Abstract: Objective To Evaluate the clinical outcome of gastric tube in radical surgeries to treat esophageal and cardial carcinoma. Methods From January to October 2008, 74 patients with esophageal or cardial carcinoma in Ruijin Hospital were enrolled in our study. Based on the surgical method, they were divided into the gastric tube group and the traditional way group. The gastric tube group had 46 patients, including 36 male patients and 10 female patients, whose age averaged 59.67±9.96 years (36 to 77 years). Among them, 31 patients had esophageal carcinoma with 1 upper, 23 middle and 7 lower esophageal carcinoma, and 15 patients had cardial carcinoma. In this group, 2 patients were treated with anastomosis in the left neck, 19 with anastomosis in the upper aortic arch, 10 with anastomosis in the lower aortic arch and 15 cardial carcinoma patients underwent radical resection. In the traditional way group, there were 28 patients, 25 male patients and 3 female patients, whose age averaged 59.17±11.33 years (37 to 86 years). In these patients, 22 had esophageal carcinoma with 1 in the upper esophagus, 17 in the middle esophagus, 4 in the lower esophagus; and 6 patients had cardial carcinoma. In this group, 2 patients were treated with anastomosis in the left neck , 17 with anastomosis in the upper aortic arch, 3 with anastomosis in the lower aortic arch, and 6 cardial carcinoma patients underwent radical resection. The rate of anastomotic leakage, operation time, and length of stay in hospital of these two groups were observed. Results All surgeries in the two groups were successfully performed. There was no anastomotic leakage case in the gastric tube group, while there were 4 pulmonary infection cases and 1 death case in the traditional way group. There was no statistically difference in the operation time (180.00±10.34 min vs. 185.00±6.23 min, t=1.669, P=0.078) and length of stay in hospital (16.78±9.98 d vs. 16.89±11.53 d, t=1.665, P=0.075) between the gastric tube group and the traditional way group. Conclusion Gastric tube has a good value in clinical application with fewercomplications and without prolonging operation and hospitalization time, which can surely better quality of life of the patients.
Objective To evaluate the effects of robot-assisted Ivor Lewis esophagectomy (RAILE) in surgical treatment of esophageal cancer. Methods We retrospectively analyzed the clinical data of 70 patients diagnosed with mid-lower esophageal cancer undergoing RAILE in the Department of Thoracic Surgery in Ruijin Hospital Affiliated to Shanghai Jiaotong University between May 2015 and April 2018. There were 54 males and 16 females at average age of 62.0±7.6 years. Forty patients underwent circular end-to-end stapled intrathoracic anastomosis and 30 had a double-layered, completely hand-sewn intrathoracic anastomosis. Results The mean operating time was 308.7±60.6 minutes. And blood loss was 190.0±95.1 ml. There were 2 patients who underwent conversion to thoracotomy. There was no in-hospital and 30-day mortality. Overall complications were observed in 24 patients (34.3%), of whom 6 patients (8.6%) had anastomotic leakage. The median length of hospitalization was 9.0 (interquartile range, IQR, 5.0) days. The mean tumor size was 3.2±1.5 cm, and R0 resection was achieved in all patients. The mean number of totally dissected lymph nodes was 19.3±8.7. Conclusion RAILE is safe and technically feasible with satisfactory perioperative outcomes.
ObjectiveTo explore the training mode of robotic surgical system for thoracic surgeons.MethodsThirteen surgeons enrolled in the Department of Thoracic Surgery, Ruijin Hospital from May 2015 to December 2019 were targeted for training. Training methods included learning basic knowledge of Da-Vinci robotic system, simulation platform training, physical simulation training, training on animal models, practice of thoracic surgery and video analysis.ResultsThe robotic operation skills of the surgeons were improved. Currently 4 surgeons were qualified for using robotic system to do thoracic surgery, and 9 surgeons had assistant qualification.ConclusionMultiple modes of training can help surgeons learn and master the techniques of robotic surgery, and will provide the basis for robotic training standard.
Uniportal video-assisted thoracic surgery (UniVATS) is a significant approach of mini-invasive surgery for lung cancer. UniVATS was first used for treatment of lung cancer in 2010. The European consensus and the Chinese consensus were published in 2019 and 2020 respectively. The latest Chinese consensus included the definition of UniVATS, indications for lung cancer treatment, safety and feasibility, surgical skills, learning curve, short-term and long-term results, providing suggestions for the standardization of uniportal video-assisted thoracic surgery, which are essential to improve the quality of surgery and reduce the incidence of related complications. The Chinese consensus also summarized the current status of subxiphoid UniVATS and non-intubated UniVATS for lung cancer. Considering the technical difficulties and challenges, the application of both technologies in clinical treatment has certain limitation. This article aims to give an interpretation of the results of the Chinese consensus and the similarities and to compare the differences with the European consensus, and to provide a reference for the majority of thoracic surgery colleagues.
The precise localization of pulmonary nodules has become an important technical key point in the treatment of pulmonary nodules by thoracoscopic surgery, which is a guarantee for safe margin and avoiding removal of too much normal lung parenchyma. With the development of medical technology and equipment, the methods of locating pulmonary nodules are also becoming less trauma and convenience. There are currently a number of methods applied to the preoperative or intraoperative localization of pulmonary nodules, including preoperative percutaneous puncture localization, preoperative transbronchial localization, intraoperative palpation localization, intraoperative ultrasound localization, and localization according to anatomy. The most appropriate localization method should be selected according to the location of the nodule, available equipment, and surgeon’s experience. According to the published literatures, we have sorted out a variety of different theories and methods of localization of pulmonary nodules in this article, summarizing their advantages and disadvantages for references.