Objective To explore the diagnostic and treatment value of computed tomography (CT)-guided embolization coil localization of pulmonary nodules accurately resected under the thoracoscope. Methods Between October 2015 and October 2016, 40 patients with undiagnosed nodules of 15 mm or less were randomly divided into a no localization group (n=20, 11 males and 9 females with an average age of 60.50±8.27 years) or preoperative coil localization group (n=20, 12 males and 8 females with an average age of 61.35±8.47 years). Coils were placed with the distal end deep to the nodule and the superficial end coiled on the visceral pleural surface with subsequent visualization by video-assisted thoracoscopic (VATS). Nodules were removed by VATS wedge excision using endo staplers. The tissue was sent for rapid pathological examination, and the pulmonary nodules with definitive pathology found at the first time could be defined as the exact excision. Results The age, sex, forced expiratory volume in the first second of expiration, nodule size/depth were similar between two groups. The coil group had a higher rate of accurate resection (100.00% vs. 70.00%, P=0.008), less operation time to nodule excision (35.65±3.38 minvs. 44.38±11.53 min,P=0.003), and reduced stapler firings (3.25±0.85vs. 4.44±1.26,P=0.002) with no difference in total costs. Conclusion Preoperative CT-guided coil localization increases the rate of accurate resection.
Objective To explore the perioperative safety of video-assisted thoracic surgery (VATS) in Day Care Unit and the risk factors for delayed discharge under centralized management model. MethodsThe patients with VATS managed by the Day Care Unit of the Drum Tower Hospital Affiliated to Nanjing University Medical School in 2021 were retrospectively collected. The patients’ postoperative data and risk factors for delayed discharge were analyzed. ResultsA total of 383 patients were enrolled, including 179 males and 204 females with an average age of 46.09±14.82 years. Eleven (2.87%) patients developed grade 3-4 postoperative complications during the hospitalization. Eighteen (4.70%) patients visited unscheduled outpatient clinic within 7 days, and 6 (1.57%) patients were re-hospitalized within 30 days after discharge. The remaining patients had no significant adverse events during the 30-day follow-up. The average length of hospital stay was 2.27±0.35 d. The length of hospital stay was over 48 h in 48 (12.53%) patients. The independent risk factor for delayed discharge was lobectomy or combined resection (OR=3.015, 95%CI 1.174-7.745, P=0.022). ConclusionVATS can be safely conducted under the centralized management in Day Care Unit. The risk factor for delayed discharge is the extent of surgical resection.