Objective To investigate the anatomical characteristics of the right top pulmonary vein(RTPV),a rare variant pulmonary vein displayed on chest CT,and its clinical significance in thoracoscopic right lung surgery.Methods The clinical data from 27 patients who underwent thoracoscopic right lung surgery were collected.Of these,24 patients were diagnosed with RTPV by preoperative chest CT.The anatomical characteristics were analyzed in combination with three-dimensional reconstruction.Three cases were diagnosed with RTPV based on preoperative chest CT after abnormal veins behind the intermediate bronchus were identified during surgery.Results Of the 27 patients of RTPV,22 cases drained blood from the posterior segment of the right upper lobe(S2),4 cases drained blood from both the S2 and S6a,and 1 case drained blood from both the S2 and S1a.After crossing behind the intermediate bronchus,13 cases returned blood to the lower pulmonary vein,5 cases returned blood to V6,7 cases returned blood to the left atrium,and 2 cases returned blood to the root of the upper pulmonary vein.The vascular diameter of the RTPV was(5.1±1.7)mm.All 27 patients successfully completed thoracoscopic surgery without massive hemorrhage caused by accidental injury to the PTRV.The intraoperative anatomy corresponded to the preoperative chest CT and three-dimensional reconstruction.The intraoperative bleeding volume was(44.6±43.7)mL,and there was no massive hemorrhage caused by accidental injury to the RTPV.Nine patients underwent right lower lobectomy,and four patients had the RTPV preserved,with no postoperative hemoptysis.Five patients underwent RTPV transection,of which two experienced transient hemoptysis following surgery with no serious complications.Conclusion Chest thin-section CT can be applied to diagnose RTPV.Preoperative identification via CT is crucial to avoid massive hemorrhage resulting from accidental injury during thoracoscopic surgery of the right lung.RTPV can be preserved as appropriate in patients undergoing right lower lobectomy.

Objective To investigate the anatomical characteristics of the right top pulmonary vein(RTPV),a rare variant pulmonary vein displayed on chest CT,and its clinical significance in thoracoscopic right lung surgery.Methods The clinical data from 27 patients who underwent thoracoscopic right lung surgery were collected.Of these,24 patients were diagnosed with RTPV by preoperative chest CT.The anatomical characteristics were analyzed in combination with three-dimensional reconstruction.Three cases were diagnosed with RTPV based on preoperative chest CT after abnormal veins behind the intermediate bronchus were identified during surgery.Results Of the 27 patients of RTPV,22 cases drained blood from the posterior segment of the right upper lobe(S2),4 cases drained blood from both the S2 and S6a,and 1 case drained blood from both the S2 and S1a.After crossing behind the intermediate bronchus,13 cases returned blood to the lower pulmonary vein,5 cases returned blood to V6,7 cases returned blood to the left atrium,and 2 cases returned blood to the root of the upper pulmonary vein.The vascular diameter of the RTPV was(5.1±1.7)mm.All 27 patients successfully completed thoracoscopic surgery without massive hemorrhage caused by accidental injury to the PTRV.The intraoperative anatomy corresponded to the preoperative chest CT and three-dimensional reconstruction.The intraoperative bleeding volume was(44.6±43.7)mL,and there was no massive hemorrhage caused by accidental injury to the RTPV.Nine patients underwent right lower lobectomy,and four patients had the RTPV preserved,with no postoperative hemoptysis.Five patients underwent RTPV transection,of which two experienced transient hemoptysis following surgery with no serious complications.Conclusion Chest thin-section CT can be applied to diagnose RTPV.Preoperative identification via CT is crucial to avoid massive hemorrhage resulting from accidental injury during thoracoscopic surgery of the right lung.RTPV can be preserved as appropriate in patients undergoing right lower lobectomy.

Objective To compare the clinical application of empirical thoracoscopic segmentectomy and precise segmentectomy planned by artificial intelligence software, and to provide some reference for clinical segmentectomy. Methods A retrospective analysis was performed on the patients who underwent thoracoscopic segmentectomy in our department from 2019 to 2022. The patients receiving empirical thoracoscopic segmentectomy from January 2019 to September 2021 were selected as a group A, and the patients receiving precise segmentectomy from October 2021 to December 2022 were selected as a group B. The number of preoperative Hookwire positioning needle, proportion of patients meeting oncology criteria, surgical time, intraoperative blood loss, postoperative chest drainage time, postoperative hospital stay, and number of patients converted to thoracotomy between the two groups were compared. Results A total of 322 patients were collected. There were 158 patients in the group A, including 56 males and 102 females with a mean age of 56.86±8.82 years, and 164 patients in the group B, including 55 males and 109 females with a mean age of 56.69±9.05 years. All patients successfully underwent thoracoscopic segmentectomy, and patients whose resection margin did not meet the oncology criteria were further treated with extended resection or even lobectomy. There was no perioperative death. The number of positioning needles used for segmentectomy in the group A was more than that in the group B [47 (29.7%) vs. 9 (5.5%), P<0.001]. There was no statistical difference in the number of positioning needles used for wedge resection between the two groups during the same period (P=0.572). In the group A, the nodule could not be found in the resection target segment in 3 patients, and the resection margin was insufficient in 10 patients. While in the group B, the nodule could not be found in 1 patient, and the resection margin was insufficient in 3 patients. There was a statistical difference between the two groups [13 (8.2%) vs. 4 (2.4%), P=0.020]. There was no statistical difference between the two groups in terms of surgical time, intraoperative blood loss, duration of postoperative thoracic drainage, postoperative hospital stay, or conversion to open chest surgery (P＞0.05). Conclusion Preoperative surgical planning performed with the help of artificial intelligence software can effectively guide the completion of thoracoscopic anatomical segmentectomy. It can effectively ensure the resection margin of pulmonary nodules meeting the oncological requirements and significantly reduce the number of positioning needles of pulmonary nodules.

Objective:To discuss the feasibility of control the pulmonary artery (PA) with rumel and bulldog clamp during uniportal thoracoscopic left upper lobectomy.Methods:Retrospective analysis of clinical data of 21 patients whose left PA infiltrated by tumor or lymph nodes.The Rumel was used to proximal control of the left PA, and the endoscopic bulldog clamp to distal control. The left upper lobectomy and PA reconstruction were completed under single-port thoracoscopy.Results:All patients were successfully operated, one patient underwent thymectomy, and one patient underwent left S6a subsegmentectomy at the same time. PA reconstruction was performed by running suture under single-port thoracoscopy in 18 patients, by pericardial patch in 2 patients assisted by small incision, and by circumferential resection in one patient associated with left upper sleeve lobectomy assisted by small incision. The operation time was (213.3±40.5) min, the PA control time was (16.5±4.6) min.The blood loss was (152.9±99.9) ml. Postoperative indwelling time of thoracic drainage tube was (5.3±2.8) days, and the postoperative hospitalization time was (9.1±3.6) days. There were no serious complications during the perioperative period.Conclusion:The PA control technique using rumel and bulldog clamp is reliable and occupies less space, which is helpful for the left upper lobectomy and PA reconstruction under uniportal thoracoscopy

Objective:To analyze the clinical efficacy of three-dimensional(3D) reconstruction guided uniportal fluorescence thoracoscopic subsegmentectomy for the pulmonary nodules.Methods:We retrospectively analyzed 50 patients with nodules who underwent uniportal fluorescence thoracoscopic subsegmentectomy from December 2021 to February 2024. All patients underwent thin-slice CT scanning and 3D reconstruction preoperatively. 12 patients were given CT-guided hookwire localization preoperatively.The intersegmental plane was identified by fluorescence method.Results:One patient was converted to right upper lobectomy due to no lesion found in S1b. The mean blood loss was(23.4±16.5)ml and the mean operative time was(126.5±38.5)min. The mean duration of postoperative drainage was(2.6±0.8)days. Mean postoperative hospitalization was(4.8±1.8)days. There were 2 cases with postoperative pulmonary infections, including one with encapsulated pleural effusion. There was no air leakage over 3 days, and no death within 30 days after surgery.Conclusion:3D reconstruction guided uniportal fluorescence thoracoscopic subsegmentectomy is a safe and feasible technique for resection of pulmonary nodules in lung subsegments, and surgical indications must be strictly controlled.

Objective    To summarize the clinical experience of thoracoscopic combined subsegmentectomy (CSS). Methods    The clinical data of 76 patients who underwent thoracoscopic CSS in Anqing Municipal Hospital from May 2018 to July 2022 were retrospectively analyzed, including 22 males and 54 females, aged 27.0-76.0 (54.3±10.5) years. All patients underwent preoperative three-dimensional computed tomography bronchography and angiography using dual source CT. The modified inflation-deflation technique or indocyanine green was used to identify the intersubsegmental border. Results    A total of 86 pulmonary nodules were resected in 76 patients. One patient of left upper lobe S1+2c+S4a, 1 patient of right upper lobe S2b+S3a and 1 patient of right upper lobe S1b+S3b were further performed lobectomy due to insufficient margin. One patient of left upper lobe S1+2+S3a was further performed left upper division segmentectomy due to residual atelectasis. One patient of left upper lobe S1+2c+S3a was further performed left upper division segmentectomy due to B3b+c injury, and the rest completed planned surgeries successfully. The operative time was 90.0-350.0 (174.9±53.2) min. The operative hemorrhage volume was 50.0 (20.0, 50.0) mL. The postoperative hospital stay time was 6.0 (5.0, 7.0) d. Postoperative complications included pulmonary infection in 9 patients, hemoptysis in 3 patients, persistent pulmonary leakage>3 d in 4 patients, pneumothorax in 1 patient, pleural effusion in 1 patient, and myocardial infarction in 1 patient. All of the patients were cured and discharged without perioperative death. Conclusion    Thoracoscopic CSS is relatively complex. Preoperative planning under three-dimensional reconstruction and intraoperative fine operation are helpful for safe completion.

Objective    To explore the clinical issues associated with video-assisted pulmonary segmentectomy and to provide reference for better implementation of thoracoscopic pulmonary segmentectomy and reduction of perioperative complications through analyzing the clinical results of thoracoscopic segmentectomy. Methods    The clinical data of 90 patients who planned to undergo thoracoscopic segmentectomy in our department from October 2017 to December 2019 were retrospectively analyzed, including 35 males with an average age of 60.34±9.40 years and 55 females with an average age of 56.09±12.11 years. The data including lung nodule number, benign or malignant, preoperative location by Hookwire, preoperative planning and actual implementation, operation time, intraoperative blood loss, postoperative drainage volume and time of drainage tube removal, postoperative hospital stay and complications were collected and analyzed. Results    Among the 90 patients, 38 were preoperatively positioned by Hook-wire, 52 were directly operated on; 87 were completed under thoracoscopic surgery among whom 3 underwent passive lobectomy after segmentectomy under thoracoscopic surgery, and 3 were converted to thoracotomy among whom 1 underwent lobectomy. Operation time was 198.58±56.42 min, intraoperative blood loss was 129.78±67.51 mL, lymph node samples were 6.43±1.41, drainage time was 2.98±1.25 d, the amount of postoperation drainage was 480.00±262.00 mL, hospital stay was 7.60±2.38 d. In all patients, 73 had single nodules and 17 had multiple nodules. Totally 113 pulmonary nodules were resected, 14 (12.39%) were benign nodules and 99 (87.61%) were malignant nodules. There was no perioperative death or serious complications. Conclusion    For those pulmonary parenchymal nodules which meet the  indications, it is feasible to perform thoracoscopic anatomic pulmonary segmentectomy according to preoperative thin-slice CT and three-dimensional computed tomography-bronchography and angiography (3D-CTBA) reconstruction results. Preoperative Hookwire localization can ensure effective edge resection and reduce unplanned lobotomy for intersegmental nodules and non-palpable peripheral pure ground-glass nodules.

Objective    To evaluate the efficacy of thoracoscopic complex segmentectomy for stageⅠnon-small cell lung cancer (NSCLC). Methods    We retrospectively reviewed the perioperative clinical data of patients with stageⅠNSCLC who underwent thoracoscopic complex segmentectomy (n=58) or simple segmentectomy (n=33) between January 2017 and March 2020 in our hospital. There were 36 males and 55 females with a median age of 57 years (range: 50-66 years). The clinical data of the two groups were compared. Results    There were no significant differences between the two groups in characteristics including age, sex, weight, comorbidities, preoperative pulmonary function, dominant composition of tumor, tumor histology and size, overall complications, estimated blood loss, prolonged air leakage, length of hospital stay, length of drainage, surgical margin distance or number of dissected lymph nodes. Only the operation time and number of staples for making intersegmental plane were significantly different between the two groups (P<0.05). There was no perioperative death in both groups. Conclusion    Thoracoscopic complex segmentectomy is a feasible and safe technique for stageⅠNSCLC.

Objective Comparative study on efficacy and complications between totally laparo-thoracoscopic Ivor-Lewis esophagectomy(LTILE)combined with jejunostomy,and esophagectomy with assisted abdominal incision.Methods Clinical data of 160 patients with mid-lower thoracic esophageal cancer who underwent thoracoscopic laparoscopic oesophagectomy within the same therapeutic group from January 2017 to July 2018 were retrospectively analyzed.79 patients underwent totally LTILE combined with jejunostomy;the rest 81 patients had LTILE with assisted abdominal incision and nasointestinal tube placement.Preoperative,intraoperative and postoperative clinical data and complicatioos were analyzed.Results There was no significant difference between two groups,including operation time,intraoperative blood loss,number of lymph nodes dissection,postoperative drainage and total treatment cost.In terms of the postoperative pain scores within 3 days,incision complications,pulmonary infection rate and postoperative hospitalization time,there were significant differences(P ＜ 0.05).Conclusion Complete LTILE with jejunostomy appeared to render better short-term clinical outcomes.

Objective    To compare the short-term efficacy of Ivor-Lewis via hand-sewn purse-string approach and purse-string forceps approach in minimally invasive esophagectomy for middle and lower esophageal cancer, and to discuss the safety and feasibility of hand-sewn purse-string anastomosis technique for minimally invasive Ivor-Lewis esophagectomy (MIILE). Methods     The clinical data of 151 patients undergoing thoracoscopic and laparoscopic esophageal cancer surgery from January 2014 to January 2017 in our hospital were retrospectively analyzed. According to the different methods of purse string making, the patients were divided into a purse-string forceps group including 49 males and 16 females with a mean age of 67.98±7.07 years ranging from 51 to 80 years treated with forceps to make purse-string and a handcraft group including 61 males and 25 females with a mean age of 67.76±8.18 years ranging from 52 to 83 years using hand-sewn way. The perioperative data of two two groups were compared. Results    The purse-string making time and postoperative total volume of chest drainage were less in the handcraft group than those in the purse-string forceps group (P<0.05). There was no significant difference between the two groups in hemorrhage during operation, the operation duration or postoperative hospital stay (P>0.05). There was also no statistical difference between the two groups in the rate of anastomotic or gastric tube fistula, anastomotic stenosis, pulmonary infection or incision infection (P>0.05). Conclusion    In minimally invasive esophagectomy for middle-lower section, MIILE by hand-sewn purse-string is as safe as purse-string forceps, with no more complications, needing no professional equipments, and easy to learn, master and promote.