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Nii K, Igai H, Numajiri K, Ohsawa F, Kamiyoshihara M. Uniportal thoracoscopic mediastinal lymphadenectomy using appropriate surgical steps. J Thorac Dis 2024; 16:321-332. [PMID: 38410588 PMCID: PMC10894416 DOI: 10.21037/jtd-23-1350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/24/2023] [Indexed: 02/28/2024]
Abstract
Background Although lymphadenectomies play an important role in the surgical treatment of patients with non-small cell lung cancer (NSCLC), the quality of lymphadenectomies via a uniportal approach has only been evaluated in a few studies. We describe the surgical steps for a mediastinal lymphadenectomy via uniportal video-assisted thoracoscopic surgery (uVATS) and compare the quality of mediastinal lymphadenectomies using uVATS versus multiportal video-assisted thoracoscopic surgery (mVATS). Methods Between April 2017 and January 2023, we analyzed data from 304 patients with NSCLC who underwent (bi-)lobectomy with nodal dissection (ND)2a-1 or greater lymphadenectomy via uVATS or mVATS. We compared patient characteristics and perioperative results, including the number of harvested lymph nodes (LNs), between the two approaches. In addition, the factors associated with N-upstage were identified. Results No significant differences in the total number of harvested LNs were detected between the two approaches. Significantly more LN#2R/4R zone LNs were harvested in the uVATS group compared with the number harvested in the mVATS group [uVATS group: 8.5, interquartile range (IQR), 5-12.3; mVATS group: 7, IQR, 5-9, P=0.0177], while no significant differences in total nodes or nodes harvested in other zones were detected. Multivariable analysis revealed that pathologic invasion size [odds ratio: 1.0200, 95% confidence interval (CI): 1.0100-1.0400, P=0.0050], but not approach (uVATS, odds ratio: 0.6240, 95% CI: 0.3160-1.2300, P=0.1750), significantly contributed to N factor upstages. Conclusions The use of appropriate surgical steps enabled us to achieve similar quality lymphadenectomies via mVATS or uVATS.
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Affiliation(s)
- Kazuhito Nii
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Kazuki Numajiri
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
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Hamanaka K, Miura K, Eguchi T, Shimizu K. Harnessing 3D-CT Simulation and Planning for Enhanced Precision Surgery: A Review of Applications and Advancements in Lung Cancer Treatment. Cancers (Basel) 2023; 15:5400. [PMID: 38001660 PMCID: PMC10670431 DOI: 10.3390/cancers15225400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/05/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
The clinical application of three-dimensional computed tomography (3D-CT) technology has rapidly expanded in the last decade and has been applied to lung cancer surgery. Two consecutive reports of large-scale prospective clinical trials from Japan and the United States have brought a paradigm shift in lung cancer surgery and may have led to a rapid increase in sublobar lung resections. Sublobar resection, especially segmentectomy, requires a more precise understanding of the anatomy than lobectomy, and preoperative 3D simulation and intraoperative navigation support it. The latest 3D simulation software packages are user-friendly. Therefore, in this narrative review, we focus on recent attempts to apply 3D imaging technologies, particularly in the sublobar resection of the lung, and review respective research and outcomes. Improvements in CT accuracy and the use of 3D technology have advanced lung segmental anatomy. Clinical applications have enabled the safe execution of complex sublobar resection through a minimally invasive approach, such as video-assisted thoracoscopic surgery and robotic surgery. However, currently, many facilities still render 3D images on two-dimensional monitors for usage. In the future, it will be challenging to further spread and advance intraoperative navigation through the application of 3D output technologies such as extended reality.
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Affiliation(s)
- Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
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Bertolaccini L, Mohamed S, Diotti C, Uslenghi C, Cara A, Chiari M, Casiraghi M, Spaggiari L. Differences in selected postoperative outcomes between simple and complex segmentectomies for lung cancer: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107101. [PMID: 37778194 DOI: 10.1016/j.ejso.2023.107101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to synthesize the evidence on the preoperative characteristics, operative outcomes, and postoperative complications of simple and complex segmentectomy for lung cancer. METHODS A systematic review of EMBASE (through Ovid), MEDLINE (via PubMed), and Cochrane CENTRAL (January 1990 - January 2023) was done. We included studies to compare simple versus complex segmentectomies for lung cancer in terms of characteristics and operative and postoperative outcomes. RESULTS There was a statistically significant difference regarding higher operative time in favor of simple segmentectomies (Mean Difference, MD = 15.76, 95% Confidence Interval, CI: 2.46 - 29.07, p = 0.02). The incidence of postoperative complications did not change between the two groups (Risk Ratio, RR = 0.86, 95% CI: 0.66 - 1.13, p = 0.27). There were no significant differences regarding postoperative length of hospital stay between simple or complex segmentectomies (MD = -0.02, 95% CI: 0.56 - 0.51, p = 0.93). CONCLUSIONS Simple and complex segmentectomies have comparable postoperative outcomes; in particular, postoperative complication rates and length of hospital stay were similar. Complex segmentectomies were associated with a longer operative time.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Shehab Mohamed
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Cristina Diotti
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Clarissa Uslenghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Cara
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Chiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Moon MH. Beyond the limits: journey to feasible and safe uniportal VATS surgery for lung cancer. J Thorac Dis 2023; 15:246-249. [PMID: 36910107 PMCID: PMC9992570 DOI: 10.21037/jtd-22-1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Mi Hyoung Moon
- Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea
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Li B, Zou Z, Zhang W, Bian H, Li Y. Clinical application of bronchial high-frequency ventilation in 2-port thoracoscopic segmentectomy. Medicine (Baltimore) 2022; 101:e31611. [PMID: 36316920 PMCID: PMC9622583 DOI: 10.1097/md.0000000000031611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the safety and clinical application of a computer-aided surgery system (CAS) combined with high-frequency bronchial ventilation in 2-port thoracoscopic anatomical segmentectomy. A total of 301 patients who underwent 2-port thoracoscopic segmentectomy between January 1, 2019 and March 1, 2022 in the 960th Hospital of the People's Liberation Army and the Department of Thoracic Surgery of Zibo Municipal Hospital were retrospectively analyzed. The experimental and control groups were created according to the different methods of appearing the intersegmental plane of the lung. The experimental group comprised 152 patients who underwent CAS reconstruction combined with high-frequency ventilation, and the control group comprised 149 patients who underwent CAS reconstruction combined with expansion collapse. The characteristics of the patients, including age, sex, smoking history, forced expiratory volume in 1 second/forced vital capacity, Maximal ventilation, diameter of pulmonary nodules, intraoperative blood loss, postoperative drainage volume, drainage tube removal time, length of hospital stay after extubation, postoperative complication rate, operation time and appearance time of the intersegmental plane, were compared between the 2 groups. All patients completed the operation between high-frequency bronchial ventilation and expansion collapse group. There was no significant difference in Forced expiratory volume in 1 second/Forced vital capacity [(101.05 ± 11.86) vs (101.86 ± 11.61)], maximum expiratory volume [(86.36 ± 17.59 L) vs (85.28 ± 17.68 L)], the diameter of lung nodules [(13.61 ± 3.51 cm) vs (13.21 ± 3.41 cm)], intraoperative blood loss [(47.50 ± 45.90 mL) vs (48.49 ± 34.65 mL)], postoperative drainage volume [(425.16 ± 221.61 mL) vs (444.70 ± 243.72 mL)], drainage tube removal time [(3.88 ± 1.85 days) vs (3.43 ± 1.81 days)], or postoperative hospital stay [(6.07 ± 2.14 days) vs (5.82 ± 1.88 days) between the experimental group and the control group (P > .05)]. There were significant differences in operation time [(95.05 ± 26.85 min) vs (117.85 ± 31.70 min), P = .017] and intersegmental plane appearance time [(2.37 ± 1.03 min) vs (14.20 ± 3.23 min), P < .001]. High-frequency bronchial ventilation is safe and feasible when used in quickly and accurately identifying the intersegmental plane and is worthy of clinical application in 2-port thoracoscopic segmentectomy.
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Affiliation(s)
- Bing Li
- Weifang Medical College, Shandong Province, China
- Zibo Municipal Hospital, Shandong Province, China
- The 960th Hospital of the joint Service Surport Force of the Chinese People’s Liberation Army, Shandong Province, China
| | - Zhiqiang Zou
- The 960th Hospital of the joint Service Surport Force of the Chinese People’s Liberation Army, Shandong Province, China
| | - Wei Zhang
- Zibo Municipal Hospital, Shandong Province, China
| | - Hongchun Bian
- The 960th Hospital of the joint Service Surport Force of the Chinese People’s Liberation Army, Shandong Province, China
| | - Yucai Li
- Zibo Municipal Hospital, Shandong Province, China
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Luo T, Chen Q, Zeng J, Cai L, Huang X. Dorsal incision shows more efficacy and safety to traditional incision in single-portal video-assisted thoracoscopic surgery segmentectomy of LS9+10: a non-randomized prospective clinical trial. J Thorac Dis 2022; 14:4073-4080. [PMID: 36389335 PMCID: PMC9641346 DOI: 10.21037/jtd-22-1202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Segmentectomy is increasingly performed as a surgical technique. Traditional anterior axillary line and mid-axillary line video-assisted thoracoscopic surgery (VATS) incision meets difficulties when dealing with left segment 9+10 (LS9+10), as the distance and angle of view make it uneasy to expose the trachea, blood vessels and intersegment plane. As an alternative, dorsal incision may be advantageous as which faces the key structures of LS9+10, may facilitate the management of trachea and blood vessels of LS9+10, but there was no clinical proof reported ever. This study is targeted to compare the efficacy and safety of these two incisions in segmentectomy of LS9+10. METHODS The dorsal incision is made behind the posterior axillary line, 8th intercostal space. Patients with ground glass opacity (GGO) which solid ingredients is less than 25%, locates at LS9+10, and segmentectomy of LS9+10 could ensure the cut edge were enrolled in the study and were allocated to the traditional incision group or dorsal incision group based on the parity of hospital number. Efficacy outcomes such as the duration of surgery and safety outcomes including postoperative air-leakage duration, length of hospital stay, amount of bleeding and pain score were recorded. The Independent-samples t-test and Mann-Whitey U test were applied in data analysis. RESULTS A total of 68 patients were enrolled and allocated into the traditional incision group and dorsal incision group. In the traditional incision group, the average surgery time was 71.03±6.87 min (median 71.5 min), while that in the dorsal incision group was an average of 62.72±6.24 min (median 61.0 min, P=0.001). The postoperative duration of air-leakage was 2.16±1.63 and 1.36±1.33 days for traditional incision group and dorsal incision group (P=0.030), respectively. The traditional incision group had a greater length of postoperative hospital stay (3.69±1.36 days) than the dorsal incision group (3.08±1.03 days, P=0.041), when amount of bleeding and pain score showed no differences between these two groups. Data suggested a statistically significant advantage for the dorsal incision procedure. CONCLUSIONS Dorsal incision can facilitate the segmentectomy of LS9+10, and significantly reduce the surgery time, postoperative duration of air-leakage and length of hospital stay.
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Affiliation(s)
- Taobo Luo
- Department of Thoracic Surgery, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China;,Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China;,Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, China
| | - Qixun Chen
- Department of Thoracic Surgery, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China;,Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China;,Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, China
| | - Jian Zeng
- Department of Thoracic Surgery, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China;,Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China;,Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, China
| | - Lei Cai
- Department of Thoracic Surgery, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China;,Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China;,Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiancong Huang
- Department of Thoracic Surgery, Cancer Hospital of The University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China;,Institute of Cancer & Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China;,Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), Zhejiang Cancer Hospital, Hangzhou, China
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Matsuura N, Igai H, Kamiyoshihara M. Uniportal thoracoscopic lateral and posterior basal segmentectomy using intersegmental tunneling: Comparison with multiportal approach. Asian J Endosc Surg 2022; 15:863-866. [PMID: 35620902 DOI: 10.1111/ases.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
Thoracoscopic lateral and posterior basal (S9 + 10) segmentectomy (or S10 segmentectomy) is one of the most technically challenging anatomical segmentectomies. We have used "intersegmental tunneling" in the multiportal approach, and we now apply this with a little ingenuity in the uniportal approach. However, because of interference between instruments and the limited insertion angles in the uniportal approach, complex segmentectomies such as S9 + 10 or S10 become even more difficult. The perioperative outcomes were compared between uniportal and multiportal thoracoscopic lateral and posterior basal segmentecomy using intersegmental tunneling. There were no significant differences between the groups in patient characteristics and perioperative outcomes other than operation time, which was significantly shorter in the uniportal group than in the multiportal group (169 ± 21 vs 216 ± 34 min, P = .011). Thoracoscopic S9 + 10 (S10) segmentectomy can be safely performed through the uniportal approach without any difficulties using an intersegmental tunneling method and adding a little ingenuity.
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Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan
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Wang X, Wang Q, Zhang X, Yin H, Fu Y, Cao M, Zhao X. Application of three-dimensional (3D) reconstruction in the treatment of video-assisted thoracoscopic complex segmentectomy of the lower lung lobe: A retrospective study. Front Surg 2022; 9:968199. [PMID: 36248370 PMCID: PMC9559829 DOI: 10.3389/fsurg.2022.968199] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background An increasing number of lung ground-glass nodules (GGNs) have been detected ever since low-dose computer tomography started growing in popularity. Three-dimensional (3D) reconstruction technology plays a critical role in lung resection, especially in segmentectomy. In this study, we explore the role of 3D reconstruction in thoracoscopic complex segmentectomy of lower lung lobe. Methods A total of 97 patients who underwent complex segmentectomy of lower lung lobe from January 2021 to March 2022 were retrospectively analyzed. We divided these patients into a 3D group (n = 42) and a routine group (n = 55) based on preoperative 3D reconstruction or without this procedure. The demographics of patients and GGNs were collected and perioperative outcomes were compared between the two groups. Results All of the baseline characteristics between the groups were comparable (all P > 0.05). There was no 30-day postoperative mortality and conversion in the two groups. The operation time of the 3D group was significantly shorter than that of the routine group (111.4 ± 20.8 min vs. 127.1 ± 32.3 min, P = 0.007). The number of stapler reloads during surgery in the 3D group was less than that in the routine group (9.0 ± 2.2 vs. 10.4 ± 2.6, P = 0.009). The rate of air leakage on postoperative days 1–3 was lower in the 3D group (11.9% vs. 30.9%, P = 0.027). In addition, the resection margins of all patients in the 3D group were adequate, while four patients in the routine group had inadequate resection margins, although there was no statistically significant difference (P = 0.131). Intraoperative blood loss, postoperative drainage, postoperative hospital stay, pneumonia/atelectasis, and hemoptysis were similar between the two groups. Conclusions For performing complex segmentectomy of the lower lung lobe, the procedure of 3D reconstruction may shorten the operation time, decrease the number of stapler reloads, prevent postoperative air leakage, and guarantee a safe surgical margin. Therefore, 3D reconstruction is recommended for complex segmentectomy of the lower lung lobe.
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Affiliation(s)
| | | | | | | | | | - Min Cao
- Correspondence: Xiaojing Zhao Min Cao
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Schlachtenberger G, Fabian D, Hruy M, Hagmeyer L, Bennink G, Gaisendrees C, Wahlers T, Hekmat K, Heldwein MB. Sublobar resection without staging and lymphadenectomy for ≤2 cm Non-Small Cell Lung Cancer is no adequate therapy. Surg Oncol 2022; 44:101840. [DOI: 10.1016/j.suronc.2022.101840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
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