Video-assisted thoracic surgery (VATS) is high-skilled operation,which is tacit,scene-related,hard to transfer and individualized.The action formation of VATS is implemented by action orientation,imitation,integration,training and automation.The skill acquisition of VATS involves four overlapping steps:studying examples to do analogy,developing abstract rules,slowly moving to the use of production rules and retrieving specific examples.Research on teaching methods of VATS in the view of tacit knowledge helps to learn this skill better and more quickly.

Objective To analyze the safety, feasibility and operative technique details of non-grasping en bloc mediastinal lymph nodes dissection technique in uniportal video-assisted thoracic surgery(VATS) for lung cancer.Methods From April, 2014 to March, 2015,46 patients with lung cancer received non-grasping en bloc mediastinal lymph nodes dissection after uniportal VATS lobectomy.Clinical data of the cases were analyzed retrospectively.There were 19 males and 27 females.The age was(57.2 ± 9.0) (38-73) years.The first 6 cases were performed in the lateral decubitus position while the later 40 cases were all performed in the semiprone position.Results All cases accepted uniportal VATS non-grasping en bloc mediastinal lymph nodes dissection successfully.Arm fatigue of surgeon and assistant was obviously relieved when the patient was placed in the semiprone position.The thoracic drainage time was(3.2 ± 2.1) (1-12)days and the postoperative length of hospital-stay was(6.0 ± 4.5) (2-27) days.The number of dissected mediastinal lymph nodes stations was (4.3 ± 0.8) (3-6)and the number of dissected mediastinal lymph nodes was (11.8 ± 4.9) (4-30).There were 42 cases with stage No , lease wit stage N1, and 3 cases with stage N2 in pathological examination.Five patients developed minor postoperative complications.No perioperative death occurred.Conclusion Uniportal VATS non-grasping en bloc mediastinal lymph nodes dissection for lung cancer was safe and feasible, which could decrease the interference of the instruments and help to keep the surgical field clear.Non-grasping en bloc mediastinal lymph nodes dissection would be performed more smoothly in the semiprone position with less damage to lung and better ergonomics.

Background and purpose:With the improvement of skill of video-assisted thoracic surgery, thoracoscopic anatomic segmentectomy becomes more and more mature. This paper aimed to study the safety, feasibility and clinical features of thoracoscopic anatomic segmentectomy for stageⅠ lung cancer.Methods:Data from 64 patients who was diagnosed as having clinicalⅠ stage lung cancer and received thoracoscopic anatomic pulmonary segmentectomy were retrospectively analyzed from Mar. 2008 to Jan. 2014. There were 28 men and 36 women with a median age of 59 years (39-86 years).Results:Sixty-four patients underwent thoracoscopic anatomic segmentectomy successfully. The median operative time was 120 min (90-240 min). The median blood loss in operation was 50 mL (10-200 mL). The median thoracic drainage time was 3 d(2-7 d). The median postoperative length of stay was 5 d(3-23 d). There was no postoperative mortality or severe complications. There was one conversion to lobectomy but no conversion to thoracotomy. There were 51 patients with ground glass opacity (GGO). Of the 51 patients, postoperative pathology showed invasive adenocarcinoma in 30, adenocarcinoma in situ in 10, minimally invasive adenocarcinoma in 6 and benign lesions in 5.Conclusion:Thoracoscopic anatomic pulmonary segmentectomy is a feasible and safe technique for a skilled doctor. Not only can it be a method of diagnosis, but also it can be a method of treatment for clinical stageⅠ lung cancer, especially for GGO in lung.

Objective To analyze safety,efficacy and resection methods of video-assisted thoracic surgery(VATS) for the treatment of intralobar pulmonary sequestration(IPS).Methods Data of 17 patients who were diagnosed as IPS and received VATS from December 2006 to September 2011 were retrospectively analyzed.The patients were 7 males and 10 females with the mean age of 40.3 (14-61) years.Diagnosis was confirmed in 9 patients by enhanced CT and unconfirmed in 8 patients.Three ports were used for surgery.After the aberrant artery was confirmed,liner stapler was used in 16 patients to cut it and Hem-o-lok was used in 1 patient because the aberrant artery was about 3 mm in diameter and long enough.If the diameter of the aberrant artery was longer than 10 mm,a stapling device without knife was used to occlude it centrally and a second stapling device was used to cut it peripherally.Wedge resection or lobectomy was performed due to the different conditions.When the lesion was small with linited range in CT image and the lesion was easily distinguished from normal lung tissue during operation,wedge resection was preferred.Results Seventeen patients underwent VATS successfully without any conversion to thoracotomy or any serious complications.Five patients were planned to receive wedge resection and one was converted to lobectomy.Another 12 patients were planned to receive lobectomy and all succeeded.The mean operating time was 128 (80-170)min.The mean blood loss was 80 (5-200) ml.The mean days of chest tube maintained were 4.0 (2-6) days.The mean postoperative hospitalization days were 7.6 (4-11) days.All patients were diagnosed as IPS according to operating in-sight and postoperative pathology.There was no patient suffering from chronic cough,bloody sputum or recurrent pneumonia during the follow-up.Conclusion VATS for the treatment of IPS is safe and feasible.If conditions permit,wedge resection or segmentectomy may be preferred.

Objective:To analyze the safety and feasibility of lobectomy combined with mediastinal lymphadenectomy by uniportal thoracoscope in semi‐prone position .Methods:The clinical data of 20 patients who received lobectomy by uniportal thoracoscope in semi‐prone position were retrospectively analyzed .The patients consist of 6 males and 14 females with the age 24‐73 (56 .4 ± 12 .7) years old .Results:In 16 patients of the 20 patients ,lobectomy by uniportal thoracoscope in semi‐prone position was completed successfully .The operating time was 85‐340 (175 .7 ± 61 .5) min .The bleeding volume was 20‐600 mL . The thoracic dralnage time was 1‐12 (3 .3 ± 2 .5) d .The postoperative length of hospital stay was 3‐14 (5 .1 ± 2 .6) d .In 15 patients with primary bronchogenic carcinoma who completed lobectomy by uniportal thoracoscope successfully , the mean number of retrieved lymph node groups was 5‐9 (6 .9 ± 0 .9) and the number of retrieved lymph nodes was 13‐35 (20 .1 ± 5 .5) . There was 1 patient who converted to two‐ports thoracoscope ,2 patients who converted to three‐ports thoracoscope ,and 1 patient who converted to small incision surgery .There were postoperative minor complications in 2 patients and no perioperative mortality .Conclusions:The lobectomy combined with mediastinal lymphadenectomy by uniportal thoracoscope in semi‐prone position is safe and feasible .The adoption of semi‐prone position can relieve surgeon's fatigue and reduce stretch injury to lung , facilitate converting to two‐ports or three‐ports thoracoscopic surgery and facilitate converting to thoracotomy .

Objective:To explore the etiology ,as well as the clinical prevention and treatment strategy ,of hyperglycemic hyperosmolar nonketotic coma after esophagectomy .Methods :The clinical data of five patients who suffered hyperglycemic hyperosmolar nonketotic coma after esophagectomy in Department of Thoracic Surgery ,Zhongshan hospital ,Fudan Unviersity during January 2009 and December 2014 ,were retrospectively analyzed .Results:There was no case with diabetes history among the five cases before operation .All the 5 cases received enteral nutrition after operation ,among which 4 cases suffered postoperative complications .The main symptoms included dehydration and psychogenia .And coma occurred in severe cases . Three cases recovered well and reach an average hospital stay of 42 days owning to early diagnosis and treatment .The other two were diagnosed too late .One case died in hospital on the 54th day after operation and the other case had been staying in hospital for 210 days .Furthermore ,no patient developed diabetes .Conclusions :Hyperglycemic hyperosmolar nonketotic coma may even occur after esophagectomy in patients without diabetes ,especially in the patients who suffer from complications or received enteral nutrition . Postoperative monitoring of blood glucose could prevent this complication . Early diagnosis and treatment could improve its prognosis .

OBJECTIVE To explore the effect and mechanism of Huanglian Jiedu decoction in reducing inflammation of abscess from the perspective of lncRNA NEAT1. METHODS C57BL/6 mice were divided into blank group, model group, Huanglian Jiedu decoction group and control group. After the intervention, the tissue were separated and collected under anesthesia. Animal experiment: the wound tissue of each group was observed by morphology. Real-time PCR and Western blotting were used to detect lncRNA NEAT1, miR-146a-5p gene level changes and RELA, TNF-α, TGF-β1, α-SMA, Collagen Ⅲ protein expression respectively. Cell experiments: Real-time PCR was used to detect the changes of lncRNA NEAT1 and miR-146a-5p gene levels. The effect of flow cytometry on apoptosis rate was detected. Fluorescence intensity was measured by FISH. The expression of related proteins was detected by Western blotting. RESULTS Compared with model and control group, the wound was repaired well and the inflammatory cell infiltration in the wound of the Huanglian Jiedu decoction group was reduced. Compared with the model and control group, the level of lncRNA NEAT1 and protein expressions of RELA, TNF-α, TGF-β1 in the Huanglian Jiedu decoction group were significantly reduced, while the gene level of miR-146a-5p and the protein expressions of α-SMA and Collagen III were significantly increased(P<0.05). Compared with LPS+Lenti-control group, lncRNA NEAT1 gene level in LPS+Lenti-sh-NEAT1 group was significantly decreased, while miR-146a-5p gene level was increased(P<0.05). Flow cytometry showed that Huanglian Jiedu decoction could reduce the apoptosis rate and fluorescence intensity of lncRNA NEAT1(P<0.05). Compared with the blank group, the protein expressions of RELA, TNF-α, TGF-β1 in LPS group were significantly increased, while the protein expressions of α-SMA and Collagen III were significantly decreased (P<0.05). After sh-NEAT1 treatment, The regulatory effects of Huanglian Jiedu decoction on the expression of above molecule were reduced(P<0.05). CONCLUSION Huanglian Jiedu decoction can alleviate the inflammatory state of mouse abscess wound through lncRNA NEAT1, which is closely related to the regulation of miR-146a, RELA, TNF-α, TGF-β1, α-SMA and Collagen III expression.

Objective:To investigate the influence of admission to intensive care unit (ICU ) on the postoperative complications in patients with esophageal carcinoma .Methods :A total of 391 patients with esophageal carcinoma confirmed by surgery in Department of Thoracic Surgery ,Zhongshan Hospital ,Fudan University ,from Jan 2009 to Dec 2009 ,were chosen .All the patients had clinical data and postoperative follow‐up data in detail . Patients were divided into postoperative ICU group (treatment group) and postoperative general ward group(control group) .The control group was further classified into control group A(without unplanned ICU admission) and control group B(with unplanned ICU admission) based on whether unplanned admission to ICU was conducted .The occurrence rates of postoperative complications were compared among the three groups . Logistic regression was performed in multivariate analysis of postoperative complications .Results:On Day 1 after surgery ,the APACHE Ⅱ score was higher in treatment group than in control group I(P<0 .05) .However ,there was no increase on rate of postoperative complications in treatment group .The APACHE Ⅱ score ,as well as the occurrence rate of postoperative complications ,was lower in control group A than those in control group B (P<0 .01) .The APACHE Ⅱ score in treatment group was higher than that in control group B (P< 0 .05) .However ,the occurrence rate of postoperative complications in treatment group was lower than that in control group B (P<0 .01) .On Day 1 after surgery ,the higher the postoperative acute physiology and chronic health evaluation(APACHE)Ⅱ score was ,the higher the occurrence rate of postoperative complications was(HR= 0 .631 ,95% CI:0 .405~ 0 .983 ,P< 0 .05) .Postoperative planned ICU admission could diminish postoperative complications ,and it was the independent factor(HR= 1 .588 ,95% CI:1 .147‐2 .199 ,P< 0 .01).Conclusions :If prompt admission to ICU for comprehensive treatment was conducted after esophageal cancer operation , the occurrence rate of complications could be reduced in esophageal cancer patients .

A 59‐year‐old female patient with a ground‐glass opacity(GGO) in the right upper lobe of lung was prepared for surgery .CT and positron emission computed tomography(PCT) of thorax revealed a 9 mm GGO in the right upper lobe ,with no metastasis .A 3D printing of the right lung was performed to simulate the lesion .The surgical plan was made according to the model .A video‐assisted thoracoscopic segmentectomy of apical segment of right upper lobe was performed .A microinvasive ade‐nocarcinoma was proved by frozen section .Since the cutting border was larger than 2 cm from the lesion ,no further resection was performed .Subsequently ,a systemic mediastinal lymph node sampling was performed .Final pathology demonstrated a pT1aN0M0 microinvasive adenocarcinoma of the right upper lung .This case report illustrated that the 3D printing technology may be helpful in the procedure of surgical planning in resection of GGO .

Objective To increase the advantage and decrease the disadvantage of posterior approach for uniportal video-assisted thoracic surgery (VATS) right upper lobectomy. Methods Data of 97 consecutive patients who received uniportal VATS right upper lobectomy using posterior approach in the semiprone position were retrospectively analyzed from Dec, 2014 to Dec, 2017. There were 41 males and 56 females at age of 26–79 (57.8±10.6) years. The hilar structure was cut from posterior to anterior one by one. The mediastinal lymph nodes were dissected if lung cancer was diagnosed. Results Ninety three of 97 patients were successfully completed with uniportal VATS right upper lobectomy using posterior approach, 3 of them were completed with posterior approach combined with anterior approach, and 1 of them needed thoracotomy. The mean operative time was 76–192 (127.0±32.0) min. The thoracic drainage time was 2–20 (3.4±2.7) d. The postoperative length of hospital stay was 3–23 (5.4±3.1) d. There were postoperative complications in 7 patients and no postoperative mortality. Conclusion Posterior approach for uniportal video-assisted thoracic surgery right upper lobectomy is safe and feasible, which can decrease the fatigue of both the surgeon and the assistant. It also provides with better exposure of posterior mediastinum, less dragging lung, and less interference of the instruments and help keep the clear surgical field. In complicated cases, posterior approach could combine with anterior approach to complete the VATS lobectomy.