[Video-assisted thoracic surgery : A global development]

Comparison of thoracoscopy-guided thoracic paravertebral block and patient-controlled intravenous analgesia for postoperative analgesia after uniportal thoracoscopic pulmonary wedge resection: a prospective randomized controlled trial

Introduction

Patients often experience persistent, intense pain following uniportal thoracoscopic pulmonary wedge resection (UTPWR). This pain is usually intervened with patient-controlled intravenous analgesia (PCIA) or thoracoscopic-guided thoracic paravertebral block (TG-TPB), a novel peripheral nerve block technique. Herein, we compared the analgesic effects of TG-TPB and PCIA post-UTPWR.

Methods

Sixty patients allocated into two groups: T and P. Group T patients were administered TG-TPB with 20 mL 0.375% ropivacaine at the fourth intercostal plane before sealing the chest, and connected to a PCIA pump containing 0.9% sodium chloride (NaCl). Group P patients received TG-TPB with 20 mL 0.9% NaCl and were connected to a PCIA pump containing sufentanil. The Visual Analogue Scale (VAS) scores were recorded at 2, 6, 12, 24, 36, and 48 h postoperatively. Data on sufentanil consumption, number of PCIA presses, number of rescue analgesia interventions, adverse reactions (ARs), and the 15-item Quality of Recovery Scale (QoR-15) scores were also recorded within 24 h postoperatively.

Results

Compared to the P group, the T group showed lower VAS scores at 2, 6, 12, and 24 h postoperatively, as well as lower sufentanil consumption levels, number of PCIA presses, number of rescue analgesia interventions, and ARs incidences within 24 h postoperatively (all p < 0.05). Furthermore, the T group showed higher QoR-15 scores within 24 h postoperatively than the P group (90.5 ± 7.3 vs. 76.6 ± 6.2; p < 0.001).

Conclusion

Compared to PCIA, TG-TPB exerted a better analgesic effect post-UTPWR, with less opioid drug use, fewer ARs, and a significantly better recovery quality within 24 h postoperatively.

Clinical trial registration

https://www.chictr.org.cn/, ChiCTR2000034726.

Comparison of thoracoscopic-guided intercostal nerve block and ultrasound-guided intercostal nerve block in postoperative analgesia of uniportal video-assisted lobectomy: a pilot randomized controlled trial

BACKGROUND

Ultrasound-guided intercostal nerve block (UINB) and thoracoscopic-guided intercostal nerve block (TINB) are often used for analgesia after thoracic surgery. Herein, we compared the application of TINB and UINB for analgesia after uniportal video-assisted lobectomy.

METHODS

Sixty patients were randomly allocated into two groups: UINB and TINB. The surgical time of intercostal nerve block (INB), the success rate of the first needle, visual analog scale (VAS) scores, the time of the first patient-controlled intravenous analgesia (PCIA) press, the time for removing the thoracic drainage tube, consumption of sufentanil and the number of PCIA presses within 24 hours postoperatively, and adverse reactions (ARs) were compared between the two groups.

RESULTS

The surgical time of INB was significantly shorter in the TINB group than in the UINB group ( P < 0.001). The time of the first press of PCIA was significantly earlier in the TINB group than in the UINB group ( P < 0.001). The success rate of the first needle was significantly higher in the TINB group than in the UINB group ( P < 0.001). No significant differences were observed between the two groups regarding VAS scores, time for removing the thoracic drainage tube, the consumption of sufentanil, the number of PCIA presses within 24 hours postoperatively, and ARs.

CONCLUSION

TINB and UINB have similar analgesic effects after uniportal video-assisted lobectomy. However, TINB demonstrates shorter surgical time and a higher success rate than UINB.

Comparison of postoperative pulmonary complications and intraoperative safety in thoracoscopic surgery under non-intubated versus intubated anesthesia: a randomized, controlled, double-blind non-inferiority trial

PURPOSE

Traditional anesthesia for video-assisted thoracoscopy (VATS) such as double-lumen tracheal intubation (DLT) and one-lung ventilation (OLV), may lead to post-operative pulmonary complications (PPCs). Non-intubation VATS (NIVATS) is an anesthetic technique that avoided DLT and OLV, maybe avoiding the PPCs. So we hypothesized that NIVATS would non-inferiority to intubation VATS (IVATS) in the risk of developing PPCs and some safety indicators.

METHODS

This study is a randomised, controlled, double-blind, non-inferiority trial, 120 patients were randomly assigned to the NIVATS group and IVATS group according to 1:1. The primary outcome was the incidence of PPCs with a pre-defined non-inferiority margin of 10%. The second outcome was the safety indicators, including the incidence of cough/body movement, hypoxemia, malignant arrhythmia, regurgitation and aspiration, and transferring to endobronchial intubation intraoperatively (The malignant arrhythmia was defined as an arrhythmia that caused hemodynamic disturbances in a short period of time, resulting in persistent hypotension or even cardiac arrest in the patient).

RESULTS

There was no significant difference in demographic indicators such as gender and age between the two groups. The incidence of PPCs in the NIVATS group was non-inferior to that in the IVATS group (1.67% vs. 3.33%, absolute difference: - 1.67%; 95%CI - 7.25 to 3.91). In additionan, no significant differences were found between the two groups for the incidence of cough/body movement (10.00% vs. 11.67%, p = 0.77), the incidence of hypoxemia (25% vs. 18.33%, p = 0.38), the incidence of malignant arrhythmia (1.67% vs. 6.67%, p = 0.36), the incidence of regurgitation and aspiration (0% vs. 0%, p > 0.999) and the incidence of transferring to endobronchial intubation intraoperatively (0% vs. 0%, p > 0.999).

CONCLUSION

We conclude that when using the non-intubation anesthesia for VATS, the incidence of PPCs was not inferior to intubation anesthesia. Furthermore, NIVATS had little effect on perioperative safety.

Comparison of postoperative analgesia by thoracoscopic-guided thoracic paravertebral block and thoracoscopic-guided intercostal nerve block in uniportal video-asssited thoracic surgery: a prospective randomized controlled trial

BACKGROUND

Thoracoscopic-guided thoracic paravertebral nerve block (TG-TPVB) and thoracoscopic-guided intercostal nerve block (TG-INB) are two postoperative analgesia technology for thoracic surgery. This study aims to compared the analgesic effect of TG-TPVB and TG-INB after uniportal video-asssited thoracic surgery (UniVATS).

METHODS

Fifty-eight patients were randomly allocated to the TG-TPVB group and the TG-INB group. The surgical time of nerve block, the visual analog scale (VAS) scores, the consumption of sufentanil and the number of patient-controlled intravenous analgesic (PCIA) presses within 24 h after surgery, the incidence of adverse reactions were compared between the two groups.

RESULTS

The VAS scores were significantly lower during rest and coughing at 2, 6, 12, and 24 h in the TG-TPVB group than in the TG-INB group (P < 0.05). The consumption of sufentanil and the number of PCIA presses within 24 h after surgery were significantly lower in the TG-TPVB group than in the TG-INB group (P < 0.001).The surgical time of nerve block was significantly shorter in the TG-TPVB group than in the TG-INB group (P < 0.001). The incidence of bleeding at the puncture point was lower in the TG-TPVB group than that in the TG-INB group (P < 0.05).

CONCLUSION

TG-TPVB demonstrated superior acute pain relieve after uniVATS, shorter surgical time and non-inferior adverse effects than TG-INB.

Comparison of Thoracoscopy-Guided Thoracic Paravertebral Block and Ultrasound-Guided Thoracic Paravertebral Block in Postoperative Analgesia of Thoracoscopic Lung Cancer Radical Surgery: A Randomized Controlled Trial

INTRODUCTION

Ultrasound-guided thoracic paravertebral block (UTPB) is widely used for postoperative analgesia in thoracic surgery. However, it has many disadvantages. Thoracoscopy-guided thoracic paravertebral block (TTPB) is a new technique for thoracic paravertebral block (TPB). In this study, we compared the use of TTPB and UTPB for pain management after thoracoscopic radical surgery for lung cancer.

METHODS

In total, 80 patients were randomly divided 1:1 into the UTPB group and the TTPB group. The surgical time of TPB, the success rate of the first puncture, block segment range, visual analog scale (VAS) scores at 2, 6, 12, 24, and 48 h post operation, and the incidence of postoperative adverse reactions were compared between the two groups.

RESULTS

The surgical time of TPB was significantly shorter in the TTPB group than in the UTPB group (2.2 ± 0.3 vs. 5.7 ± 1.7 min, t = - 12.411, P < 0.001). The success rate of the first puncture and the sensory block segment were significantly higher in the TTPB group than in the UTPB group (100% vs. 76.9%, χ2 = 8.309, P < 0.001; 6.5 ± 1.2 vs. 5.1 ± 1.3 levels, t = - 5.306, P < 0.001, respectively). The VAS scores were significantly higher during rest and coughing at 48 h post operation than at 2, 6, 12, and 24 h post operation in the TTPB group. The VAS scores were significantly lower during rest and coughing at 12 and 24 h post operation in the TTPB group than in the UTPB group (rest: 2.5 ± 0.4 vs. 3.4 ± 0.6, t = 7.325, P < 0.001; 2.5 ± 0.5 vs. 3.5 ± 0.6, t = 7.885, P < 0.001; coughing: 3.4 ± 0.6 vs. 4.2 ± 0.7, t = 5.057, P < 0.001; 3.4 ± 0.6 vs. 4.2 ± 0.8, t = 4.625, P < 0.001, respectively). No significant difference was observed in terms of postoperative adverse reactions between the two groups.

CONCLUSIONS

Compared with UTPB, TTPB shows advantages, such as simpler and more convenient surgery, shorter surgical time, a higher success rate of the first puncture, wider block segments, and superior analgesic effect. TTPB can effectively reduce postoperative pain due to thoracoscopic lung cancer radical surgery.

TRIAL REGISTRATION

https://www.chictr.org.cn , identifier ChiCTR2300072005, prospectively registered on 31/05/2023.

Experience of a modified chest tube suture-fixation technique in uniportal thoracoscopic pulmonary resection

OBJECTIVE

This study aimed to explore the feasibility and advantages of a modified chest tube suture-fixation technique in uniportal video-assisted thoracic surgery for pulmonary resection.

METHODS

A retrospective analysis was conducted on 116 patients who underwent uniportal video-assisted thoracic surgery (U-VATS) for lung diseases in Zhengzhou People's Hospital between October 2019 and October 2021. Patients were stratified into two groups based on the applied suture-fixation methods, i.e., 72 patients in the active group and 44 patients in the control group. The two groups were subsequently compared in the terms of gender, age, operation method, indwelling time of chest tube, postoperative pain score, chest tube removal time, wound healing grade, length of hospital stay, incision healing grade, and patient satisfaction.

RESULTS

There was no significant difference between the two groups in terms of gender, age, operation method, indwelling time of chest tube, postoperative pain score, and length of hospital stay (P = 0.167, 0.185, 0.085, 0.051, 0.927, and 0.362, respectively). However, the chest tube removal time, incision healing grade, and incision scar satisfaction in the active group were significantly better compared with those of the control group (P = < 0.001, 0.033, and < 0.001, respectively).

CONCLUSION

In summary, the new suture-fixation approach can minimize the number of stitches, and time necessary for chest tube removal process, and avoid the pain experienced when removing the drainage tube. This method is more feasible, has better incision conditions, and provides a convenient tube removal, making it more suitable to patients.

Circulating tumour cells and circulating cell-free DNA in patients with lung cancer: a comparison between thoracotomy and video-assisted thoracoscopic surgery

INTRODUCTION

The type of lung cancer surgery impacts on tumour manipulation during surgery and may drive dissemination of cancer cells into the vasculature, thus facilitating metastatic spread. The aim of this study was to investigate the impact of surgically induced trauma using peripheral blood from preoperative and postoperative patients with non-small cell lung cancer (NSCLC) undergoing thoracotomy or video-assisted thoracoscopic surgery (VATS) resection.

METHODS

Imaging flow cytometry was used to measure circulating cancer-associated cells (CCs). Circulating cell-free DNA (ccfDNA) isolation was performed using Promega dsDNA HS Assay Kit. DNA integrity measurements were calculated by the ALU247 to ALU115 ratio and cytokine levels measured using the Luminex screening assay.

RESULTS

CCs were increased in postoperative blood samples in 54 patients with NSCLC. Patients who underwent thoracotomy instead of VATS had higher numbers of EpCAM (p=0.004) and PanCK-labelled (p=0.03) CCs postoperatively. ccfDNA and DNA integrity index were also significantly increased in postoperative samples (p=0.0009 and p=0.04), with concomitant increase in interleukin 6 and interleukin 10 levels in the same cohorts (p=0.0004 and p=0.034, respectively).

CONCLUSIONS

In this study we have shown the potential clinical utility of several biomarkers from liquid biopsies to guide perioperative management, as well as provide a snapshot of the type of surgical resection in terms of circulating tumour cell release. Obtaining reliable readouts from blood can provide crucial information for disease progression, as well as being of prognostic value monitoring patients' response to treatment.

[Robot-assisted thoracic surgery-Areas of application and limitations]

The proportion of robot-assisted thoracic surgery (RATS) is continuously increasing. The main areas of clinical application are anatomical lung resections with lymphadenectomy and resection of mediastinal tumors. Especially in the area of the thymus robot-assisted procedures can now be considered the gold standard. Overall, the limitations of video-assisted thoracoscopic surgery (VATS) can be overcome by the use of robot-assisted surgery and thus a larger proportion of patients can be treated with minimally invasive procedures. The safety of the RATS procedure has been repeatedly demonstrated, although it remains difficult to demonstrate scientifically measurable benefits. With the introduction of new systems on the market further technical evolution and improvement can be expected in the future.

Effect of Single-Injection Thoracic Paravertebral Block via the Intrathoracic Approach for Analgesia After Single-Port Video-Assisted Thoracoscopic Lung Wedge Resection: A Randomized Controlled Trial

Introduction

Pain 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.

Methods

Sixty 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.

Results

The 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].

Conclusions

Single-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 Registration

ChiCTR2000034726.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40122-020-00231-y.

[Application of artificial intelligence in thoracic surgery]

BACKGROUND

The application of artificial intelligence is a relatively new option to enable improved patient treatment in modern medicine and is therefore currently the focus of many research projects. In the clinical practice the application of artificial intelligence so far seems to be confined to the analysis of medical imaging.

OBJECTIVE

In which form is the use of artificial intelligence possible in routine daily work in thoracic surgery and is already being practiced?

MATERIAL AND METHODS

A search of the currently available literature was performed.

RESULTS

Under current conditions artificial intelligence can best be used as part of diagnostics and treatment planning; however, in order to enable a comprehensive use standardization and evaluation of the centralized data collection are necessary.

CONCLUSION

At the present time promising study results are available but the implementation into the surgical routine has so far been very difficult.