Objective To compare clinical outcomes and safety between minimally invasive mitral valve replacement via right minithoracotomy （mini-MVR） and traditional mitral valve replacement （MVR）. Methods Clinical data of 68 patients with valvular heart diseases who underwent mini-MVR from February 2009 to December 2011 in Wuhan Asia Heart Hospital were retrospectively analyzed. There were 36 males and 32 females in this mini-MVR group with their mean age of 34.2±11.2 years. Preoperatively， there were 21 patients with mitral stenosis （MS）， 17 patients with mitral insufficiency （MI）， 30 patients with MS and MI， and 19 patients with tricuspid insufficiency （TI）. Another 200 patients with valvular heart diseases who underwent traditional MVR during the same period were included as the control group. There were 86 males and 114 females in the control group with their mean age of 49.4±13.2 years. Preoperatively， there were 85 patients with MS， 66 patients with MI， 49 patients with MS and MI， and 76 patients with TI. Hospital mortality， aortic crossclamp time， length of intensive care unit （ICU） stay， postoperative chest tube drainage， reexploration for bleeding and postoperative morbidities were compared between the two groups. Results There was no in-hospital death in the mini-MVR group. There was no statistical difference in hospital mortality， cardiopulmonary bypass time， incidence of reexploration for bleeding， postoperative arrhythmias， dialysis-requiring acute renal failure and wound infection between the two group （P＞0.05）. Aortic crossclamp time of the mini-MVR group was significantly longer than that of the control group. But postoperative mechanical ventilation time （10.2±3.1 h vs. 15.2±7.1 h， P=0.008）， chest tube drainage（92.0±28.0 ml vs. 205.0±78.0 ml， P=0.000）， blood transfusion （0.8±1.6 U vs. 1.9±2.1 U， P=0.006）， length of ICU stay （14.0±8.0 h vs. 26.0±12.0 h， P=0.003） and length of hospital stay （14.8±4.6 d vs. 19.7±3.2 d， P=0.006）of the mini-MVR group were significantly shorter or less than those of the control group. Conclusion The safety of mini-MVR is comparable to that of traditional MVR without causing higher postoperative morbidities， while the postoperative recovery after mini-MVR is better than traditional MVR.
Objective To investigate the impact of complete video-assisted thoracoscopic lobectomy and open lobectomy on perioperative heart rate （HR） and blood oxygen saturation （SO2） of lung cancer patients，and explore whether minimally invasive surgery can enhance postoperative recovery of lung cancer patients. Methods A total of 138 lung cancer patients were chosen from 161 consecutive patients with pulmonary diseases who were admitted to West China Hospital of Sichuan University between September 2010 and December 2011. According to different surgical approach，all the 138 lung cancer patients were divided into routine thoracotomy group （thoracotomy group，70 patients including 53 males and 17 females with their average age of 56.1±9.7 years） and complete video-assisted thoracoscopic lobectomy group （VATS group，68 patients including 46 males and 22 females with their average age of 53.4±6.5 years）. There was no statistical difference in preoperative clinical characteristics between the 2 groups. Preoperative and postoperative （1st，3rd，7th and 30th day） numeric pain rating scale （NPRS），HR and SO2 were compared between the 2 groups. Results （1） There was no statistical difference in NPRS on the 1st and 3rd postoperative day between the 2 groups （3.83±0.79 vs. 3.93±0.67， 2.88±0.59 vs. 3.03±0.71，P＞0.05），but on the 7th and 30th postoperative day，NPRS of the thoracotomy group was signi- ficantly higher than that of VAST group （1.61±0.33 vs. 1.22±0.12，1.58±0.26 vs. 1.19±0.31，P＜0.05）. （2） Postop- erative sedentary HR of both VATS group and thoracotomy group were significantly higher than preoperative levels ［（84.13±17.21） / minute vs. （73.67±10.32）/minute， （86.13 ±19.67） / minute vs. （72.24±14.21） / minute， P＜0.05］. Postoperative HR of VATS group decreased to preoperative level on the 3rd postoperative day，while postoperative HR of the thoracotomy group decreased to preoperative level on the 7th postoperative day. （3） There was no statistical difference between preoperative and postoperative （all the time points） sedentary SO2 of both VATS group and thoracotomy group （96.34 %±2.11% vs. 97.12%±2.31%，95.33%±4.13% vs. 94.93% ±4.31%，P＞0.05）.（4） The changes of HR and SO2 before and after exercise of VATS group were significantly smaller than those of the thoracotomy group on the 3rd postoperative day ［（11.11±4.81）/minute vs. （18.23±6.17）/minute，3.1%±1.2% vs. 7.4 %±2.7%，P＜0.05］ . Conclusion The impact of complete video-assisted thoracoscopic lobectomy on cardiopulmonary function is comparatively smaller，which is helpful for postoperative fast-track recovery of lung cancer patients.
Objective To compare surgical results between real-time three dimensional echocardiography（RT-3DE） guided closure of atrial septal defect （ASD） through a right minithoracotomy and traditional surgical repair under cardiopulmonary bypass （CPB）. Methods Sixty-four patients with secundum ASD received surgical repair in the First People’s Hospital of Honghe Autonomous Prefecture from April 2009 to April 2012. According to different surgical approach, all the patients were divided into group A and B. In group A, 35 patients underwent traditional ASD repair under CPB including 20males and 15 females with their age of 12-56 （16.4±4.0） years. In group B, 29 patients received real-time RT-3DE guidedASD closure through a right minithoracotomy without CPB, including 20 males and 15 females with their age of 15-50 （18.5±0.2） years. Operation time，postoperative mechanical ventilation time，hospital stay，chest drainage，mortality，morbidity and follow-up outcomes were compared between the 2 groups. Results Operation time （110.47±35.90 minutesvs. 159.32±20.60 minutes），postoperative mechanical ventilation time （10.40±22.30 hours vs. 16.40±12.20 hours），chestdrainage （106.71±85.20 ml vs. 146.70±75.63 ml）and postoperative hospital stay （4.0±1.0 days vs. 7.0±1.0 days）ofgroup B were significantly shorter or less than those of group A. In group A, 1 patient died postoperatively and 7 patientshad postoperative complications. In group B, there was no in-hospital mortality and 3 patients had postoperative complications.Postoperative morbidity of group A was significantly higher than that of group B （20.0% vs. 10.3%，P＜0.05） . ConclusionFor ASD patients with definite surgical indications，RT-3DE guided ASD closure through a right minithoracotomy has more advantages over traditional surgical repair under CBP.
Abstract： Objective To evaluate video-assisted thoracic surgery（VATS）and minimal incision thoracotomy（MIT）lobectomy for early stage non-small cell lung cancer patients and the impact upon postoperative quality of life（QOL）. Methods A prospective randomized controlled trial was conducted. From January 1, 2008 to December 10, 2011, the qualified patients with early stage NSCLC were recruited and randomized to VATS group （57 patients）and MIT group（49 patients）, totally 106 patients，57 males and 49 females, aged 57.60 years. The quality of life was assessed using Lung Cancer Symptom Scale （LCSS） before operation and at 1,3,6,9,12 months after operation. Results There were no significant differences between the 2 groups in age, sex, the location of tumor, tumor pathologic stage, pathological types, postoperative complications, tumor size, operative time, operative bleeding and air leak days. There were no symptoms after operation at the VATS group worse than the leve before operation. Five major symptoms, including appetit（1.04±0.71 vs.2.00±0.83, F=6.357，P=0.021）, fatigue （4.55±1.17 vs.10.19±2.10, F=4.721，P=0.043）, dyspnea（2.18±0.86 vs.10.26±2.05, F=10.020，P=0.005）, normal activity（5.16±1.70 vs.17.60±3.17, F=12.319，P=0.002）at the MIT group were deteriorated significantly at 1 month after the operation （P＜0.05）. Conclusion The VATS will lead to better quality of life for the patients with early stage NSCLC after surgery and lead to a smooth postoperative recovery.
Objective To find out the best time and investigate the indications for conversion to horacotomy in completely thoracoscopic lobectomy. Methods Between Sep. 2006 and Feb. 2009, 172 patients including 88 male and 84 female with the median age of 58.9 years, underwent completely thoracoscopic lobectomy. Postoperative pathology showed that there were 133 cases of primary lung cancer, 7 cases of lung cancer metastasis and other malignant tumors, and 32 cases of benign diseases. Among them, 46 patients had the tumor on the right upper lobe (RUL), 23 on the right middle lobe (RML), 31 on the right lower lobe (RLL), 36 on the left upper lobe (LUL) and 36 on the left lower lobe (LLL). Three incisions were made in all operations. The procedures of systematic lymphadenectomy and anatomic lobectomy were similar with routine thoracotomy. If there was mediastinal lymph node adhesion, metastasis or bleeding, the incision would be extended to 12-15 cm and the surgery would be converted to thoracotomy. According to whether the maximum tumor dimension was above 5 cm or under 3 cm, the patients were divided into two groups. At the same time, we also divided the patients into two groups based on whether thoracotomy was performed. The data of both two groups were compared respectively. Results All surgeries were carried out safely with no serious complications or perioperative deaths. The average surgical duration was 185 minutes, and the average blood loss was 213 ml. Thirteen operations were converted to thoracotomy with a conversion rate of 7.6%. Among them, 9 were interfered by lymph nodes and bleeding happened in 4 operations. Lobectomy was performed on 12 patients and pneumonectomy was performed on 1 patient after thoracotomy. For the 16 cases of tumor with its dimension larger than 5 cm, the average operation time was 187 minutes and the average blood loss was 203.8 ml, while for the 98 cases of tumor with its dimension smaller than 3 cm, the average operation time was 202 minutes and the average blood loss was 231.3 ml. The difference between these two groups was not statistically significant. Among the 13 cases of conversion to thoracotomy, the mean age of the patients was 68.7 years old and the average tumor dimension was 23.8 mm. For the 159 cases without thoracotomy, the average age was 59.3 years old and the tumor dimension averaged 27.8 mm. There was a significant difference between them (P=0.016). Conclusion Interference by lymph nodes and bleeding are the most important causes of conversion to thoracotomy in completely thoracoscopic lobectomy while size of tumor, fused fissure or plural adhesions can be always managed thoracoscopically.
Objective To introduce the procedure of thoracic outlet tumors removal through posterior thoracotomy and its efficacy. Methods Ten patients with thoracic outlet tumors underwent surgical treatment via posterior approach from June 2004 to June 2007. Five patients suffered from neurogenic tumors, 4 patients apical lung carcinomas, and 1 patient apicoposterior lung tumor. The skin incision was started superiorly lateral to the transverse process of 6th cervical vertebrae, carried downward a way between the medial border of the scapula and the posterior midline and was extended in a gentle arc below the inferior angle of the scapula to the posterior axillary line. The chest was entered and the tumor is removed through resecting the rib(2nd or 3rd rib) located at the lower edge of the tumor after the scapula had been pushed forward. Results There was no death in this group. Tumors in 9 patients were resected completely. Thoracotomy only was done in another patients as a result of tumor invading neighboring major organs. Shoulder and back pain in 3 of 4 patients was remitted postoperatively. Two patients with “dumbell” neurogenic tumors improved strength of lower limbs. Pain and abdominal wall reflex resumed in one patient and muscle strength of lower limbs increased to 4th grade from 2nd grade in another one. Two patients required thoracentesis because of complicating with pleural effusion. The mean followup period was 18 months (range 336). Seven of 10 patients still lead a normal life. Conclusion Posterior thoracotomy can provide an excellent approach to remove the thoracic outlet tumors safely and completely.
Objective To compare the surgical trauma between videoassisted thoracoscopic surgery(VATS) and conventional thoracotomy, and to investigate the possible minimally invasive mechanism. Methods Seventyseven patients who had undergone consecutive operations from April 2005 to January 2006 were chosen from cardiothoracic surgery department of Fujian Provincial Hospital. Twentytwo cases had spontaneous pneumothorax diagnosed by chest X-ray examination, twentynine had patent ductus arteriosus diagnosed by color echocardiography, and twentysix had congenital atrial septal defect. According to lesions and operative methods, the patients were divided into two groups: conventional thoracotomy group(CTH group) and videoassisted thoracoscopic surgery group(VATS group). The concentrations of serum C-reactive protein（CRP），interleukin6 (IL-6)，interleukin-8（IL-8） and tumor necrosis factor-α(TNF-α) were selected as indexes to measure surgical trauma. ARRAY360 specific protein and pharmaceutical analysis system were used to determine CRP automaticly at the day before operation and on the 1st, 2nd and 3rd day after operation. Radioimmunoassay was used to measure the concentrations of IL-6，IL-8 and TNF-α. Clinical indexes such as operative time, cardiopulmonary bypass (CPB) time, intraoperative blood lost, postoperative analgesic time and hospitalization time were analyzed and compared. Results Under the condition that patients had the same diseases, there was no statistical significance in preoperative concentrations of serum CRP，IL-6，IL-8 and TNFα between VATS group and CTH group（P=0.067, 0.062, 0.053,0.064）. The concentrations of serum CRP(P=0.045,0.043,0.044), IL-6(P=0.042，0.032，0.039), IL-8(P=0.046，0.045，0.048) and TNF-α(P=0.041，0.043，0.043) on the 1st, 2nd and 3rd day after operation were significantly lower in VATS group than that in CTH group (Plt;0.05). Compared with CTH group, there were less blood lost（P=0.032）, shorter postoperative analgesic time and hospitalization time（P=0.041） in VATS group. There was no statistical significance in CPB time between two groups. However, hospitalization time varied with different diseases. Conclusion Compared with conventional thoracotomy，videoassisted thoracoscopic surgery has less surgical trauma, less intraoperative blood lost, shorter postoperative analgesic time, and can make patients recover rapidly. So it is worth spreading.
Abstract: Objective To investigate the feasibility of the diagnosis and treatment of pleurallung diseases by minithoracotomy and videoassisted thoracic surgery(VATS) under local anesthesia. Methods From February 2002 to March 2005,30 cases were performed by thoracotomy under local anesthesia,which were divided into two groups including minithoracotomy group and VATS group according to the different approaches; inithoracotomy group was used just for the biopsy of thicken pleura and diffuse pulmonary diseases on the state of open pneumothorax, and VATS group was for the diagnosis and treatment of malignant effusion and recurrent pneumothorax on the state of closed pneumothorax,all of them were ompleted under local anesthesia. Results Minithoracotomy group: biopsy of pleura were performed on 13 cases, 10 cases of which has been diagnosed with metastasis, one case was amyloidosis of pleura, two cases were proliferation of pleura.Three cases on diffuse pulmonary diseases were done for biopsy, 2 of which were pulmonary interstitial fibrosis, 1 of which was pulmonary tuberculosis (type Ⅱ). VATS group: Except one was converted to general anesthesia and minithoracotomy to resect the lesion due to heavy pleural adhesion, other patients who had thicken pleura and diffuse pulmonary diseases were performed operation for biopsy, bullarectomy was done on recurrent pneumothorax,and pleurodesis was done on ntractable pleuaral effusion under local anesthesia. 4 cases on pleural effusion were done by diagnostic thoracoscope under local anesthesia, 1 of which was liverrelated pleural effusion. 14 cases has been done by remedial thoracoscope, 8 cases of which malignant pleural effusion were done for pleurodesis, the other cases which have recurrent pneumothorax were given bullaectomy and pleurodesis. Spontaneous breathing and hemodynamics was maintained well during the operation. There was neither severe complication nor mortality in two groups. Conclusion Videoassisted thoracoscopic resection of peripheral pulmonary nodule and biopsy of pleura through minithoracotomy can be performed safely under local anesthesia. The novel approach will be the cost-effective procedure for management of pulmonary nodules in the present time.
Objective To summarize the experience of surgical treatment of congenital heart diseases through right axillary mini-thoracotomy and analyse related problems. Methods Two hundred and twenty-four patients of congenital heart diseases underwent open heart surgery under cardiopulmonary bypass （CPB） through a right axillary mini-thoracotomy（3rd or 4th intercostal）. Among them repair of ventricular septal defect （VSD） in 168, repair of atrial septal defect （ASD） in 48, total correction of tetralogy of Fallot （TOF） in 6, double-outlet right ventricular in 1 and Ebstein syndrome in 1. Results There was 1 postoperative death （0.45%）, the cause of death was acute pulmonary edema. Postoperative complication occurred in thirteen cases （5.8%）. There were no significant changes in CPB time, aortic cross clamping time, ventilating time and hospital stay days between right axillary minithoracotomy and median sternotomy at the same period （Pgt;0. 05）, but the bleeding volume both intraoperative and postoperative in the patients of right axillary mini-thoracotomy were significantly less than those in the patients of median sternotomy （Plt;0. 01）. Two hundred and fourteen patients were followed up （follow-up time from 2 months to 7 years）, 3 of them had early mild cardiac function insufficiency（ejection fractionlt;0. 50）, small residual shunt were found in 2 patients after VSD operation and the others recovered satisfactorily. Conclusion There were merits in right axillary mini-thoracotomy approach for treatment of properly selected congenital heart diseases; safe and reliable, low operative bleeding volume, and good results of aesthetics. But the use of this incision for repair of TOF and more complex congenital heart diseases should be careful.
Objective To review the clinical experience of Heller myotomy for treatment of achalasia through a small thoracotomy. Methods Twenty-five patients with achalasia (9 moderate, 16 severe) underwent Heller myotomy without concomitant antireflux procedure through a small incision. A left thoracotomy was carried out through either the seventh or eighth intercostals space. The length of skin incision was 6 to 8 cm. Results There was no hospital death and severe postoperative complications. The mean operating time was 50 minutes. Mean hospital stay was 10 days. There was one intraoperative perforation and repaired successfully. All patients reported good to excellent relief of dysphagia and no symptom of gastroesophageal reflux after surgery. Eight patients were subsequently studied with a 24-hour esophageal pH monitoring and no evidence of pathologic reflux found. Conclusions Transthoracic Heller myotomy with a small incision is effective and safe method for treatment of achalasia with minimal invasion, quick recovery, less postoperative complication and shorter hospital stay. Proper extent of the myotomy may decrease the risk of subsequent gastroesophageal reflux in the postoperative period.