In recent years, the widespread application of chest computed tomography (CT) screening has led to a significant increase in the detection rate of pulmonary nodules. As a critical diagnostic tool for early-stage lung cancer, video-assisted thoracic surgery (VATS) has emerged as the preferred therapeutic approach for pulmonary nodules. Clinical evidence demonstrates that precise preoperative localization significantly enhances surgical success rates (reducing conversion to thoracotomy), minimizes complications, and shortens operation time. This comprehensive review systematically evaluates six cutting-edge localization techniques: percutaneous puncture-assisted localization, electromagnetic navigation bronchoscopy (ENB) localization, 3D-printed auxiliary localization, basin-analysis-based localization, robotic navigation system localization, and mixed reality (MR)-guided localization. By critically analyzing their operational principles, efficacy, safety profiles, and clinical applicability, this paper aims to provide evidence-based recommendations for optimizing clinical decision-making in pulmonary nodule management.
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Humans ; Lung Neoplasms/diagnosis* ; Solitary Pulmonary Nodule/diagnostic imaging* ; Thoracic Surgery, Video-Assisted/methods* ; Multiple Pulmonary Nodules/diagnostic imaging* ; Tomography, X-Ray Computed

BACKGROUND: With the extensive application of segmental lung resection in the treatment of early-stage lung cancer, how to complete segmentectomy more accurately and minimally invasively has become a research hotspot. The aim of this study is to explore the application of three-dimensional computed tomography bronchography and angiography (3D-CTBA) combined with perfusion area recognition technique in single-hole thoracoscopic complex segmentectomy. METHODS: From January 2021 to January 2022, the clinical data of 112 consecutive patients undergoing single-port thoracoscopic complex segmentectomy in the Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University were retrospectively analyzed. The three-dimensional reconstruction combined with perfusion area identification technique was used to perform the operation and the clinical data were analyzed. RESULTS: The average operation time was (141.1±35.4) min; the initial time of intersegmental plane display was (12.5±1.7) s; the maintenance time of intersegmental plane was (114.3±10.9) s; the intersegmental plane was clearly displayed (100%); the amount of bleeding was [10 (10, 20)] mL; the total postoperative drainage volume was (380.5±139.7) mL; the postoperative extubation time was (3.9±1.2) d; and the postoperative hospitalization time was (5.2±1.6) d. Postoperative complications occurred in 8 cases. CONCLUSIONS The advantages of 3D-CTBA combined with perfusion area recognition technique are fast, accurate and safe in identifying intersegmental boundary in single-port thoracoscopic complex segmentectomy, which could provide guidances for accuratding resection of tumors, shortening operation time and reducing surgical complications.
Humans ; Lung Neoplasms/pathology* ; Bronchography ; Pneumonectomy/methods* ; Retrospective Studies ; Thoracic Surgery, Video-Assisted/methods* ; Tomography, X-Ray Computed ; Angiography/methods* ; Perfusion

The rapid development and promotion of minimally invasive thoracic surgery represented by video-assisted thoracoscopy surgery has gradually replaced traditional thoracic surgery technique as the primary choice for the treatment of pulmonary nodules, including early lung cancer. With the clinical application of double-lumen bronchial catheters, the realization of one-lung ventilation technology not only provides a solid anesthesia foundation for the popularization of minimally invasive thoracic surgery, but also provides a guarantee for the rapid and smooth implementation of the operation. However, compared with single-lumen bronchial catheters, the diameter of the double-lumen bronchial catheter is thicker, and the tube body is hard and difficult to shape, which brings inconvenience to anesthesia intubation. The bronchial structure is different, and the incidence of dislocation during anesthesia intubation is also high. With the gradual clinical use of video double-lumen tube (VDLT), it has become a hot spot in thoracic surgery in recent years. This article reviews the application and research progress of VDLT in thoracic surgery.
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Humans ; Intubation, Intratracheal/methods* ; Lung Neoplasms/surgery* ; One-Lung Ventilation/methods* ; Thoracic Surgery ; Thoracic Surgery, Video-Assisted/methods*

BACKGROUND: Patients who underwent lobectomy resection are prone to hypoxemia, and the vast majority present with type I respiratory failure. Thus, improvement of hypoxemia is one of the most important factors to facilitate postoperative recovery of patients. In this study, the superiority-inferiority of different oxygen inhalation methods were compared with high-flow nasal oxygen therapy (HFNO), noninvasive mechanical ventilation (NIMV) and nasal oxygen breath (NOB) in patients with hypoxemia after single-port video-assisted thoracoscopic (VATS) lobectomy, and the clinical efficacy of HFNO in these patients was further investigated. METHODS: A total of 180 patients from the Second Affiliated Hospital of Soochow University in China with hypoxemia who accepting single-port VATS lobectomy from June 2021 to March 2022 were randomly divided into three groups (n=60), which were treated with HFNO, NIMV and NOB, respectively. The results of arterial blood gas analysis, patient's comfort score and incidence of complications were observed before, 1 h, 6 h-12 h and after use. Statistical analyses were conducted using statistical program for social sciences 25.0 (SPSS 25.0), and P<0.05 was considered as statistical significance. RESULTS: For patients with hypoxemia after accepting single-port VATS lobectomy, HFNO was no less effective than NIMV (P=0.333), and both of whom could fast increase patients' partial pressure of oxygen/fraction of inspiration O₂ (PaO₂/FiO₂) compared to NOB (P<0.001). Besides, HFNO shows a great advantage in comfort degree and stay length (P<0.001, P=0.004), and incidence of complications were slightly lower than other groups (P=0.232). But it is worthy to note that HFNO is still slightly less effective than NIMV in patients with postoperative hypoxemia accompanied by elevated partial pressure of carbon dioxide (PaCO₂). CONCLUSIONS For patients with hypoxemia who accepting single-port VATS lobectomy, HFNO can be used as the first choice. However, for patients with postoperative hypoxemia accompanied by elevated PaCO₂, NIMV is still recommended to improve oxygenation.
Carbon Dioxide ; Humans ; Hypoxia/surgery* ; Lung Neoplasms/surgery* ; Oxygen ; Pneumonectomy/methods* ; Thoracic Surgery, Video-Assisted/methods*

BACKGROUND: In recent years, with the advancement of minimally invasive techniques, thoracoscopic thymoma resection has experienced a development process from three-port video-assisted thoracic surgery (VATS) to two-port (TP) and single-port (SP) variants. However, the feasibility and safety of SP-VATS have not been generally recognized. This study intends to explore the safety and feasibility of SP-VATS in thymoma resection, in order to provide a reference for clinical surgicalselection. METHODS: The clinical data of 197 patients who underwent thoracoscopic thymoma resection in Beijing Tongren Hospital from January 2018 to September 2021 were retrospectively analyzed. The patients were divided into SP-VATS group (n=42) and TP-VATS group (n=155). After matching propensity scores, there is no statistically significant difference in preoperative baseline data between SP-VATS group and TP-VATS group. Among them, there were 17 males and 25 females with an average age of 28-72 (48.00±9.43) years in the SP-VATS group, and 20 males and 22 females with an average age of 30-75 (50.38±9.83) years in TP-VATS group. The clinical effects of the two groups were compared. RESULTS: The operation was successfully completed in both groups, and there was no conversion to thoracotomy or increased surgical incisions. Compared with the TP-VATS group, the chest drainage time and hospital stay in the SP-VATS group were shorter [(2.95±0.76) d vs (3.33±0.85) d; (4.57±0.83) d vs (5.07±1.13) d], and the visual pain score at 24 h and 72 h after surgery were lower [(3.64±0.85) points vs (4.05±0.66) points; (2.33±0.75) points vs (3.07±0.68) points] (P<0.05). There was no statistically significant difference between the two groups in operation time [(130.00±26.23) min vs (135.24±27.03) min], intraoperative blood loss [(69.52±22.73) mL vs (82.38±49.23) mL] (P>0.05). CONCLUSIONS SP-VATS in thymoma is a safe, feasible, and less invasive procedure, with less postoperative pain and faster recovery than multi-port VATS.
Adult ; Aged ; Female ; Humans ; Lung Neoplasms/surgery* ; Male ; Middle Aged ; Retrospective Studies ; Thoracic Surgery, Video-Assisted/methods* ; Thymoma/surgery* ; Thymus Neoplasms/surgery*

In video-assisted thoracoscopic surgery (VATS), general anesthesia with endotracheal intubation was considered an optimal method of anesthesia for a long time. However, complications due to general anesthesia and one-lung ventilation have become a problem. In recent years, epidural anesthesia without endotracheal intubation has been attempted in various thoracic surgical procedures with various advantages and disadvantages reported. We compared postoperative pain and prognosis when different anesthesia methods were used in a patient who underwent the same operation twice in the interval of one year. When non-intubated video-assisted thoracoscopic surgery (NIVATS) underwent under epidural anesthesia, postoperative pain score was lower, adverse events were fewer, and the hospital stay was shorter than that of VATS. The patient also expressed high subjective satisfaction. Like previous studies, the results favored NIVATS under epidural anesthesia. However, greater attention and proficiency are required from the anesthesiologist for proper analgesia and sedation.
Analgesia ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Humans ; Intubation ; Intubation, Intratracheal ; Length of Stay ; Methods ; One-Lung Ventilation ; Pain, Postoperative ; Prognosis ; Thoracic Surgery, Video-Assisted ; Thoracic Surgical Procedures

Image-guided localization materials are constantly evolving, providing options for the localization of small pulmonary nodules to guide minimally invasive thoracic surgery. Several preoperative methods have been developed to localize small pulmonary lesions prior to video-assisted thoracic surgery. These localization techniques can be categorized into 4 groups according to the materials used: localization with metallic materials (hook-wire, microcoil, or spiral coil), localization with dye (methylene blue or indigo carmine), localization with contrast agents (lipiodol, barium, or iodine contrast agents), and radiotracers (technetium-99m). However, the optimal localization method has not yet been established. In this review article, we discuss the various localization techniques and the advantages and disadvantages of localization techniques as well as the available safety and efficacy data on these techniques.
Barium ; Coloring Agents ; Contrast Media ; Indigo Carmine ; Iodine ; Lung ; Methods ; Plants ; Thoracic Surgery ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND: A method of wound closure using knotless suture material in the chest tube site has been introduced at our center, and is now widely used as the primary method of closing chest tube wounds in video- assisted thoracic surgery (VATS) because it provides cosmetic benefits and causes less pain. METHODS: We included 109 patients who underwent VATS pulmonary resection at Samsung Medical Center from October 1 to October 31, 2016. Eighty-five patients underwent VATS pulmonary resection with chest drain wound closure utilizing knotless suture material, and 24 patients underwent VATS pulmonary resection with chest drain wound closure by the conventional method. Complications related to the chest drain wound were compared between the 2 groups. RESULTS: There were 2 cases of pneumothorax after chest tube removal in both groups (8.3% in the conventional group, 2.3% in the knotless suture group; p=0.172) and there was 1 case of wound discharge due to wound dehiscence in the knotless suture group (0% in the conventional group, 1.2% in the knotless suture group; p=0.453). There was no reported case of chest tube dislodgement in either group. The complication rates were non-significantly different between the 2 groups. CONCLUSION: The results for the complication rates of this new chest drain wound closure method suggest that this method is not inferior to the conventional method. Chest drain wound closure using knotless suture material is feasible based on the short-term results of the complication rate.
Chest Tubes ; Humans ; Lung ; Methods* ; Pneumothorax ; Sutures* ; Thoracic Surgery ; Thoracic Surgery, Video-Assisted ; Thorax* ; Wounds and Injuries*

BACKGROUND: Currently, there are many reports on the advantages of three portal video-assisted thoracic surgery (VATS) in the treatment of lung cancer, but there are few reports on the comparison between uniportal and three portal video-assisted thoracic surgery. In this study, we aimed to evaluate the recent curative effect of the postoperative short-term quality of life between uniportal and three portal video-assisted thoracic surgery for non-small cell lung cancer. METHODS: We retrospectively evaluated 266 patients with NSCLC who underwent intended VATS lobectomy by a single surgical team in our ward between January 2016 and August 2017. The general clinical date, perioperative data and short-term life quality were individually compared and analyzed between the two groups. RESULTS: The two groups were similar in terms of clinicopathological features, total number of dissected lymph nodes and nodal stations, postoperative complications and pulmonary complications (P>0.05). Compared with three portal VATS, the intraoperative blood loss, chest tube duration, postoperative thoracic drainage, length of stay and NRS score were significantly decreased in uniportal VATS, with significant differences (P<0.05). CONCLUSIONS As a more minimally invasive surgery, uniportal VATS can be safely and effectively performed for resectable lung cancer, which would achieve even better operation curative effect than three portal VATS.
Aged ; Carcinoma, Non-Small-Cell Lung ; pathology ; surgery ; Female ; Humans ; Lung ; pathology ; surgery ; Lung Neoplasms ; pathology ; surgery ; Middle Aged ; Operative Time ; Postoperative Complications ; etiology ; Quality of Life ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; adverse effects ; methods ; Treatment Outcome

Recently, with the proliferation of high-resolution computed tomography (CT), the frequency of small pulmonary nodules appears higher and more precise than previously estimated, especially in CT screening in patients with high risk factors for lung cancer. Video-assisted thoracoscopic surgery (VATS) provides a new minimally invasive treatment for the diagnosis and treatment of small pulmonary nodules. The VATS results in less pain, shorter hospital stay, and reduced surgical complications, making it more widely available. How to accurately locate and mark lesions is important for video-assisted thoracoscopic surgery. This article reviews the various techniques used to locate pulmonary nodules in surgery in recent years and summarizes the advantages and disadvantages of them.
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Humans ; Lung Neoplasms ; surgery ; Metals ; Solitary Pulmonary Nodule ; surgery ; Surgery, Computer-Assisted ; Thoracic Surgery, Video-Assisted ; methods