Three-dimensional (3D) vision systems are now available for thoracic surgery. It is unclear whether 3D video-assisted thoracic surgery (VATS) is superior to 2D VATS systems. This study aimed to compare the operative and perioperative data between 2D and 3D VATS lobectomy (VTL) and to identify the actual role of 3D VTL in thoracic surgery.A two-institutional comparative study was conducted from November 2013 to November 2014 at Liaoning Cancer Hospital & Institute and the First Affiliated Hospital of Guangzhou Medical University, China, of 300 patients with resectable non-small cell lung cancer (NSCLC). Patients were assigned to receive either the 3D VATS (n=150) or 2D VATS (n=150) lobectomy. The operative and perioperative data between 2D VATS and 3D VATS were compared.Although there was no significant difference between the two groups regarding the incidence of each single complication, a significantly less operative time was found in the 3D VATS group (145 min) than in the 2D VATS group (176 min) (P=0.006). Postoperative mortality rates in 3D VATS and 2D VATS groups were both 0%.No significant difference was found between groups for estimated blood loss (P=0.893), chest drainage tube placement time (P=0.397), length of hospital stay (P=0.199), number of lymph nodes resected (P=0.397), postoperative complications (P=0.882) and cost of care (P=0.913).Early results of this study demonstrate that the 3D VATS lobectomy procedure can be performed with less operative time. 3D VATS and 2D VATS lobectomy are both safe procedures in first-line surgical treatment of NSCLC.
Purpose To explore the efficacy and safety of fast-track surgery (FTS) in the perioperative period of single-hole thoracoscopic radical resection of lung cancer. Methods The clinical data of 152 lung cancer patients undergoing single-hole thoracoscopic radical resection of lung cancer in our hospital from October 2016 to March 2019 were collected. Among them, 76 patients were treated with perioperative FTS (FTS group) following in-depth information and education, effective analgesia, early ambulation and early extubation, while the other 76 patients received conventional perioperative treatments (Control group). Results The intraoperative volumes of blood loss and fluid infusion in FTS group were smaller than those in Control group. Moreover, the mean time to postoperative drainage tube removal, time to the first postoperative ambulation and length of postoperative hospital stay in FTS group were substantially shorter than those in Control group. Moreover, the visual analog scale (VAS) scores of patients at 48 and 72 h after operation in FTS group were considerably lower than those in Control group. Besides, the total incidence rate of postoperative complications in FTS group was considerably lower than that in Control group. Compared with those before operation, all pulmonary function indicators declined substantially after operation, and the postoperative forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and maximum voluntary ventilation (MVV) in FTS group were remarkably higher than those in Control group. Conclusion FTS in the perioperative period of single-hole thoracoscopic radical resection of lung cancer can effectively accelerate the recovery of patients, alleviate their pain, shorten the length of hospital stay, reduce hospitalization expense and improve patient's satisfaction, so it is worth clinically applying.
Diaphragmatic hernia following an esophagectomy for esophageal cancer (EC) can be both an early and late complication. The esophageal hiatus within the diaphragm is disrupted during the operation. However, the incidence of Post-Esophagectomy Diaphragmatic Hernia (PEDH) is unknown. PEDH can be life-threatening and surgical treatment is challenging. However, all PEDH do not require surgery. The rate of EC diagnosis is rising. Therefore, esophageal surgery, particularly esophagectomy, is gradually increasing. Undoubtedly, the numbers of PEDH increase as well.This review describes the presentation and diagnosis of PEDH after surgery for esophageal malignancy, as well as the management options for PEDH.Fifteen papers regarding PEDH have been published. There are many different surgical approaches to complete an esophagectomy, while there are different approaches to repair PEDH.Upper GI surgeons need to have an index of suspicion for PEDH. They must investigate and operate these patients if this complication develops, since an immediate surgery has a high mortality and poor outcome.
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