stage peripheral lung carcinoma, pulmonary metastases and benign pulmonary diseases. Methods We retrospectively analyzed 20 patients who received total thoracoscopic anatomic pulmonary segmentectomy in Zhongshan Hospital of Fudan University from March 2008 to November 2011. There were ten male and ten female patients with a mean age of 58.0（14-86）years. Three ports were used. The pulmonary artery and vein of the segment were dealt with Hem-o-lok or stapler. The bronchi of the segment were dealt with staplers. Staplers were used in peripheral lung of intersegmental plane. Results All the twenty patients underwent total thoracoscopic anatomic segmentectomy successfully without any conversion to thoracoctomy or lobectomy. No perioperative morbidity or mortality occurred. Postoperative pathological examinations showed lung cancer in 10 patients, pulmonary metastases in 3 patients and benign pulmonary diseases in 7 patients. The mean operative time was 133.0（90-240）min. The mean blood loss was 85.0（50-200）ml. The chest tubes were maintained in position for 3.2 （2-7） d. The mean postoperative hospitalization time was 6.7 （4-11）d. Conclusion Total thoracoscopic anatomic pulmonary segmentectomy is a feasible and safe technique to be used selectively for Ⅰa stage lung cancer, pulmonary metastases and benign pulmonary diseases that are not appropriate for wedge resection.
Abstract： The principles of 2010 National Comprehensive Cancer Network（NCCN） clinical practice guidelines in non-small cell lung cancer address that anatomic pulmonary resection is preferred for the majority of patients with non-small cell lung cancer and video-assisted thoracic surgery (VATS) is a reasonable and acceptable approach for patients with no anatomic or surgical contraindications. By reviewing the literatures on general treatment, pulmonary segmentectomy, pulmonary function reserve, and the anatomic issue of early stage non-small cell lung cancer surgery, the feasibility and reliability of thoracoscopic pulmonary segmentectomy are showed.
ObjectiveTo explore the safety and feasibility of the application of video-assisted thoracic surgery (VATS) anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis.MethodsFrom June 2014 to June 2018, 19 patients with bilateral localized bronchiectasis underwent single-stage bilateral thoracic surgery with VATS anatomic segmentectomy, including 11 males and 8 females aged 38.0±12.5 years. The clinical efficacy of the surgery was evaluated.ResultsAll surgeries were successfully completed, of which 17 were bilateral VATS, 2 were unilateral VATS with the other lateral converted to thoracotomy. The average number of bilateral resected segments was 4-8 (5.9±1.2). Mean operation time was 330.0±40.0 min and mean blood loss was 150.0±60.0 mL. Mean ventilator-assisted breathing time was 6.0±1.8 h, mean duration of chest-tube placement was 4.0±1.0 d and mean hospital stay time was 14.0±1.5 d. Three patients suffered pulmonary infection and 1 patient received tracheotomy. No perioperative death occurred. Arterial oxygen pressures on postoperative day (POD) 1 (F=340.18, P<0.05) and POD 3 (F=131.26, P<0.05) were significantly lower than that before operation, arterial carbon dioxide pressures on POD 1 (F=46.62, P<0.05) and POD 3 (F=48.21, P<0.05) were significantly higher than that before operation, and pulse oximeter saturation on POD 1 was significantly lower than that before operation (F=210.82, P<0.05). The patients were followed up for one to five years without recurrence.ConclusionApplication of VATS anatomic segmentectomy in single-stage bilateral thoracic surgery for the treatment of bilateral localized bronchiectasis is safe and feasible with strictly selected patients. Postoperative airway management is very important. The surgery is worthy of wide clinical practice.
Objective To evaluate the feasibility and safety of complete video-assisted thoracoscopic surgery （VATS）anatomic segmentectomy. Methods Clinical data of 26 patients with lung diseases who underwent complete VATS anatomic segmentectomy in the First Affiliated Hospital of Nanjing Medical University from November 2010 to July 2011 were retrospectively analyzed. There were 8 male and 18 female patients with their age of 13-81 （53.2±3.1） years. There were 23 patients with pulmonary nodules including 13 patients who underwent direct surgical resection and 10 patients with ground-glass opacity nodules （3 patients received preoperative localization and the other 7 patients received direct surgical resection）. All the 3 patients with non-nodule pulmonary diseases （bronchiectasis, pulmonary bulla and pulmonary cyst respectively） underwent direct surgical resection. Results All the 26 patients received complete VATS anatomic segme- ntectomy successfully. The operation time was 150-250 （193.7±7.3） min，and intraoperative blood loss was 10-200 （65.7±12.7） ml. Patients with lung cancer received 4-7 （5.1±0.3） stations of lymph node dissection and the number of lymph node dissection was 4-16 （12.3±0.5） for each patient. There was no in-hospital death or postoperative complication. Postoperative thoracic drainage time was 3-7 （3.9±0.4） days. All the patients were discharge uneventfully. Lung cancer patients were followed up for 3-6 months without recurrence or metastasis. Conclusion Complete VATS anatomic segmentectomy is a safe and feasible surgical procedure.
ObjectiveTo explore the efficacy of single-port thoracoscopic anatomical lung segmentectomy in treating Stage IA non-small-cell lung cancer (NSCLC) and to analyze its impact on the body's stress response and lung function. MethodsA retrospective analysis was conducted on the clinical data of patients with stageⅠA NSCLC admitted to the Second Affiliated Hospital, Air Force Military Medical University, from January 2021 to June 2022. Patients were divided into two groups based on their treatment plans: those who underwent single-port thoracoscopic lobectomy were in the lobe group, and those who underwent single-port thoracoscopic anatomical lung segmentectomy were in the segment group. The surgical-related indicators, complication rates, survival rates of the two groups were compared, as well as the body's stress response indicators before and after surgery [C-reactive protein (CRP), interleukin-6 (IL-6), cortisol (Cor), creatine kinase (CK)], prognostic lung function indicators [forced vital capacity (FVC), maximal voluntary ventilation (MVV), forced expiratory volume in one second (FEV1), FEV1/FVC ratio], and auxiliary tumor markers [carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), CA724, cyto-keratin 21-1 fragment (CYFRA21-1)]. ResultsEach group included 53 patients, with 29 males and 24 females in the segment group, with an average age of (70.38±3.67) years; and 26 males and 27 females in the lobe group, averaging an age of (71.09±3.80) years. The intraoperative blood loss in the segment group was less than that in the lobe group [(118.41±14.58) mL vs. (130.36±10.61) mL, P＜0.001], and the hospital stay was shorter in the segment group [(7.13±1.14) d vs. (8.52±1.33) d, P＜0.001]. One day and three days post-surgery, the serum levels of CRP, IL-6, Cor, and CK in the segment group were lower those in the lobe group, while the levels of FVC, FEV1, FEV1/FVC ratio, and MVV were higher (P＜0.05). One month and three months post-surgery, the serum levels of CEA, CA125, CA724, and CYFRA21-1 in the segment group showed no statistically significant difference compared to the lobe group (P＞0.05); the incidence of postoperative complications and survival rates in the segment group were 3.77% and 80.39%, respectively, while they were 7.55% and 76.92% in the lobe group, respectively, with no statistical difference between the two groups (P＞0.05). ConclusionSingle-port thoracoscopic anatomical lung segmentectomy for stage ⅠA NSCLC has significant advantages in reducing intraoperative damage, stabilizing the body's stress response, and has less impact on lung function, which is beneficial for postoperative recovery.