OBJECTIVETo assess the clinical value of single-port video-assisted thoracoscopic surgery (VATS) for treatment of pulmonary diseases.

METHODSFrom October, 2009 to December, 2013, 105 patients with pulmonary diseases were scheduled for single-pore VATS for pulmonary lobectomy (19 patients), wedge resection of the lung (34 patients), and bullae resection and pleurodesis for spontaneous pneumothorax or pulmonary bleb (52 patients).

RESULTSOf the 105 patients, 101 patients underwent single-port VATS; the procedure was converted to open thoracotomy in 1 patient and to conventional three-port VATS in 2 patients. The operative time was 50.6∓36.8 min (20-200 min) with intraoperative blood loss of 70∓56.9 ml (10-300 ml), thoracic drainage time of 4.2∓3.2 days (2-14 days), and postoperative hospital stay of 5.4∓3.8 days (3-16 days). Postoperative complications of the procedures included prolonged air leakage (6 cases) and atelectasis (2 cases). All the other patients recovered smoothly without serious complications.

CONCLUSIONSingle-port VATS is a safe and efficient procedure that allows rapid postoperative recovery and is a method of choice for selected patients with pulmonary diseases.

Humans ; Length of Stay ; Lung ; surgery ; Lung Diseases ; surgery ; Pneumothorax ; Postoperative Complications ; Postoperative Period ; Thoracic Surgery, Video-Assisted ; Thoracotomy

Absorbable Implants ; Adult ; Aged ; Humans ; Male ; Middle Aged ; Pneumothorax ; etiology ; surgery ; Polyglycolic Acid ; Silicosis ; complications ; surgery ; Surgical Sponges

BACKGROUND: Morbidity, the use of analgesics, the amount of postoperative drainage and the postoperative hospital stay were reduced in VATS for pneumothorax. However, some authors preferred minithoracotomy to VATS because the rate of recurrence after VATS were between 5% and 10%. Therefore, we present a modified thoracoscopic bullectomy (MTB) which we believe has the advantages of conventional VATS and minithoracotomy. MATERIAL AND METHOD: Sixty-six patients who received the operation from January 2002 to December 2002 were divided into 3 groups. Twenty-six patients were treated by axillary minithoracotomy and thirteen by conventional VATS and 18 by modified thoracoscopic bullectomy. The mean age was 21.9 years (range, 16~35 years) for minithoracotomy group, 20.6 years (range, 17~28 years) for conventional VATS group and 22.6 years (range, 16~39 years) for MTB group. The mean follow-ups were 11.4months for minithoracotomy group, 9.5 months for conventional VATS group and 4.7 months for MTB group. RESULT: The mean duration of operation was 55.79+/-23.35 minutes in MTB and 44.23+/-19.24 minutes in conventional VATS (p=0.333). The number of staplers being used was 1.63+/-0.76 in MTB, 1.41+/-0.64 in minithoracotomy (p=0.663), and 2.92+/-1.19 in conventional VATS (p<0.001). The duration of indwelling chest tube was 1.63+/-0.76 day in MTB, 4.07+/-1.41 day in minithoracotomy (p<0.001) and 4.46+/-2.33 day in conventional VATS (p<0.001). Hospital length of stay was 3.26+/-0.81 day in MTB, 6.04+/-2.21 day in minithoracotomy (p<0.001) and 6.69+/-3.33 day in conventional VATS (p<0.001). The number of postoperative complication and recurrence were 2 in minithoracotomy (7.4%), 5 in conventional VATS (38.5%) and 1 in MTB (5.6%). CONCLUSION: Modified thoracoscopic bullectomy is an effective procedure in the treatment of spontaneous pneumothorax.
Analgesics ; Chest Tubes ; Drainage ; Follow-Up Studies ; Humans ; Length of Stay ; Pneumothorax ; Postoperative Complications ; Recurrence ; Thoracic Surgery, Video-Assisted ; Thoracoscopy

In a period from Sep 1994 to Sep 1996, 38 patients were treated for spontaneous pneumothorax by video-assisted thoracic surgery(VATS). 31 male and 7 female patients with ages between 17 and 79(mean 30.0 years). No death occured. The postoperative complication rate of VATS was 7.9%(3/38). We noted no recurrence of pneumothorax, 3 wound dehiscence, 3 persistent air leak(>7days) in the patients. We compared theses results with thoracoscopic surgery of spontaneous pneumothorax in 38 cases(Group A), with cases of 21 patients(Group B) performed by the thoracotomy in the same period. There have been no recurrence in groud A, and one recurrence in group B at a median follow-up of 14.37+/-7.48 months and 16.81+/-7.12 months, respectively. There was no significant difference in the duration of operation time including induction time between VATS and thoracotomy, but postoperative hospital stay and chest tube drainage periods were all less for these undergone VATS. Postoperative complication was less in group A(3/38=7.9%, 3 cases with persistent air leak >7days, all developed wound dehiscence, too), than in group B(9/21=42.9%, 8 cases with persistent air leak more than 7days, including 2 wound dehiscence, one recurrence, and the other one case of empyema). In our experience, VATS has the effectiveness of thoracic surgery for treating thoracic problems, has resulted in surgical intervention in spontaneous pneumothorax.
Chest Tubes ; Drainage ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Pneumothorax* ; Postoperative Complications ; Recurrence ; Thoracic Surgery ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy ; Wounds and Injuries

BACKGROUND: Recently, video-assisted thoracoscopic surgery(VATS) has been accepted as the standard treatment for spontaneous pneumothorax. However, comparatively high recurrent rate and cost-effectiveness are still controversial. The recurrent rate after bullectomy with VATS is reported to be as high as 5-10% whereas it is below 2% in thoracotomy. There is no statistical report on cost-effectiveness in Korean health care system. Material and METHOD: Our retrospective analysis was performed on 173 cases of surgically treated primary spontaneous pneumothorax at Kangbuk Samsung Hospital, Sungkyunkwan University, School of medicine, from January 1997 to July 1999. There were 104 cases VATS and 69 cases of thoracotomy. We analysed the operative indication, gender, operating time, amounts of the staples used, tube drainage, tube stay time, postoperative complications, recurrent rate, operation room cost, and total cost. RESULT: Operation time was 71.3 +/-29.5minutes in VATS group and 141 +/-52minutes in thoracotomy group(P<0.05). The postoperative tube stay and hospital stay are 3.93days and 7.5days in VATS group and 7.0 days and 13.4days in thoracotomy group, respectively(P<0.05, P<0.05). The number of recurrence after the operation in VATS group(6/104, 5.6%) was significantly higher than in thoracotomy group (1/69, 1.4%; P<0.05). The operation room cost was significantly higher in VATS group than in thoracotomy group (won 1,202,192 +/-178,992, won 1,005,669 +/-311,531; P<0.05), but considering the total cost, there was no significant difference between the two groups( won 1,946,110 +/- 487,440, won 1,793,912 +/-308,079; P=0.18). CONCLUSION: Although operative procedure and discharge policy may affect the recurrent rate and cost, there was no benefit of cost-effectiveness in VATS group and recurrent rate was higher in VATS group than in throacotomy group. It would be helpful to set up a prospective trial comparing cost and results of VATS versus minithoracotomy.
Cost-Benefit Analysis ; Delivery of Health Care ; Drainage ; Humans ; Length of Stay ; Pneumothorax* ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy*

BACKGROUND: Making the histologic diagnosis of small pulmonary nodules and ground glass opacity (GGO) lesions is difficult. CT-guided percutaneous needle biopsies often fail to provide enough specimen for making the diagnosis. Video-assisted thoracoscopic surgery (VATS) can be inefficient for treating non-palpable lesions. Preoperative localization of small intrapulmonary lesions provides a more obvious target to facilitate performing intraoperative resection. We evaluated the efficacy of CT-guided localization with using a hook wire and this was followed by VATS for making the histologic diagnosis of small intrapulmonary nodules and GGO lesions. MATERIAL AND METHOD: Eighteen patients (13 males) were included in this study from August 2005 to March 2008. 18 intrapulmonary lesions underwent preoperative localization by using a CT-guided a hook wire system prior to performing VATS resection for intrapulmonary lesions and GGO lesions. The clinical data such as the accuracy of localization, the rate of conversion-to-thoracotomy, the operation time, the postoperative complications and the histology of the pulmonary lesion were retrospectively collected. RESULT: Eighteen VATS resections were performed in 18 patients. Preoperative CT-guided localization with a hook-wire was successful in all the patients. Dislodgement of a hook wire was observed in one case. There was no conversion to thoracotomy. The median diameter of lesions was 8 mm (range: 3~15 mm). The median depth of the lesions from the pleural surfaces was 5.5 mm (range: 1~30 mm). The median interval between preoperative CT-guided localization with a hook-wire and VATS was 34.5 min (range: 10~ 226 min). The median operative time was 43.5 min (range: 26~83 min). In two patients, clinically insignificant pneumothorax developed after CT-guided localization with a hook-wire and there were no other complications. Histological examinations confirmed 8 primary lung cancers, 3 cases of metastases, 3 cases of inflammation, 2 intrapulmonary lymph nodes and 2 other benign lesions. CONCLUSION: CT-guided localization with a hook-wire followed by VATS for treating small intrapulmonary nodules and GGO lesions provided a low conversion thoracotomy rate, a short operation time and few localization-related or postoperative complications. This procedure was efficient to confirm intrapulmonary lesions and GGO lesions.
Biopsy, Needle ; Glass ; Humans ; Inflammation ; Lung Neoplasms ; Lymph Nodes ; Neoplasm Metastasis ; Operative Time ; Pneumothorax ; Postoperative Complications ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Thoracotomy

BACKGROUND: The aim of this study was to evaluate the feasibility of single-port video-assisted thoracic surgery (VATS) in the treatment of secondary spontaneous pneumothorax (SSP). METHODS: Twenty-four patients who were scheduled to undergo single-port VATS for SSP were studied. The medical records of the patients were retrospectively reviewed. The mean follow-up duration was 26.1+/-19.8 months. In order to evaluate the feasibility of single-port VATS for SSP, the postoperative results of single-port VATS (n=15) in patients with emphysema were compared with those of emphysematous patients who underwent three-port VATS (n=15) during the study period. RESULTS: Single-port VATS was feasible in 19 of 24 patients (79.2%), while an additional port was needed in five patients. In the single-port VATS patients, the median operation time, duration of chest tube drainage, and hospital stay were 84.0 minutes, one day, and two days, respectively. Postoperative complications included prolonged chest tube drainage for more than five days (n=1), wound infection (n=1), and vocal fold palsy (n=1). No recurrence of pneumothorax was observed during the follow-up period. The median operation time, duration of chest tube drainage, and hospital stay of the emphysematous patients who underwent single-port VATS were shorter than those who underwent three-port VATS group (p<0.05 for all parameters). CONCLUSION: Single-port VATS proved to be a feasible procedure in the treatment of patients with secondary spontaneous pneumothorax.
Chest Tubes ; Drainage ; Emphysema ; Follow-Up Studies ; Humans ; Length of Stay ; Medical Records ; Pneumothorax* ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Thoracic Surgery, Video-Assisted* ; Vocal Cord Paralysis ; Wound Infection

BACKGROUND: Although treatment of spontaneous pneumothorax by video-assisted thoracic surgery(VATS) has generally shown better clinical results than conventional thoracotomy, treatment of spontaneous pneumothorax by midaxillary thoracotomy(MAXT) has also shown good clinical results. The author studied to compare the clinical results of MAXT group I and VATS group II. MATERIAL AND METHOD: Group I included 30 midaxillary thoracotomy among 83 operative cases of spontaneous pneumothorax from Jan. 1992 to Dec. 1993. Group II included 30 VATS among 101 operative cases of pneumothorax from Jan. 1994 to Aug. 1995. The author selected the 30 patients, age 18 to 25 years, with recurrent spontaneous pneumothorax in each group. The author analyzed the operative indication, gender, operating time, amounts of the used staplers, tube drainage, total amounts of analgesics used during postoperative 24hr, tube stay time, postoperative complications and mortality. RESULT: The follow-up periods of both procedures were from 6 to 43 months. The operating time from start of skin incision to end of skin closure was 84.79+/-21.70(from 40 to 150) minutes in MAXT group I and 108.8+/-42.02(from 58 to 120) minutes in VATS group II(p<0.001). The numbers of the used staples useo was 1.31+/-0.6(from 0 to 3) in group I and 3.41+/-2.37(from 0 to 11) in group II. The amounts of postoperative 24hour tube drainage were 220.76+/-106.73(from 65 to 400) ml in group I and 260.63+/-233.18(from 70 to 320) in group II(p>0.05). The amounts of postoperative 24 hourly used analgesics(Tarasyn ) was 1.38+/-1.32(from 0 to 5) amples in group I and 0.72+/-1.02(from 0 to 4) amples in group II (p<0.05). The postoperative tube stay is 5.45+/-30.9 (from 3 to 7) days in group I and 4.75+/-3.1(9 from 2 to 14) days in group II(p>0.05). The number of complications after operations was 2 cases of prolonged air leakage in group I, and in group II. (P is not significant). The number of recurrence after the operation was one in group I and also one in group II(P is not significant). In conclusion, there were no statistical differences in the postoperative 24 hour chest tube drainage, days of postoperative tube stay, postoperative complications and recurrence in the analysis between group I and group II. CONCLUSION: The author found that group II of VATS between 18 years and 25 years of age in recurrent spontaneous pneumothorax, statistically, requires longer operative time, more number of autosuture staples and less postoperative analgesic dosage than the midaxillary thoracotomy group.
Analgesics ; Chest Tubes ; Drainage ; Follow-Up Studies ; Humans ; Mortality ; Operative Time ; Pneumothorax* ; Postoperative Complications ; Recurrence ; Skin ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy*

BACKGROUND: Thoracic sympathicotomy has been used safely and successfully to manage palmar hyperhidrosis. The preoperative and postoperative recording of Sympathetic Skin Responses(SSR) was performed for objective evaluation and follow-up of thoracic sympathicotomy in hyperhidrosis patients, and also for ascertaining the clinical usefullness of SSR. MATERIAL AND METHOD: The recording of SSR was performed on 15 patients suffering from palmar hyperhidrosis with Medelec Sapphire Plus electromyogragh before and after thoracic sympathicotomy. Eletrical stimuli on the right median nerve was made in patients in supine position and results were recorded on right and left palms with soles at the same time by 4 channels. Skin temperatures were also monitored simultaneously. T2,3 sympathicotomy was performed with VATS in every patients. SSR was done in 2 patients one month later. RESULT: Clinically, all patients had symptomatic improvement with satisfaction. Postoperative complication was small amount of residual pneumothorax in 5 patients but it was absorbed sponteneously. There was no recurrence during follow-up period and ten patients(66%) complained compensatory hyperhidrosis. After operation, SSR change was shown in every 15 patients. Abolition of SSR on both palms was achieved in 12 patients(80%) and on both soles in 6 patients. In the other 3 patients, the latencies were significantly delayed and the amplitudes were significantly reduced at both palms and soles. In two patients who were examined at one month later after operation, similar results with postoperative SSRs were shown. The skin temperature on preoperative both palm and sole were lower than normal temperature, and those on postoperative both palm and sole were increased. Those had statistical significance(p<0.05), and the temperature on the palm was increased higher that than on the sole. CONCLUSION: After thoracic sympathicotomy was performed on palmar hyperhidrosis patients, an increment of skin temperatures and SSR changes were achieved at both palms and soles of all patients. Palmar SSRs were completely abolished in 12 patients(80%), and similar results of postoperative SSRs were achieved. The recording of SSR may be useful to easily and objectively assess the completeness of sympathicotomy and the follow-up of recurrence in hyperhidrosis patients.
Aluminum Oxide ; Follow-Up Studies ; Humans ; Hyperhidrosis* ; Median Nerve ; Pneumothorax ; Postoperative Complications ; Recurrence ; Skin Temperature ; Skin* ; Supine Position ; Sympathetic Nervous System ; Thoracic Surgery, Video-Assisted

PURPOSE: Several risk factors for development of reexpansion pulmonary edema (REPE) after drainage of pneumothoraces have been reported, but the association between the method of thoracostomy and the development of REPE is unknown. The aim of this study was to compare the frequency of REPE after treatment of spontaneous pneumothorax with trocar or hemostat assisted closed thoracostomy. MATERIALS AND METHODS: We performed a prospective, observational study including 173 patients with spontaneous pneumothorax who visited the emergency department from January 2007 to December 2008. In 2007, patients were treated with hemostat-assisted drainage, whereas patients in 2008 were treated with trocar-assisted drainage. The main outcome was the development of REPE, determined by computed tomography of the chest 8 hours after closed thoracostomy. Outcomes in both groups were compared using univariate and multivariate analyses. RESULTS: Ninety-two patients were included, 48 (42 males) of which underwent hemostat-assisted drainage and 44 (41 males) underwent trocar-assisted drainage. The groups were similar in mean age (24+/-10 vs. 26+/-14 respectively). The frequencies of REPE after hemostat- and trocar-assisted drainage were 63% (30 patients) and 86% (38 patients) respectively (p=0.009). In multivariate analysis, trocar-assisted drainage was the major contributing factor for developing REPE (odds ratio=5.7, 95% confidence interval, 1.5-21). Age, gender, size of pneumothorax, symptom duration and laboratory results were similar between the groups. CONCLUSION: Closed thoracostomy using a trocar is associated with an increased risk of REPE compared with hemostat-assisted drainage in patients with spontaneous pneumothorax.
Adult ; Female ; Hemostatic Techniques ; Humans ; Male ; Multivariate Analysis ; Pneumothorax/*complications/*surgery ; Prospective Studies ; Pulmonary Edema/*diagnosis/etiology/*surgery ; Risk Factors ; Surgical Instruments ; Thoracostomy/*adverse effects/*methods ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult