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Robotic hilum-mediastinal lymph nodes dissection for operable non-small cell lung cancer (NSCLC) patients: state of art 机器人门纵隔淋巴结清扫术用于可手术的非小细胞肺癌(NSCLC)患者:最新进展
IF 0.2 4区 医学 Q4 SURGERY Pub Date : 2021-01-01 DOI: 10.21037/vats-21-18
F. Gallina, G. Alessandrini, F. Facciolo
In the last few years, minimally invasive thoracic surgical techniques were strongly improved enough to become part of daily lung cancer surgical treatment. Although the minimally invasive lobectomy techniques were well-established, controversial still remain about the lymphadenectomy. The first studies about the video-assisted thoracoscopic surgery (VATS) reported better perioperative outcomes compared to thoracotomy but the long-term efficacy is uncertain. The robotic approach represents a technological evolution of VATS procedure that leads to some technical advantages derived from the wide angle of maneuverability of the instruments, which is even superior to that of the human hand. Overall survival after surgery for pN0 non-small cell lung cancer is associated with a higher numbers of lymph nodes resected. This achieves a more accurate staging and a quick starting of the postoperative treatments if needed. Previous studies reported that there are differences in terms of lymphadenectomy with VATS compared to thoracotomy. The thoracoscopic approach showed a lower rate of nodal upstaging. In this review we analyzed the principal technical aspects of the mediastinal lymph nodes dissection and we reported the principal studies that are conducted about the postoperative nodal upstaging following the minimally invasive lung cancer surgery. The results showed that the robotic approach allows to achieve a more accurate lymphadenectomy compared to VATS with a higher number of nodal upstaging. The consequence of this would be that the postoperative oncological treatment can be set faster and more accurately.
在过去的几年里,微创胸外科技术得到了很大的改进,足以成为日常肺癌手术治疗的一部分。虽然微创肺叶切除术技术已经建立,但关于淋巴结切除术仍存在争议。关于视频胸腔镜手术(VATS)的初步研究报告了比开胸手术更好的围手术期结果,但长期疗效尚不确定。机器人方法代表了VATS程序的技术演变,导致了一些技术优势,这些优势来自仪器的广角可操作性,甚至优于人手。pN0非小细胞肺癌手术后的总生存率与切除的淋巴结数量增加有关。这实现了更准确的分期和快速开始术后治疗,如果需要的话。先前的研究报道,与开胸手术相比,VATS的淋巴结切除术存在差异。胸腔镜入路显示淋巴结占优率较低。在这篇综述中,我们分析了纵隔淋巴结清扫的主要技术方面,并报道了微创肺癌手术后淋巴结占位的主要研究。结果表明,与VATS相比,机器人方法可以实现更准确的淋巴结切除术,淋巴结数量较多。这样做的结果是,术后肿瘤治疗可以更快,更准确地设定。
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引用次数: 0
Literature review: non-intubated (tubeless) VATS for lung volume reduction surgery 文献综述:非插管(无管)VATS用于肺减容手术
IF 0.2 4区 医学 Q4 SURGERY Pub Date : 2021-01-01 DOI: 10.21037/vats-21-23
Yi Zhang, Xin Jin
The non-intubated video-assisted thoracoscopic surgery (NI-VATS) is developed from traditional video-assisted thoracoscopic surgery (VATS). In NI-VATS, deep anesthesia is avoided, and a face or laryngeal is used instead of ordinary tracheal intubation. Patients usually have fewer complaints of postoperative discomfort and recover faster by this method. Since the first report of NI-VATS wedge resection, surgical teams from all over the world have enlarged the range of non-intubation to almost all kinds of VATS treatments, such as mediastinal tumor resection (1), carinal reconstruction (2), and lobectomy (3). Lung volume reduction surgery (LVRS) is taken as an interventional therapy for severe emphysema caused by chronic obstructive pulmonary disease (COPD), smoking, or other factors. In LVRS, the damaged emphysematous upper lobe tissue is resected, in which the expiratory airway collapses, gas traps severely, and the alveolus is over-inflated. Then the remaining lung expands, and the patient’s symptoms like shortness of breath or dyspnea may improve (4,5). Objective: To describe the reproducible surgical and anesthesia techniques of lung volume reduction surgery (LVRS) under non-intubation. In addition, the advantages of modified non-intubated unilateral LVRS are also introduced in this article. Background: The perioperative complications and unsatisfied mortality of the typical LVRS under general anesthesia hinder the popularity of the surgery. In recent years, the concept of non-intubation has been introduced to LVRS. However, the reports and researches in this field are not so common. Methods: We searched current literature related to LVRS and non-intubated LVRS of recent 20 years in PubMed and compared different resection ranges and methods of LVRS under non-intubation. Conclusions: Our group reviewed the current papers in this field and found that the poor lung quality (and cardiac function in some cases) of the target patient is not the absolute contradiction to adopting the non-intubation anesthesia technique in LVRS. On the contrary, the non-intubated LVRS may be even safer and bring more benefits than the traditional operation method among selected patients. Furthermore, the modified non-intubated unilateral LVRS can reduce perioperative complications by comparing to the traditional bilateral LVRS. The LVRS on the opposite side is unnecessary if no significant progression is found by regular follow-up. In summary, the surgical team can make an attempt to non-intubation in LVRS after thorough evaluation.
非插管电视胸腔镜手术(NI-VATS)是在传统电视胸腔镜手术(VATS)基础上发展起来的。在NI-VATS中,避免深度麻醉,并使用面部或喉部插管代替普通的气管插管。患者术后不适感较少,恢复较快。自首次报道i -VATS楔形切除术以来,世界各地的外科团队已经将非插管的范围扩大到几乎所有类型的VATS治疗,如纵隔肿瘤切除术(1)、隆突重建术(2)、肺叶切除术(3)。肺减容手术(LVRS)被作为慢性阻塞性肺疾病(COPD)、吸烟或其他因素引起的严重肺气肿的介入治疗。在LVRS中,切除受损的肺气肿上叶组织,此时呼气气道塌陷,气体严重困住,肺泡过度充气。然后剩余的肺扩张,患者的呼吸短促或呼吸困难等症状可能会改善(4,5)。目的:探讨非插管下肺减容手术(LVRS)的可重复性手术及麻醉技术。此外,本文还介绍了改良的非插管单侧LVRS的优点。背景:典型LVRS在全身麻醉下的围手术期并发症和不满意的死亡率阻碍了手术的普及。近年来,LVRS引入了非插管的概念。然而,这方面的报道和研究并不多见。方法:检索PubMed近20年LVRS与非插管LVRS相关文献,比较非插管LVRS的不同切除范围和方法。结论:本组回顾了目前该领域的相关文献,发现目标患者肺质量差(部分病例存在心功能差)并不是LVRS采用非插管麻醉技术的绝对矛盾。相反,在选定的患者中,非插管LVRS可能比传统手术方式更安全,带来更多的益处。此外,与传统双侧LVRS相比,改进的非插管单侧LVRS可减少围手术期并发症。如果定期随访未发现明显进展,则无需对侧LVRS。综上所述,外科团队在对LVRS进行充分评估后,可以尝试不插管。
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引用次数: 0
Indication of uniportal video-assisted thoracoscopic surgery 单门静脉电视胸腔镜手术指征
IF 0.2 4区 医学 Q4 SURGERY Pub Date : 2021-01-01 DOI: 10.21037/vats-20-40
K. Hirai, J. Usuda
: Uniportal video-assisted thoracoscopic surgery (U-VATS) has been recognized as a one of minimally invasive surgery among thoracic surgeons. For some diseases such as some benign inflammatory diseases, mediastinal tumor, metastatic lung tumor, and lung cancer in thoracic surgery, U-VATS has already been applied. There is no definite indication of U-VATS even in lung cancer. According to the surgeon’s ability at the institute, indication of U-VATS for the lesion that is benign or malignant is determined at this moment. The clarification of indication of U-VATS is also essential for doing safe surgery. On the other hand, prognosis of U-VATS anatomical lung resection for early lung cancer remains still unclear in detail. Recently, U-VATS has been started to perform even in advanced lung cancer. In spite of the vague surgical outcomes of U-VATS, it is certain that indication of U-VATS has gradually expanded. Oncologically, there is a room to argue on U-VATS anatomical lung resection for lung cancer still more. Additionally, the application of U-VATS for advanced lung cancer possesses a little unreliable due to possibility of incomplete lymph node dissection. Because the unfavorable outcomes for the patients with lung cancer such as local recurrence and severe troubles during surgery causes, the clarification of indication of U-VATS is an urgent issue. Based on our experience, we reviewed the indication of U-VATS for lung cancer.
单门视频胸腔镜手术(U-VATS)已被公认为胸外科微创手术之一。对于胸外科中的一些良性炎性疾病、纵隔肿瘤、转移性肺肿瘤、肺癌等疾病,U-VATS已经得到了应用。即使在肺癌中也没有明确的U-VATS的适应症。根据外科医生在研究所的能力,此时确定U-VATS用于良性或恶性病变的适应症。明确U-VATS的适应症对安全手术也很重要。另一方面,U-VATS解剖肺切除术治疗早期肺癌的预后尚不清楚。最近,U-VATS在晚期肺癌患者中也开始发挥作用。尽管U-VATS的手术结果不明确,但可以肯定的是,U-VATS的适应症正在逐渐扩大。从肿瘤学角度看,U-VATS解剖肺切除术在肺癌中的应用仍有很大的争议空间。此外,U-VATS在晚期肺癌中的应用也存在不完全淋巴结清扫的可能性,存在一定的不可靠性。由于肺癌患者局部复发、手术过程中出现严重麻烦等不良后果,明确U-VATS的适应症是一个迫切需要解决的问题。根据我们的经验,我们回顾了U-VATS治疗肺癌的适应症。
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引用次数: 0
Risk prediction for lung cancer surgery in the current era 当代肺癌手术风险预测
IF 0.2 4区 医学 Q4 SURGERY Pub Date : 2021-01-01 DOI: 10.21037/vats-21-47
M. Taylor, G. Whittaker, S. Grant, R. Booton, R. Shah
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引用次数: 0
Mediastinal up-staging: risk factors and prognosis: a narrative review 纵隔前期:危险因素和预后:叙述性回顾
IF 0.2 4区 医学 Q4 SURGERY Pub Date : 2021-01-01 DOI: 10.21037/vats-21-24
D. Nachira, M. Chiappetta, E. Zanfrini, E. Meacci, M. Congedo, F. Lococo, M. Vita, L. Petracca-Ciavarella, D. Tabacco, C. Sassorossi, V. Porziella, S. Margaritora
Mediastinal nodal upstaging after surgical resection for nonsmall cell lung cancer (NSCLC) is defined as the finding of mediastinal node disease (pN2) at pathological staging in presumed clinical N0-1 tumors (1,2). Pathological mediastinal lymph node involvement is one of the most important prognostic factors in NSCLC and the main determinant for adjuvant therapy after surgery. The aim of this review is to analyze the principal risk factors for mediastinal nodal upstaging and to evaluate the prognostic implications for patients affected by NSCLC. Review Article
非小细胞肺癌癌症(NSCLC)手术切除后的纵隔结节直立是指在假定的临床N0-1肿瘤的病理分期发现纵隔结节疾病(pN2)(1,2)。病理性纵隔淋巴结受累是非小细胞肺癌最重要的预后因素之一,也是术后辅助治疗的主要决定因素。本综述的目的是分析纵隔淋巴结隆起的主要危险因素,并评估对NSCLC患者的预后影响。审阅文章
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引用次数: 0
Role and evidence for targeted therapies in surgically resectable non-small cell lung cancer: a narrative review 靶向治疗在可手术切除的非小细胞肺癌中的作用和证据:综述
IF 0.2 4区 医学 Q4 SURGERY Pub Date : 2021-01-01 DOI: 10.21037/vats-21-39
C. Escriu
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引用次数: 0
A narrative review of paraconduit hernia after esophagectomy: where are we now? 食管切除术后导管旁疝的叙述性回顾:我们现在在哪里?
IF 0.2 4区 医学 Q4 SURGERY Pub Date : 2021-01-01 DOI: 10.21037/vats-21-28
J. R. Mondoñedo, A. Chang
Objective: To discuss potential mechanisms and risk factors for the rise in incidence with MIE techniques as well as examine recent data supporting indications and techniques for repair of paraesophageal hernias. Background: Esophagectomy is the standard of care for surgically resectable esophageal cancers. Recent advances in minimally invasive esophagectomy (MIE) and hybrid techniques over the past several years have provided less morbid, oncologic equivalent strategies as compared with traditional open abdominal or transthoracic approaches. While this has generally led to improved patient outcomes, there has been a commensurate rise in the incidence of paraesophageal hernias, a known complication that is likely secondary to iatrogenic widening and instrumentation of the hiatus. Currently, indications and timing for repair of paraconduit hernias remain disputed. Methods: We performed a literature review of reports describing the incidence rate, operative techniques, and recent advances in the diagnosis and management of paraconduit hernias over the past decade. Conclusions: Incidence rates appear to be highest for the MIE transthoracic Ivor Lewis approach, although the increasingly utilized transhiatal robot-assisted esophagectomy may be associated with similar rates of hernia occurrence. Surveillance is a reasonable option for patients without symptoms, especially those with limited life expectancy given the nontrivial morbidity and recurrence rates after repair; however, laparoscopic surgical repair should be considered for symptomatic patients given the risk of rapid progression and subsequent perforation. Future work should examine surgical techniques for prevention of post-esophagectomy hernia.
目的:探讨MIE技术提高发病率的潜在机制和危险因素,并检查支持食管旁疝修补指征和技术的最新数据。背景:食道切除术是可手术切除的食道癌的标准治疗方法。在过去几年中,微创食管切除术(MIE)和混合技术的最新进展与传统的腹部或经胸入路相比,提供了较少的病态、肿瘤学等效的策略。虽然这通常会改善患者的预后,但食管旁疝的发病率也相应上升,这是一种已知的并发症,可能继发于医源性扩大和裂孔内固定。目前,导管旁疝修补的适应症和时机仍有争议。方法:我们对过去十年中导管旁疝的发病率、手术技术以及诊断和治疗的最新进展进行了文献综述。结论:尽管越来越多地使用经口机器人辅助食管切除术可能与类似的疝发生率有关,但MIE经胸Ivor-Lewis方法的发病率似乎最高。对于没有症状的患者,尤其是那些预期寿命有限的患者,监测是一个合理的选择,因为修复后的发病率和复发率很低;然而,考虑到快速进展和随后穿孔的风险,有症状的患者应考虑腹腔镜手术修复。未来的工作应该检查预防食管切除术后疝的手术技术。
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引用次数: 1
A narrative review on lymphadenectomy: from open to minimally invasive surgery 淋巴结切除术的叙述回顾:从开放到微创手术
IF 0.2 4区 医学 Q4 SURGERY Pub Date : 2021-01-01 DOI: 10.21037/vats-21-33
V. Aprile, Ilaria Ceccarelli, S. Korasidis, M. G. Mastromarino, D. Bacchin, E. Sicolo, M. Ambrogi, M. Lucchi
Lymphadenectomy plays a crucial role during surgical treatment for lung cancer and represents a cornerstone to assess staging and prognosis since lymph-nodes (LN) involvement is an important factor to define post-operative strategies and to predict oncological outcomes [namely overall survival (OS) and disease-free interval] (1,2). According to the 8th TNM edition of non-small cell lung Review Article
淋巴结切除术在肺癌手术治疗中起着至关重要的作用,是评估分期和预后的基石,因为淋巴结(LN)受累是确定术后策略和预测肿瘤预后的重要因素[即总生存期(OS)和无病间期](1,2)。根据第八期TNM版非小细胞肺综述文章
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引用次数: 3
Searching for evidence of VATS lung metastasectomy 寻找VATS肺转移切除术的证据
IF 0.2 4区 医学 Q4 SURGERY Pub Date : 2021-01-01 DOI: 10.21037/VATS-2020-LM-10
M. Migliore, Michel Gonzalez
We are pleased to introduce this issue devoted to video-assisted thoracic surgery (VATS) for lung metastases. Although not confirmed with prospective randomized trials, pulmonary resection(s) is the operation of choice for lung metastases with a relatively low postoperative complication rate. Nonetheless, the surgical approach to perform lung metastasectomy remains a point of debate as VATS or open transthoracic approach can both be performed. Though surgeons are looking for reliable data in favor of VATS for lung metastasectomy, there is scarce prospective data and most available practices raise questions (1) instead of giving answers. Nevertheless, after 10 years of ESTS project dedicated to lung metastases (2), this special issue dedicated to VATS metastasectomy, which also includes exceptional videos, will help to publicize important experiences, and will also stimulate young surgeons, oncologists and scientists to find new ideas for the future. There will also be an article which reports on the TNM classification for lung metastases which we initially proposed in 2016 (3). It could be an easy way to finally “personalize” the treatment of the difficult patients with lung metastases (4). One thing is certain, in the absence of scientific evidence that demonstrates that one approach (open or VATS) is better than the other, the less invasive approach should be chosen. Therefore, there is no doubt that VATS (uniportal, multiportal or subxiphoid) represents nowadays the most used “standard practice” to remove lung metastases. Nevertheless, surgeons should never forget that the fundamental goal of the procedure of lung metastasectomy is not the minimal invasiveness of the skin incision but the prolonged survival. We are in debt of gratefulness to the outstanding contributors for offering their knowledge and practice with lung metastasectomy. Finally, we would like to acknowledge Video-Assisted Thoracic Surgery (VATS) journal for allowing us organize this important special issue and for the exceptional work done by all the staff.
我们很高兴地介绍这期关于肺转移的电视胸腔镜手术(VATS)。尽管未经前瞻性随机试验证实,肺切除术是肺转移瘤的首选手术,术后并发症发生率相对较低。尽管如此,肺转移切除术的手术方法仍然是一个争论点,因为VATS或开放式经胸入路都可以进行。尽管外科医生正在寻找有利于VATS治疗肺转移切除术的可靠数据,但前瞻性数据很少,大多数可用的实践都提出了问题(1),而不是给出答案。尽管如此,经过10年专注于肺转移的ESTS项目(2),这期专注于VATS转移切除术的特刊,其中还包括特殊的视频,将有助于宣传重要的经验,也将激励年轻的外科医生、肿瘤学家和科学家为未来寻找新的想法。还有一篇文章报道了我们最初在2016年提出的肺转移的TNM分类(3)。这可能是一种简单的方法,最终“个性化”治疗肺转移的困难患者(4)。有一点是肯定的,在没有科学证据表明一种方法(开放式或VATS)比另一种更好的情况下,应该选择侵入性较小的方法。因此,毫无疑问,VATS(单门、多门或剑突下)是目前最常用的去除肺转移的“标准做法”。然而,外科医生永远不应该忘记,肺转移切除术的根本目标不是皮肤切口的最小侵袭性,而是延长生存期。我们感谢杰出的贡献者提供了他们在肺转移切除术方面的知识和实践。最后,我们要感谢视频辅助胸外科(VATS)杂志允许我们组织这一重要的特刊,并感谢所有工作人员所做的出色工作。
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引用次数: 0
Influence of mentorship on the duration and safety of robotic learning curve for anatomical lung resections 指导对解剖肺切除机器人学习曲线持续时间和安全性的影响
IF 0.2 4区 医学 Q4 SURGERY Pub Date : 2021-01-01 DOI: 10.21037/vats-21-38
M. Gómez-Hernández, M. Jiménez
The introduction of the surgical robotic system in 2000 supposed a major advancement in minimally invasive surgery and has become a disruptive technology in surgical practice (1,2). However, the adoption of new technologies such as robotics by practicing surgeons involves an unavoidable learning curve (3). Moreover, there is a belief that learning curves may have a negative impact on patient Original Article
2000年引入的手术机器人系统被认为是微创手术的重大进步,并已成为外科实践中的颠覆性技术(1,2)。然而,外科医生对机器人等新技术的采用涉及一个不可避免的学习曲线(3)。此外,有一种观点认为,学习曲线可能对患者产生负面影响
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引用次数: 0
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Video-Assisted Thoracic Surgery
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