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Ropivacaine for thoracoscopy-guided thoracic paravertebral block (TTPB) offers only a short duration of postoperative pain relief, which is inadequate for managing pain following thoracic surgery. Research has shown that combining dexamethasone with ropivacaine significantly prolongs the duration of analgesia from the nerve block. We hypothesised that TTPB with ropivacaine combined with dexamethasone would enhance postoperative analgesia and prolong the duration of analgesia in patients undergoing radical thoracoscopic lung cancer surgery. The study randomly assigned patients to either a control group (Group C, n = 40) or a dexamethasone group (Group D, n = 40). TTPB injection of ropivacaine or ropivacaine combined with dexamethasone prior to surgical sutures. The study compared postoperative pain satisfaction scores、48 h postoperative rescue analgesia frequency、visual analogue scale (VAS) scores, the 24-h patient-controlled analgesia (PCIA) sufentanil consumption, blood glucose levels, adverse events and recovery status. Group D demonstrated higher postoperative pain satisfaction scores and lower 48 h postoperative rescue analgesia frequency compared to Group C. Additionally, Group D had significantly lower VAS scores at 6, 12, 24, and 48 h post-operation, as well as a reduced 24-h PCIA sufentanil consumption, shorter time to first mobilization, and shorter hospital stay compared to Group C (all P < 0.05). The VAS scores at 2 h postoperatively were significantly lower in Group D compared to scores at 24 and 48 h postoperatively. Conversely, Group C showed significantly lower VAS scores at 2 h postoperatively compared to scores at 6, 12, 24, and 48 h postoperatively. The addition of dexamethasone as an adjuvant to ropivacaine enhanced the analgesic efficacy of TTPB, prolonged the duration of pain relief, and reduced the time to first ambulation and hospital stay duration.Trial Registry: ChiCTR (2400086347); Registered 28/06/2024., Competing Interests: Declarations. Ethics approval and consent to participate: This research project was approved by the Ethics Committee of the Lihuili Hospital, Affiliated to Ningbo University (Approval number: KY2023SL340-01). All participants included in the study signed their informed consents. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

With the increasing use of image-based 3D reconstruction in medical procedures, accurate scene reconstruction plays a crucial role in surgical navigation and assisted treatment. However, the monotonous colors, limited image features, and obvious brightness fluctuations of thoracoscopic scenes make the feature point matching process, on which traditional 3D reconstruction methods rely, unstable and unreliable. It brings a great challenge to accurate 3D reconstruction. In this study, a new method for implicit 3D reconstruction of monocular thoracoscopic scenes is proposed. The method combines a pre-trained metric depth estimation model with neural radiation field (NeRF) technique and uses dense SLAM to accurately compute the camera pose. To ensure the accuracy of the depth values and the structural consistency of the reconstructed scene, depth and normal constraints are added to the original color constraints of the NeRF network to achieve high-quality scene reconstruction results. We conducted experiments on the SCARED dataset and the clinical dataset. After comparing with other methods, the depth estimation accuracy and point cloud reconstruction quality of this paper outperform the existing methods. The method in this paper can provide more accurate 3D reconstruction of complex thoracic surgical scenes, which can significantly improve the accuracy and therapeutic efficacy of surgical navigation., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2025. International Federation for Medical and Biological Engineering.)

A 14-year-old, male castrated, Domestic Short Hair cat was presented for thoracic duct ligation via thoracoscopy. To optimise surgical visualisation, the surgeons requested one-lung ventilation. Because adequately sized bronchial blockers or fibreoptic bronchoscopes were not available, a modified single-lumen endotracheal tube guided by a novel method was used. The distance between the incisors, the carina and the mainstem bronchi was premeasured on a computed tomography scan. Once under general anaesthesia, one-lung ventilation was achieved by introducing a guidewire through a modified, previously extended endotracheal tube, confirming its advancement towards the left main bronchus with fluoroscopy, and subsequently advancing the endotracheal tube over the guidewire. Confirmation of one-lung ventilation was initially obtained by observation of unilateral thoracic excursions and later confirmed by thoracoscopic visualisation of right lung atelectasis. The manoeuvre was successfully completed in 8 minutes and no clinically significant complications occurred. Adequate ventilation was achieved using pressure control mode and positive end-expiratory pressure, and allowing permissive hypercapnia. After thoracic duct ligation, bilateral lung ventilation was resumed by slight withdrawal of the endotracheal tube. The cat was allowed to recover from anaesthesia and transferred to the intensive care unit. This report describes a novel method to achieve one-lung ventilation in a cat that may constitute a valid alternative when adequately sized bronchial blockers or fibreoptic bronchoscopes are not available., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To investigate symptom burden and symptom cluster trajectories in patients undergoing surgery for esophageal cancer., Methods: A convenience sample of 210 patients who underwent thoracoscopic surgery for esophageal cancer was included from July to December 2023. The symptoms of the patients were evaluated at the following time points: preoperatively (T0), 1-3 days postoperatively (T1), 7 days postoperatively (T2), 1 month postoperatively (T3), and 3 months postoperatively (T4). This was done via the Chinese version of the MD Anderson Symptom Scale and the Supplementary Questionnaire for Perioperative Esophageal Cancer Symptoms. Exploratory factor analysis was used to identify symptom clusters, and latent class growth modeling was used to analyze the trajectories of each different symptom cluster., Results: Exploratory factor analysis revealed the presence of four symptom clusters: mood-related symptom clusters (worst at T1, T2, and T4), gastrointestinal symptom clusters (worst at T0), fatigue-related symptom clusters (worst at T3), and surgery-related symptom clusters, with cumulative variance contribution rates of 64.34%, 62.29%, 68.23%, 70.29%, and 63.82%, respectively. The latent category growth model identified the existence of 2-3 distinct trajectories in each symptom cluster., Conclusion: This study identified 4 distinct symptom clusters in patients undergoing esophageal cancer surgery. The mood-related and gastrointestinal symptom clusters exhibited worsening and recurrence within 7 days post-surgery, necessitating particular attention. A subset of patients in the fatigue-related symptom cluster showed a tendency for continued exacerbation, emphasizing the need for long-term monitoring. Furthermore, symptom management strategies can be prioritized based on the severity of the symptom clusters., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: This study aimed to evaluate the characteristics of congenital lung malformations (CLMs) in patients from infancy to adulthood, and to determine the optimal timing for thoracoscopic surgery., Methods: All patients with CLMs who underwent thoracoscopic surgery between 2017 and 2023 were retrospectively reviewed. The patients were divided into five age groups: 1-6 months, 6-12 months, 1-4 years, 4-16 years, and >16 years. Clinical characteristics and surgical outcomes were compared and analyzed for variance among the age groups., Results: A total of 173 patients with CLM were included. Thirteen (7.5%) patients were categorized in the 1-6 months age group, 44 (25.4%) in the 6-12 months age group, 58 (33.5%) in the 1-4 years age group, 30 (17.3%) in the 4-16 years age group, and 28 (16.2%) in the > 16 years age group. The median age at surgery was 2.3 years (range: 1 month to 74 years). The operative time was shortest in the 1-4 years age group at 86.5 min (interquartile range: 57.3-131.5 min, p < 0.01). The results of the multivariate regression analysis indicated that age > 4 years (odds ratio [OR]: 8.70, p < 0.01) and previous infection (OR: 3.75, p < 0.01) increased the risk of operative adhesions, which increased the risk of major complications and conversion to open thoracotomy., Conclusion: Thoracoscopic surgery for CLMs is safe and feasible at all ages. Age < 4 years may predict uneventful surgical outcomes due to fewer operative adhesions., Competing Interests: Declarations. Ethics approval: This study was performed in accordance with the Declaration of Helsinki. This human study was approved by the Ethics Committee of China Medical University, approval no. 2018PS391K. Conflict of interest: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A 79-year-old man was found to have multiple nodules in the lung fields on chest computed tomography. Metastatic lung cancer was suspected; however, the primary site remained elusive. After 1 year of follow-up, both the nodules had enlarged. After 2 years, one of the nodules continued to enlarge; however, the other nodule cavitated and decreased in size. Concomitantly, the previously observed fluorodeoxyglucose uptake in the cavitated nodules disappeared. A comprehensive search for the primary cancer included a thoracoscopic lung biopsy which revealed that these nodules were metastatic lung lesions from prostate cancer. Pathological examination revealed necrosis within these metastatic lesions. To date, only three case reports of cavitary lung metastases from prostate cancer have been published; however, no explanation has been provided for the pathological mechanism of cavitation. To our knowledge, this is the first case to provide a potential explanation for cavitation in metastatic lung lesions from prostate cancer., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.)

Background: In select patients with type C esophageal atresia, primary anastomosis is not appropriate and a staged approach is required. We aim to summarize our experience in the management of type C EA using a staged approach., Methods: A retrospective chart-review of patients with type C EA admitted to Beijing Children's Hospital between July 2020 to October 2023 were conducted. Those diagnosed with type C EA who were not amendable to primary anastomosis were included for analysis. Clinical information was recorded, and follow- up was performed., Results: Seven (five boys) patients with type C EA who received staged repair were included in the study. Initial surgeries included thoracotomy and thoracoscopy. 71% (5/7) patient had complications after the initial surgery, including pyopneumothorax, pneumonia, recurrent tracheoesophageal fistula (rTEF), and anastomotic leak. Esophageal elongation techniques were applied in 3 patients. All delayed anastomosis were performed thoracoscopically, except for in one case where spontaneous fistulization occurred and no anastomosis were necessary. Complications after delayed anastomosis included recurrent esophageal pulmonary fistula (rEPF) in 50% (3/6), anastomotic leak in 33% (2/6), and esophageal stricture in all (6/6) patients. After a median follow-up of 14 months (range: 2-24), all patients were in generally good condition., Conclusion: Primary operations should be kept simple and minimal in patients diagnosed with type C EA who are not appropriate for primary anastomosis. Internal traction is an effective method that allows for subsequent anastomosis. Intraoperative indocyanine green fluorescence can aid in fistula determination and anastomosis., Competing Interests: Declarations. Ethics approval and consent to participate: Information obtained from the data of the study participants is kept confidential. To ensure confidentiality, the names of study participants were not included in the data. All studies were conducted in accordance with the Declaration of Helsinki. Due to the retrospective nature of this study, the need for informed consent was waived by the Medical Ethics Committee of Beijing Children’s Hospital (2019-K-333). This study does not include participants above 16 years of age. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Introduction: Lung cancer thoracoscopic postoperative wound complications bring great pain and inconvenience to patients., Methods: To provide clinical nurses with a more scientific and effective nursing plan, this study evaluated the effect of refined nursing on wound complications after thoracoscopic surgery for lung cancer. Two-hundred thirty patients undergoing thoracoscopic radical resection for lung cancer were randomly divided into two groups according to the random number table method. The study group received refined nursing intervention (115 cases), and the control group received routine nursing intervention (115 cases). The effects of the two groups' nursing modes on the wound complications (pleural effusion, incision infection, lung leakage, and wound bleeding) after thoracoscopic surgery for lung cancer were compared., Results: According to the study results, the study group experienced a shorter intraoperative blood loss, lower extubation time, shorter hospital stay, and lower wound complication rate than the control group (p < 0.05). Compared to the control group, the study group had significantly lower Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and visual analog scale (VAS) scores, and higher the short form 36 health survey questionnaire (SF-36) scores (p < 0.05)., Conclusion: Compared with the control group, the implementation of refined nursing intervention for patients with thoracoscopic radical resection of lung cancer has fewer postoperative wound complications and can improve patients' nursing satisfaction and quality of life, which is worthy of clinical promotion and application., (© 2025 The Author(s). The Clinical Respiratory Journal published by John Wiley & Sons Ltd.)

Objective: To evaluate the effectiveness of surgical approach for resection of retrosternal and intrathoracic goiter., Material and Methods: There were 33 patients who underwent surgery for retrosternal (31) and intrathoracic goiter (2) through various surgical approaches. For retrosternal goiter, a Farabeuf hook was used to remove a large retrosternal component of tumor., Results: In 28 cases (84.8%), substernal goiter was resected through cervical collar incision. In 4 cases, a Farabeuf hook was used to extract retrosternal part of the goiter to the neck and avoid sternotomy. In one case, a combined approach was used (thoracoscopy and cervical collar incision). Sternotomy was performed in only one patient for suspected thyroid malignancy. In two patients with tumors of posterior mediastinum, intrathoracic goiter was removed through thoracoscopic access., Conclusion: Cervical collar incision allows resection of retrosternal goiter in 84.4% of cases. Retrosternal part can be effectively displaced to the neck wound using a Farabeuf hook. Thoracoscopy is preferable for removal of intrathoracic goiter and can be used to mobilize a large node in mediastinum as an alternative to sternotomy.

Objective: Severe postoperative pain can occur after subxiphoid video-assisted thoracoscopic thymectomy (SVATT), affecting the quality of postoperative recovery. This study aimed to evaluate the effect of ultrasound-guided external oblique intercostal (EOI) block on recovery after SVATT., Methods: A total of 60 patients undergoing SVATT were randomly divided into the EOI group (group E, n = 30) and the control group (group C, n = 30). Group E underwent ultrasound-guided bilateral EOI block at the 6th rib level and was injected 20 mL of 0.375% ropivacaine on each side. Group C was injected with 20 mL of 0.9% saline at the same site. After the operation, both groups received a patient-controlled intravenous analgesic (PCIA) pump. The 15-item Quality of Recovery (QoR-15) scores were recorded at 24 hours before surgery (T0), 24 hours after surgery (T3), and 48 hours after surgery (T4). The sufentanil usage in the first 24 hours postoperatively, the remifentanil dosage during surgery, the time of first pressing PCIA, and the cases of rescue analgesia were recorded. The visual analog scale (VAS) scores of patients at 6 (T1), 12 (T2), 24 (T3), and 48 hours (T4) after an operation during rest and coughing were recorded. The dermatomes of the sensory plane, block complications in group E, and the incidence of other postoperative adverse reactions in both groups were also recorded., Results: Compared with group C, the QoR-15 scores of patients were significantly higher at T3 and T4 in the group E. The VAS scores were significantly lower at T1, T2, and T3 during rest and coughing in the group E. The sufentanil usage in the first 24 hours postoperatively, the remifentanil dosage during surgery, and the cases of rescue analgesia were significantly lower in group E, and the time of first pressing PCIA was significantly increased in group E (all P < .05)., Conclusion: Ultrasound-guided EOI block can be safely used in patients undergoing SVATT, which can improve the quality of postoperative recovery and reduce postoperative pain., (© 2024 The Author(s). Journal of Ultrasound in Medicine published by Wiley Periodicals LLC on behalf of American Institute of Ultrasound in Medicine.)

Background: In the absence of significant pleural effusion, conventional medical thoracoscopy (MT) is often not feasible due to the risk of lung injury. Dry MT mitigates these risks by inducing artificial pneumothorax through needle insufflation or blunt dissection. Although the Veress needle is commonly used by surgeons to create pneumoperitoneum before laparoscopic surgeries, its application in dry MT has not been widely reported in recent times., Methods: We report on a series of 31 patients who underwent dry MT with artificial pneumothorax induction using Veress needle under thoracic ultrasonography (TUS) guidance. A procedure was considered technically successful if it met all the following criteria: successful pneumothorax induction, allowing smooth insertion of the semi-rigid thoracoscope; absence of immediate significant procedural-related complications; and no delayed complications such as persistent air leaks, defined as leakage lasting more than 5 days necessitating extended chest tube placement., Results: Complete pneumothorax induction was achieved in 25 cases, resulting in an 80.6% technical success rate; however, biopsies were successfully performed in all cases. The most frequent histopathological diagnoses were malignancy (n=9, 29.0%), followed by inflammatory pleuritis (n=8, 25.8%) and tuberculosis (n=8, 25.8%). No procedural complications were reported., Conclusion: These results indicate that TUS-guided dry MT utilizing a Veress needle is technically feasible and secure when performed by experienced MT practitioners in TUS.

This study aimed to investigate the safety and effect of omitting chest tubes after thoracoscopic lobectomy in children with congenital lung malformation. A multicenter retrospective study was performed with 632 thoracoscopic lobectomy CLM patients in four hospitals between 2014.1 and 2023.1, which were divided into non-chest tube (NCT)group and chest tube (CT)group. Baseline data, operation and follow-up outcomes were compared. In total, 312 patients were included in the NCT group, and 320 in the CT group. There were no statistically significant differences in baseline data between the two groups. The FLACC scale score in the NCT group was less than the CT group (2.7 ± 0.43 vs. 5.8 ± 0.26 p = 0.027). The median length of postoperative hospital stay in the CT group was significantly longer than the NCT group (5 d vs.3 d, p = 0.045). Eight (2.5%) patients developed chest tube related infections in the CT group(p = 0.004). Six patients developed atelectasis in the NCT group, which was significantly less than the 18 patients in the CT group(p = 0.014). No chest tube placement in selected CLM pediatric patients may be safe and avoid chest tube-related complications, which may also contribute to a rapid recovery., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Statement of informed consent: Informed consent was obtained from all individual participants included in the study. Ethics approval: This study was approved by the Institutional Review Board and Ethical Committee of West China Hospital of Sichuan University in China (No.1284)., (© 2024. The Author(s).)

A cervical rib is the cause of ∼5% of thoracic outlet syndromes (TOS). We report the case of a patient with arterial TOS due to the presence of a cervical rib, managed by combined thoracoscopic and supraclavicular approach. An 18-year-old female patient presented with symptoms of arterial TOS. Magnetic resonance imaging and computed tomography angiography scans showed a tortuous subclavian artery due to a fused cervical and 1st rib. Three-port thoracoscopy was performed, which allowed to mobilize the ventral part of the 1st rib. Supraclavicular access allowed mobilization as well as central division of the ribs. After removal of the ribs, the subclavian artery presented a normal calibre and aspect. In recent years, there has been a trend towards minimally invasive approach to TOS, either by thoracoscopy or by robotic-assisted surgery. The advantages of this approach are the 'enbloc'-resection of both ribs and the possibility to evaluate the subclavian artery during the same procedure and perform repair if necessary., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Objective: The objective of this study was to evaluate the short-term outcomes of single-port thoracoscopic rib fracture reduction and internal fixation for the treatment of multiple rib fractures., Methods: This study included 149 patients with multiple rib fractures admitted to the Second People's Hospital Affiliated with Fujian University of Chinese Medicine between June 2021 and April 2024. The patients were divided into two groups based on the surgical method. The study group, consisting of 84 cases, underwent rib fracture reduction using a single-port thoracoscopy and internal fixation with a memory alloy reverse rib embrace device. The control group, consisting of 65 cases, underwent traditional open surgery for rib fracture internal fixation. Perioperative and follow-up data were collected and analyzed to assess incision length, total operation time, intraoperative blood loss, number of memory alloy embrasures placed, placement success rate, drainage tube placement time, time to mobilization, total hospitalization duration, total cost, preoperative and postoperative pain levels, postoperative complications, and rib CT results three months postoperatively., Results: There was no statistically significant difference in general conditions between the study group and the control group. All 149 patients successfully completed the surgery, with 3 to 10 intrathoracic memory alloy embrace devices placed in each patient, achieving a 100% success rate. Compared to the control group, the study group showed significant improvements in incision length (3.5 ± 0.6 vs. 6.5±1.6 cm), intraoperative blood loss (92.5 ± 15.1 vs. 113 ± 18.2 ml), drainage tube placement time (75.4 ± 13.1 vs. 90.6 ± 15.4 h), mobilization time (2.9 ± 1.1 vs. 3.3 ± 1.3 days), and hospital stay (10.8 ± 2.7 vs. 12 ± 3.5 days), with differences being statistically significant (P < 0.05). In terms of preoperative Visual Analogue Scale (VAS) pain scores, the study group had a significantly lower score on the first postoperative day compared to the control group (3.9 ± 1.1 vs. 4.5 ± 1.4, P < 0.05). A follow-up CT and 3D reconstruction at 3 months post-surgery showed that all patients had securely fixed plates, with the study group demonstrating a higher rate of excellent fracture healing (94% vs. 83.1%), which was statistically significant (P < 0.05)., Conclusion: The use of a memory alloy reverse rib embrasure device for intrathoracic rib fracture fixation via single-port thoracoscopic surgery is safe and reliable. This method demonstrates a high success rate of internal fixation, excellent clinical fracture healing, and advantages such as minimal trauma, rapid recovery, and the simultaneous treatment of other intrathoracic conditions. It significantly reduces postoperative pain and enhances the quality of life., Competing Interests: Declarations. Conflict of interests: The authors declare that they have no competing interests. Ethical approval: This study was approved by the Ethics Committee of The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Patients were consented by an informed consent process that was reviewed by the Ethics Committee of The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine and certify that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki., (© 2024. The Author(s).)

Pulmonary abscess is a rare but serious condition in pediatric patients, caused by severe pulmonary infection that leads to tissue destruction and necrosis. It can be classified as primary or secondary depending on the cause. Establishing an etiology in pediatric pulmonary abscesses is challenging, underscoring the essential role of advanced imaging techniques, such as computed tomography, in achieving an accurate diagnosis and differentiating among various conditions that may mimic lung abscess. While conservative management with antibiotics is the first line of treatment, some cases may progress and require surgical intervention. We present two clinical cases of pediatric lung abscesses, emphasizing the importance of timely intervention, accompanied by a brief review of current knowledge that highlights key clinical features, diagnostic challenges, and therapeutic approaches in pediatric lung abscess.

This meta-analysis aimed to compare the outcomes of video-assisted thoracic surgery (VATS) and open thoracotomy in pediatric patients undergoing pulmonary metastasectomy for various malignancies. We systematically searched PubMed, Embase, and Cochrane Library databases for studies comparing VATS and open thoracotomy in pediatric patients. The treatment effects for continuous outcomes were compared using mean differences (MDs), and binary endpoints were evaluated using odds ratios (ORs), with 95% confidence intervals (CIs). Heterogeneity was assessed with I 2 statistics. Statistical analyses were performed using R software, version 4.4.1. A total of 4 studies involving 1,541 patients were included. There were no significant differences in overall survival (OR 0.65; 95% CI 0.36-1.18; p = 0.16) or disease-free survival (DFS) (OR 1.65; 95% CI 0.88-3.10; p = 0.12) between groups. However, VATS was associated with a significantly reduced length of hospital stay (MD -2.06 days; 95% CI - 2.93 to - 1.20; p < 0.01). This meta-analysis suggests that VATS significantly reduces hospitalization duration compared to open thoracotomy, with no significant difference in survival outcomes. Future prospective studies are needed to validate these findings and optimize patient selection criteria. International Prospective Register of Systematic Reviews; No: CRD42024581284; URL: https://www.crd.york.ac.uk/prospero/ ., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: This work aims to describe the evolution of the video-assisted Thoracoscopic Surgery (VATS) approach from a multiportal access to a biportal access for thoracic herniated disc surgery. Thoracic disc herniation remains a challenging pathology for spine surgeons. VATS of the thoracic spine was described in the 90s and represented an important technical leap by including minimally invasive options for thoracic pathology. Nowadays, VATS in thoracic surgery tends to evolve towards an even less invasive technique, from a multiportal approach to a biportal one., Methods: We describe the adoption of this approach for our spinal pathology in 3 patients. We use a two-port VATS. The largest (approximately 5 cm) with an Alexis retractor and a second port (1.5 cm) just for the camera., Results: The 3 patients started walking in less than 24 hours and none suffered any complications related to the approach. All of them reported tolerable pain at the surgical site. Changing our previous VATS system from 3 to 5 ports was relatively easy regarding the surgical technique., Conclusions: This access allows the surgeon to manipulate the instrumentation confidently and the camera does not fog up as often. Extracting a piece of rib is unnecessary and theoretically, we only manipulate 1 or at most 2 intercostal nerves, so the patient's recovery is favorable., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: Cardiac injury during the Nuss procedure is a rare risk that can lead to a catastrophic outcome. The specific aim of this pilot study was to evaluate the safety and efficacy of simultaneous bilateral thoracoscopy (SBT) compared to standard unilateral right thoracoscopy (RT) in children undergoing the Nuss procedure in order to mitigate that risk., Methods: IRB approval was obtained to analyze data on children who underwent SBT and RT during the Nuss procedure. Data retrieval included age, gender, Haller index (HI), operative time (OT), length of stay (LOS), complications and follow up., Results: From August 2022 to August 2023, 10 children who underwent SBT were compared to 10 children who underwent RT. Both groups underwent intercostal nerve cryoablation. Following completion of cryoablation, SBT or RT was carried out during the Nuss procedure. SBT allowed for the tip of the bar passer to be visualized during the entire dissection in both thoraces. There was no significant difference in either group with respect to age, HI, OT, LOS. There were no anesthetic or surgical complications in either group., Conclusion: We found that SBT is safe, effective and allows for 100% visualization of the tip of the bar passer during the entire critical phase of the Nuss procedure. It does not impact OT or LOS compared to children who underwent only RT. SBT may benefit children who undergo the Nuss procedure by reducing the risk of cardiac injury., Type of Study: Original Research Retrospective Case-control study., Competing Interests: Conflict of interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

A 6-year-old boy was referred with complaints of chest pain for 2 months with low-grade fever. A computerized tomography of the chest revealed a loculated pleural effusion on the left side. Medical thoracoscopy was performed that revealed a characteristic sago-grain follicle over the parietal pleural. Histopathology and microbiological investigations on pleural biopsy samples confirmed tubercular pleural effusion., (© 2024 Wiley Periodicals LLC.)

Background: The aim was to evaluate short- and long-term outcomes for thoracoscopic repair of EA/TEF and compare with open repair., Methods: Patients who underwent EA/TEF repair during 2000-2020 were evaluated retrospectively. Patients with delayed repair were excluded. Demographic, operative, outcome data was collected. Outcomes were compared using Wilcoxon-rank sum tests for continuous, Chi-squared/Fisher's exact tests for categorical data., Results: There were 104 patients with primary repair, 49 (47.1%) underwent thoracoscopic repair per surgeon's choice. Type C accounted for 101 (97.1%) of the cases. Gestational age and birth weight were higher in the thoracoscopy group (p = 0.001). The rate of ≥3 VACTERL anomalies was higher in the OR group (p = 0.016). Operative time, rate of anastomotic leak, time to first oral feeding were similar (p > 0.05). Thoracoscopy group had decreased length of ventilation (p = 0.026) and length of stay (p = 0.029). The incidence of anastomotic stricture was higher in the thoracoscopy group (p = 0.012). Recurrent TEF was one case in each group. Rates of tube feeding at discharge and in first year were similar (p > 0.05), rate in third year was decreased (p = 0.032) in the thoracoscopy group. Rates of anti-reflux medication in first and third years, and fundoplication rate were similar (p > 0.05)., Conclusions: Many of the short- and long-term outcomes are comparable between thoracoscopic and open repair of EA/TEF. Length of ventilation, length of stay are decreased in the thoracoscopy group. Anastomotic stricture is higher, the need for long-term tube feeding is lower after thoracoscopic repair. Although these results could be affected by selection bias, they are still promising for advancing thoracoscopic repair of EA/TEF safely and efficiently., Level of Evidence: Level III., Competing Interests: Conflict of interest All authors declare that they have no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Pulmonary sequestration (PS) is a rare lung malformation seldomly accompanied by aneurysmal deformation of its arterial vasculature. This is a first report of aneurysmal PS presenting with acute aneurysmal rupture. The ruptured aneurysm was treated uneventfully by emergency endovascular coiling, and thoracoscopic hemothorax drainage., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Thoracoscopic surgery training is a critical area in medical education, and understanding the trends and focus areas in this field is vital for enhancing training programs and guiding future research. The study aimed to retrospectively analyze the effects of two training methods for new students in actual thoracoscopic surgery and to summarize the development and trends of research in thoracoscopic surgery training through a bibliometric analysis of the relevant academic literature., Methods: 72 cases of thoracic surgery students were retrospectively analyzed and divided into observation group (n=36) and control group (n=36) according to different periods. The trainees in the control group underwent conventional instruction via book-based mapping of the chest anatomy, and those in the observational group were educated via preoperative interpretation of chest computed tomography (CT) 3D reconstruction combined with review of the related surgical videos and thoracoscopic procedures. The efficacies of these two methods were evaluated and assessed upon completion of the training session. Additionally, a comprehensive literature search was conducted on the Web of Science Core Collection (WoSCC) on May 27, 2024. VOSviewer, CiteSpace and the R-based online toolkit Shiny were employed for the bibliometric analysis, which facilitated the visualization of collaborations, keyword co-occurrences, and emerging research trends., Results: The intraoperative performance of the trainees in the observational group was significantly better than that of those in the control group in practice, including positioning and directing the shaft of the thoracoscope, interference with other devices, conversion of the near and far views, correct orientation of the lens, ensuring the operating point projected at the center of the video, cooperation with the operator, image clarity, stability of the video, the angle of the video camera lens and adjustment of the lens angle, among others (all P values <0.05). A total of 956 articles published from 1992 to 2024 were included in the study. These publications were contributed by 5,217 authors from 2,603 institutions across 289 countries. Hansen Henrik Jessen was identified as one of the most prolific authors. The University of Copenhagen emerged as the most productive institution. The journal Annals of Thoracic Surgery was identified as a prominent publisher in this field. The keyword "experience" was the most frequently occurring term., Conclusions: Preoperative interpretation of chest CT 3D reconstruction combined with the review of surgical videos for training the camera holders in thoracic surgery can greatly improve the performance and accelerate the training of the assistant during the procedure. Additionally, this bibliometric analysis highlight the importance of clinical experience and the integration of new surgical techniques and training methods. Future research should focus on advanced training methods and simulation-based learning to accelerate skill acquisition and proficiency., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-1913/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Background: With the continuous development of minimally invasive thoracic surgery, thoracoscopic thymectomy has become a routine operation. This method, now widely recognized, better protects lung function, reduces intraoperative blood loss and pain, and shortens postoperative hospital stay. We now introduce a standardized right thoracic incision for thoracoscopic thymic tumor resection, which has achieved favorable clinical outcomes., Methods: This retrospective study involves 63 patients who underwent standardized right thoracic incision for thoracoscopic thymic tumor resection from October 2022 to January 2024. We analyzed the relevant clinical data, including postoperative pathological diagnosis, operation time, intraoperative blood loss, chest tube drainage duration, postoperative hospital stay, and follow-up data., Results: All 63 patients underwent thoracoscopic surgery. Thoracoscopic surgery excised thymic tumors and mediastinal fat in 62 cases, while 1 case of thymic carcinoma underwent thoracoscopic biopsy due to invasion of the superior vena cava and innominate vein. Postoperative pathological diagnosis revealed thymoma in 35 cases (33 cases of thymoma and 2 cases of thymic adenocarcinoma). R0 resection was achieved in 33 cases and R1 resection in 1 case. Additionally, 2 patients diagnosed with thymic adenocarcinoma were advised to undergo postoperative radiotherapy. Postoperative pathological diagnosis of the other 28 cases showed thymus hyperplasia in 13 cases and thymus cysts in 15 cases. The mean operation time was 57.3 ± 14.2 min, and intraoperative blood loss was 22.5 ± 14.7 ml. The mean chest tube drainage duration was 2.7 ± 1.3 days, and the postoperative hospital stay was 3.7 ± 1.4 days. No secondary operations were required, and no severe complications or mortality were observed during the perioperative period. All patients were discharged smoothly after surgery. Ten patients were not followed up due to recent surgery. The remaining 53 patients were followed up for 6 to 12 months, with no recurrence or distant metastasis observed., Conclusion: The standardized right thoracic incision for thoracoscopic thymic tumor resection simplifies the procedure of thymectomy. The operation's risk points are relatively fixed, making it safe and feasible. It is easy for the operator to master, and the thymic tumor resection rate is high. It possesses characteristics of being minimally invasive, enabling rapid recovery, having fewer complications, and requiring simple perioperative management., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board and Ethics Committee of the Dehong People’s Hospital, Affiliated Dehong Hospital of Kunming Medical University (2022DY002). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: This study aimed to compare the clinical efficacy of thoracoscopy combined with transforaminal endoscopy and thoracoscopy alone in the treatment of thoracic tuberculosis., Methods: Patients with thoracic tuberculosis who visited our hospital from February 2018 to October 2022 were retrospectively analyzed. The patients were divided into thoracoscopic combined transforaminal endoscopic surgery group (group A) and thoracoscopic surgery alone group (group B) according to the surgical methods. Surgery-related information, VAS score, ODI score, degree of spinal cord function improvement, fusion time, and progression of kyphotic deformity were compared., Results: A total of 37 patients were included, 16 in group A and 21 in group B. Postoperative follow-up time was 10-48 months, with an average of 28.62 ± 10.53 months. All patients had significant improvement in chest and back pain and spinal cord function after the operation. There were statistical differences in operation time, intraoperative blood loss, incidence rate of complications, and JOA score at 1 week and 3 months after operation between the two groups (P<0.05). There was no significant difference in VAS, ODI score, kyphotic angle correction, kyphotic correction loss angle, postoperative drainage volume, and fusion time between the two groups (P>0.05). All patients had no recurrence of thoracic tuberculosis during follow-up., Conclusion: Thoracoscopy combined with transforaminal endoscopy produce equivalent long-term results with shorter operation time, less intraoperative blood loss, less complications and higher surgical safety comparing to thoracoscopy alone. And thoracoscopy combined with transforaminal endoscopy can fully decompress and facilitate the early recovery of spinal cord function., Competing Interests: Declarations Ethics approval and consent to participate This study involving human participants were reviewed and approved by Ethics Committee of the Yichang Central People’s Hospital. No. 2024-046-01. All methods were performed in accordance with the Declaration of Helsinki and the relevant guidelines and regulations. Informed consent to participate was waived by the Ethics Committee of the Yichang Central People’s Hospital due to the retrospective nature of the study design. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Malignant pleural effusion is the presence of malignant cells within the pleural fluid, representing the second most common cause of pleural exudate. Although diagnostic methods and management techniques for malignant pleural effusion have dramatically improved over the decades, the current treatment is still palliative, aiming to remove pleural fluid, possibly prevent its recurrence, and alleviate symptoms through a wide range of available procedures. Treatment should be tailored to the individual patient, considering comorbidities, size of the effusion, rate of fluid accumulation, underlying cardiac or respiratory conditions, rate of recurrence, presence of loculations or trapped lung, tumor characteristics, cancer type, and patient preferences. This manuscript aims to review the available literature and to present the latest evidence on malignant pleural effusion management in order to provide an updated perspective on its diagnosis and treatment.

Implications of repeated resections of pulmonary metastasis (PM) are not well documented in the modern era. Fifteen children underwent two (n = 8), three (n = 3), or four or more (n = 3) resections (total = 38 procedures), most commonly for osteosarcoma (71%). Operative approach included muscle-sparing thoracotomy (71%), non-muscle-sparing thoracotomy (18%), and video-assisted thoracoscopy (11%). Median resected nodules per procedure was four (range = 1-95). Prolonged air leaks were the most common postoperative complication (29%). Median hospital stay was 4 days, and no children were discharged with or have required oxygen. Event-free survival is 67% at median follow-up time of 54 months, with an overall survival rate of 64%. Repeat resection of PM appears to be well tolerated, without prolonged hospital stays or compromised pulmonary function., (© 2024 The Author(s). Pediatric Blood & Cancer published by Wiley Periodicals LLC.)

Background and Objectives: Malignant pleural effusions (MPE) are a frequent and major turning point in neoplastic disease usually leading to poor life expectancy. Improve quality of life and relieve the dyspnea are the main objectives in this palliative care setting. This can be achieved by the placement of an indwelling catheter (IPC) or talc pleurodesis ideally performed by thoracoscopy route (talc poudrage). Beside to misidentify a trapped-lung, the latter requires a prolonged hospital stay and the IPC placement does not allow a high pleurodesis rate. To overcome these drawbacks, a combination of both technique could be proposed for the management of recurrent malignant pleural effusions. Safety and efficacy of this pragmatic approach are reported., Methods: Consecutive patients who have been managed for recurrent MPE by a combination of talc poudrage for pleural symphysis by thoracoscopy route ending with the insertion of IPC using the same thoracic point of entry. Demographic data, hospital length of stay (LOS), procedural-related complications, patients' quality of life (QoL) and success of pleurodesis were collected. Patients were followed-up for 6 months., Results: The data of twenty-five consecutive patients undergoing the procedure were analyzed. Successful pleurodesis was obtained for 14/25 patients (66 %) at one month, 17/20 patients (85 %) at 3 months and 13/15 patients (86 %) at 6 months respectively. On average, the hospital LOS after the procedure was 3.24 days (IQR 1-4) with a median of 1 day. A prolonged hospitalization (>1 day) was never due to the procedure except for one patient (pneumothorax). No IPC related infection or procedure related deaths were noted., Conclusion: Among patients with recurrent MPE, the combination of talc poudrage symphysis by thoracoscopy route and IPC placement on the same time results in a shortened hospital LOS and higher rate of pleurodesis. Further randomized clinical trials are needed to confirm these results., Competing Interests: Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

A 58-year-old woman was pointed out an abnormal electrocardiogram during a physical examination. A chest computed tomography( CT) scan revealed a 50-mm-sized cystic mass in the posterior mediastinum near the tracheal bifurcation. The mass exhibited growth during follow-up imaging, leading to a surgical resection. The tumor appeared as a smooth mass lesion with milky white and turbid internal content, suggestive of a chyle. The presence of a contiguous lymphatic duct and positive CD31 staining on histopathological examination confirmed the diagnosis of a thoracic duct cyst. Thoracic duct cysts have the risk of rapid growth and rupture, so in addition to checking for the appearance of new subjective symptoms, we suggest that surgical treatment should be considered if a tendency toward enlargement is observed as part of a shorter-than-usual imaging follow up. Careful identification and management of the thoracic duct flowing into and out of the tumor are important to prevent postoperative complications, especially chylothorax.

Introduction: Minimally invasive surgery (MIS) is gaining traction as a first-line approach to repair congenital anomalies. This study aims to evaluate outcomes for neonates undergoing open versus MIS repairs for esophageal atresia/tracheoesophageal fistula (EA/TEF)., Methods: In this retrospective study, neonates undergoing EA/TEF repair from 2013 to 2020 were identified using the National Surgical Quality Improvement Program-Pediatric database. Proportions of operative approach (open vs. MIS) over time were analyzed. A propensity score-matched analysis using preoperative characteristics was performed and outcomes were compared including composite morbidity and reintervention rates (overall, major [thoracoscopy, thoracotomy], and minor [chest/feeding tube placement, endoscopy]) between operative approaches. Pearson's chi-square or Fisher's exact tests were used as appropriate., Results: We identified 1738 neonates who underwent EA/TEF repair. MIS utilization increased over time. Pre-match, neonates undergoing open repair were more likely to be premature, lower weight, ventilator dependent, and have cardiac risk factors with higher severity. Post-match, the groups were similar and included 340 neonates per group. MIS repair was associated with longer median operative time (209 vs. 174 min, p < 0.001) and increased overall post-operative intervention rates (7.6% vs. 2.9%, p = 0.01). There were no differences in composite morbidity (24.4% vs. 25.0%, p = 0.86) outside of reintervention., Conclusion: MIS approach for neonates with EA/TEF appears to be associated with a higher rate of reinterventions. Further studies evaluating MIS approaches for the repair of EA/TEF are needed to better define short- and long-term outcomes., Type of Study: Retrospective comparative study., Level of Evidence: Level III., Competing Interests: Conflicts of interest The authors declare there are no competing interests associated with this study., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aim: Esophageal atresia (EA) is the most common congenital esophageal malformation. Thoracoscopic repair is gaining popularity, but controversy persists regarding the ideal surgical approach for this challenging anomaly. This study's aim is to analyze outcomes in terms of quality of life (QoL) of children undergoing thoracotomy and thoracoscopy for type III EA repair., Methods: Perinatal characteristics, malformations, surgical procedures, complications, gastrointestinal, and respiratory current symptoms were collected. QoL was investigated through Esophageal-Atresia-QoL (EAQoL) and Pediatric-QoL (PedsQL) 4.0 standardized and validated questionnaires. Statistical Mann-Whitney test with significance level p < 0.05 was carried out., Main Results: A total of 32 patients undergoing type III EA primary repair answered the questionnaire, including 17 thoracotomy and 15 thoracoscopy. Median birth weight was not significantly different between two groups (median [2.385; 2.475], p = 0.3529) while gestational age showed statistically difference (median [36; 38], p = 0.0063). Thirty-five associated malformations (15 thoracotomy, 20 thoracoscopy) in 23 patients were observed. Postoperative complications occurred in nine patients in the thoracotomy group (one recurrent fistula, two leakages, six stenosis) and in six patients in the thoracoscopic group (two recurrent fistula, four stenosis). Analyzing EAQoL, we found statistically significant difference in physical health between the two groups (median [83; 96], p = 0.0119), while there was no difference in social relations, eating, and total score (median [100; 100], p = 0.3473) (median [91; 97], p = 0.5749) (median [91; 96], p = 0.1710). Investigating PedsQL, psychosocial health score (median [88; 98], p = 0.0069), and total score (median [91;99], p = 0.0043) were statically significant different between the groups, whereas there was no difference for physical health score (median [91; 100], p = 0.0706)., Conclusions: Thoracoscopic EA repair is safe and feasible, allowing patient to have a better QoL in terms of physical and psychosocial health score.

Background: Pectus excavatum is the most common chest wall deformity, with the Nuss procedure being the preferred surgical approach for correction. However, the decision to use thoracoscopic assistance remains challenging. This study aimed to evaluate the perioperative outcomes of thoracoscopic-assisted versus non-thoracoscopic-assisted minimally invasive repair of pectus excavatum (TA-MIRPE vs. NTA-MIRPE)., Methods: A comprehensive search was conducted across PubMed, Medline, Embase, WOS, and CBM databases for studies published from 2010 to the present related to this topic. Meta-analysis was performed using RevMan 5.0 and STATA 15.0, with primary comparisons focusing on postoperative complications and the incidence of poor incision healing., Results: Eighteen studies involving a total of 5933 patients were included in the analysis, with 1670 undergoing non-thoracoscopic surgery and 4263 receiving thoracoscopic surgery. The meta-analysis revealed that, compared to the NTA-MIRPE group, the TA-MIRPE group had longer operation times [SMD = 1.71, 95% CI (1.14, 2.28), P < 0.001] and extended postoperative hospital stays [SMD = 0.12, 95% CI (0.04, 0.20), P = 0.004]. However, the TA-MIRPE group showed a lower incidence of postoperative complications [OR = 0.48, 95% CI (0.35, 0.65), z = 4.63, P < 0.001] and higher patient satisfaction [OR = 1.88, 95% CI (1.32, 2.67), z = 3.51, P < 0.001]., Conclusion: While TA-MIRPE is associated with longer operation times and hospital stays, it offers greater patient satisfaction, reduces postoperative complications, and enhances surgical safety., (© 2024. The Author(s).)

Background: Tubercular Pleural effusion (TBPE) is one of most common extrapulmonary tuberculosis. It can be difficult to diagnose due to low sensitivity of pleural fluid smear, culture and CBNAAT. Diagnosis of TBPE is then dependent on the level of pleural fluid Adenosine Deaminase (ADA). Thoracoscopic pleural biopsy gives definite diagnosis specially in Low Pleural fluid ADA setting., Aims and Objective: This study was planned to find out the prevalence of tubercular etiology in patients of exudative pleural effusion with low ADA (ADA <40 IU/L)., Material and Methods: A Prospective, observational study was carried out in a tertiary teaching institute in north India. Total 142 patients of pleural effusion with low ADA were enrolled. All patients underwent rigid thoracoscopy for confirmation of their diagnosis., Results: Out of 142 patients, male were 78 (55%) and female were 64 (45%). Mean age of patients were 57.4 years. Tuberculosis was diagnosed as a cause of effusion in 22 (15.5%) out of 142 patients. Majority of TBPE patients had pleural thickening as thoracoscopic finding. Mean ADA level in TBPE was 27.36 ± 11.6 as compared to 18.55 ± 9.02 in non tubercular pleural effusion patients and this difference was significant statistically (P- 0.002)., Conclusion: The diagnosis of patients having exudative, low ADA pleural effusion can be very easily confirmed by thoracoscopy guided pleural biopsy which has a very high diagnostic yield., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2023 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: Malignant pleural effusion (MPE) is a common cancer complication. Clinical and economic implications of different recurrent MPE treatment pathways have not been evaluated fully., Research Question: What clinical outcomes, complications, health care resource use, and costs are associated with various rapidly recurrent MPE treatment pathways?, Study Design and Methods: This retrospective cohort study using Surveillance, Epidemiology and End Results Medicare data (2011-2015) included patients 66 to 90 years of age with rapidly recurrent MPE. Rapid recurrence was defined as receipt of a second pleural procedure within 14 days of the first thoracentesis, including nondefinitive repeated thoracentesis or a definitive treatment option including chest tube, indwelling pleural catheter (IPC), or thoracoscopy., Results: Among 8,378 patients with MPE, 3,090 patients (36.9%) had rapidly recurrent MPE (mean ± SD age, 75.9 ± 6.6 years; 45.6% male; primary cancer, 62.9% lung and 37.1% other). Second pleural procedures were nondefinitive thoracentesis (62.3%), chest tube (17.1%), IPC (13.2%), or thoracoscopy (7.4%). A third pleural procedure was required more frequently if the second pleural procedure was nondefinitive thoracentesis vs chest tube placement, IPC placement, or thoracoscopy (70.3% vs 44.1% vs 17.9% vs 14.4%, respectively). The mean number of subsequent pleural procedures over the patient's lifetime varied significantly among the procedures (1.74, 0.82, 0.31, and 0.22 procedures for patients receiving thoracentesis, chest tube, IPC, and thoracoscopy, respectively; P < .05). Average total costs after the second pleural procedure to death adjusted for age at primary cancer diagnosis, race, year of second pleural procedure, Charlson comorbidity index, cancer stage at primary diagnosis, and time from primary cancer diagnosis to diagnostic thoracentesis were lower with IPC ($37,443; P < .0001) or chest tube placement ($40,627; P = .004) vs thoracentesis ($47,711). Patients receiving thoracoscopy ($45,386; P = .5) incurred similar costs as patients receiving thoracentesis., Interpretation: Early definitive treatment was associated with fewer subsequent procedures and lower costs in patients with rapidly recurrent MPE., Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: C. G., M. J., M. W., S. X., A. T., and E. E. are employees of Becton, Dickinson, and Company. D. E. O. is a consultant for Becton, Dickinson, and Company, and author for UpToDate, on the test writing committee for the American Board of Internal Medicine, and an intuitive surgical consultant for Johnson and Johnson., (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Introduction: Diaphragmatic hernia is most commonly congenital; however, it can also be acquired, most often due to trauma. It is a life-threatening condition resulting in abdominal visceral incarceration and subsequent mortality., Presentation of Case: Our patient was a 27-year-old mother who presented with upper abdominal pain associated with breathlessness. There was no history of trauma. The chest X-ray suggested the diagnosis of a diaphragmatic hernia which was further confirmed on CT. The decision was made to operate on the patient through a laparoscopic approach using single-lung ventilation. A diaphragmatic rent was identified with the incarceration of the stomach and omentum. The rent was widened further which allowed partial reduction of contents and visualization of the left hemithorax which was entirely contaminated. An additional thoracic approach was opted for which enabled reduction of the herniated stomach. A large perforation was present along the greater curvature, which was resected using a linear endo stapler. The diaphragmatic rent was then repaired primarily. Adequate lavage, aspiration, and mopping were performed along with chest tube drainage. The patient remained stable post-operatively., Discussion: An optimal surgical repair along with sound perioperative care is essential for the successful management of diaphragmatic hernia. A minimally invasive approach avoided extensive open surgery and the complications that would come with it for a young nursing mother., Conclusion: Such technically challenging cases can be successfully managed with a minimally invasive approach using sound surgical skills and necessary improvisations., Competing Interests: Conflict of interest statement The authors have no sources of funding or conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Pulmonary sequestration is a rare pulmonary malformation that often necessitates surgical intervention due to potential complications such as recurrent infections or hemoptysis. This case series presents the clinical trajectory of four patients diagnosed with pulmonary sequestration, from initial diagnosis through postoperative care, with a specific focus on the limited arterial supply in two of the cases. Materials and Methods: We conducted a retrospective descriptive analysis of four patients diagnosed with pulmonary sequestration who underwent surgical treatment at our institution between January 2013 and November 2022. The affected lung segments were excised via either thoracoscopy or thoracotomy. We evaluated perioperative and postoperative complications, hospital stay duration, histological findings, and the vascular supply of the affected areas. Results: Thoracoscopic surgery was initially preferred for all patients, though one required conversion to an open procedure due to technical challenges. Perioperative complications included increased pain and atelectasis. Two patients developed pleural empyema postoperatively, necessitating additional surgical intervention. The overall outcomes were favorable, with appropriate management addressing the complications effectively. Conclusions: Pulmonary sequestration, despite its rarity, often requires surgical treatment. Both thoracoscopic and open surgical methods are effective, though thoracoscopic surgery is generally preferred when feasible. The findings underscore the importance of meticulous preoperative planning and vigilant postoperative care to manage and mitigate potential complications.

Objectives: Thrombocytosis is a clinical condition generally associated with poor prognosis in patients with cancer. Thrombocytosis may be present after lung cancer resection, but the clinical significance of thrombocytosis remains unclear. Herein, we evaluated whether postoperative thrombocytosis was a negative prognostic factor in patients undergoing thoracoscopic lobectomy for lung cancer., Methods: It was a retrospective monocentric study including consecutive patients undergoing thoracoscopic lobectomy for lung cancer from January 2020 to January 2023. The outcome of patients with postoperative thrombocytosis (defined as platelet count ≥ 450 × 10^9/L at 24 h after the surgery and confirmed at postoperative day 7) was compared with a control group. Postoperative morbidity, mortality, and survival were compared between the two groups to define whether thrombocytosis negatively affected outcomes., Results: Our study population included 183 patients; of these, 22 (12%) presented postoperative thrombocytosis: 9 (5%) mild thrombocytosis (451-700 × 10^9/L), 10 (5%) moderate thrombocytosis (701-900 × 10^9/L), and 3 (2%) severe thrombocytosis (901-1000 × 10^9/L). No significant differences were found regarding postoperative morbidity (p = 0.92), mortality (p = 0.53), overall survival (p = 0.45), and disease-free survival (p = 0.60) between the two study groups. Thrombocytosis was associated with higher rate of atelectasis (36% vs. 6%, p < 0.001) and residual pleural effusion (31% vs. 8%, p = 0.0008). Thrombocytosis group was administered low-dose acetylsalicylic acid for 10 days and no thrombotic events were observed. In all cases the platelet count returned to be within normal value at postoperative day 30., Conclusions: Postoperative thrombocytosis seems to be a transient condition due to an inflammatory state and it does not affect the surgical outcome and survival after thoracoscopic lobectomy., (© 2024. The Author(s).)

Indocyanine green has been used in clinical practice for a long time because of its many advantages such as stable coloration, safety and cheapness. With the widespread development of thoracoscopic technology, thoracic surgeons have a higher demand for the identification of lesions and tissue structures under the thoracoscope, and the traditional white light imaging can no longer fully meet the needs of thoracic surgeons. In this situation, indocyanine green combined with NIR imaging technology has brought great help to thoracic surgeons. For example, indocyanine green plays an important role in the localization of small pulmonary nodules, the imaging of intersegmental lung planes, the imaging of thoracic ducts, and the assessment of blood supply to the tubular stomach. In this paper, we review the application of indocyanine green in thoracic surgery according to the related research and application at home and abroad., Competing Interests: Declaration of competing interest The authors declare that there are no conflflicts of interest., (Copyright © 2024 Asian Surgical Association and Taiwan Society of Coloproctology. Published by Elsevier B.V. All rights reserved.)

Background: Postoperative time to extubation plays a role in prognosis after heart valve surgery; however, its exact impact has not been clarified. This study compared the postoperative outcomes of minimally invasive surgery and conventional sternotomy, focusing on early extubation and factors influencing prolonged mechanical ventilation., Methods: Data from 744 patients who underwent heart valve surgery at the Zhejiang Provincial People's Hospital between August 2019 and June 2022 were retrospectively analyzed. The outcomes in patients who underwent conventional median sternotomy (MS) and minimally invasive (MI) video-assisted thoracoscopic surgery were compared using inverse probability of treatment weighting (IPTW) and Kaplan-Meier curves. Clinical data, including surgical data, postoperative cardiac function, postoperative complications, and intensive care monitoring data, were analyzed., Results: After propensity score matching and IPTW, 196 cases of conventional MS were compared with 196 cases of MI video-assisted thoracoscopic surgery. Compared to patients in the conventional MS group, those in the MI video-assisted thoracoscopic surgery group in the matched cohort had a higher early postoperative extubation rate (P < 0.01), reduced incidence of postoperative pleural effusion (P < 0.05), significantly shorter length of stay in the intensive care unit (P < 0.01), shorter overall length of hospital stay (P < 0.01), and lower total cost of hospitalization (P < 0.01)., Conclusions: Successful early tracheal extubation is important for the intensive care management of patients after heart valve surgery. The advantages of MI video-assisted thoracoscopic surgery over conventional MS include significant reductions in the duration of use of mechanical ventilation support, reduced length of intensive care unit stay, reduced total length of hospitalization, and a favorable patient recovery rate., (© 2024. The Author(s).)

Background: Myasthenia gravis is an autoimmune disease with high prevalence of thymus disorders, in which, thymectomy is considered one of the therapeutic approaches in improving the patients' clinical outcomes. Today, thoracoscopic thymectomy has received significant attention than the classic transsternal approach due to fewer complication. Therefore, this study was designed with the aim of investigating the therapeutic outcomes of thymectomy in patients with myasthenia gravis in the Afzalipour Hospital of Kerman between 2011 and 2021., Methods: The current study is a descriptive analytical study on patients with myasthenia gravis who underwent surgical thymectomy within 2011-2021. Demographic and clinical characteristics of patients from the time of operation to three years of follow-up were extracted and recorded from clinical records or by phone calls. Data were analyzed using SPSS software., Results: The data of 70 patients who underwent surgical thymectomy were analyzed. Thymectomy caused a significant reduction in the severity of the disease according to the Osserman classification (P = 0.001). It also significantly reduced the use of corticosteroids (P = 0.001) and IVIG (P = 0.015) compared to the time before the surgery. Sixty-two patients (88.57%) needed to take less medicine than before surgery. Left VATS was associated with less post-operative severity of the disease (P = 0.023). There were only two deaths during the follow-up period., Conclusion: Overall, the findings of the present study demonstrated that thoracoscopic thymectomy is a useful surgical approach that leads to faster recovery, reducing the severity of the disease, need for medication, and complications in patients with myasthenia gravis, In comparison with the transsternal approach., (© 2024. The Author(s).)

Background: This study aimed to analyze the results, feasibility and safety of the thoracoscopic approach for patients with esophageal atresia with tracheoesophageal fistula (EA/TEF) depending on the patient's birth weight., Methods: The study involved only type C and D EA/TEF. Among the analyzed parameters were the patients' characteristics, surgical treatment and post-operative complications: early mortality, anastomosis leakage, anastomosis strictures, chylothorax, TEF recurrence, and the need for fundoplication or gastrostomy., Results: 145 consecutive newborns underwent thoracoscopic EA with TEF repair. They were divided into three groups-A (N = 12 with a birth weight < 1500 g), B (N = 23 with a birth weight ≥ 1500 g but < 2000 g), and C-control group (N = 110 with a birth weight ≥ 2000 g). Primary one-stage anastomosis was performed in 11/12 (91.7%) patients-group A, 19/23 (82.6%)-group B and 110 (100%)-group C. Early mortality was 3/12 (25%)-group A, 2/23 (8.7%)-group B, and 2/110 (1.8%)-group C and was not directly related to the surgical repair. There were no significant differences in operative time and the following complications: anastomotic leakage, recurrent TEF, esophageal strictures, and chylothorax. There were no conversions to an open surgery. Fundoplication was required in 0%-group A, 4/21 (19.0%)-group B, and 2/108 (1.9%)-group C survivors. Gastrostomy was performed in 1/9 (11.1%)-group A, 3/21 (14.3%)-group B and 0%-group C., Conclusion: In an experienced surgeon's hands, even in the smallest newborns, the thoracoscopic approach may be safe, feasible, and worthy of consideration. Birth weight seems to be not a direct contraindication to the thoracoscopic approach., (© 2024. The Author(s).)

Differentiating between giant pulmonary bullae and pneumothorax can pose a challenge in clinical settings. A chest CT scan during the patient's health assessment revealed that approximately 40% of the right chest cavity was filled with air, leading to incomplete expansion of the right lung. The patient was initially misdiagnosed with pneumothorax in the emergency department and subsequently underwent closed thoracic drainage without experiencing any improvement in symptoms. Upon further examination through thoracoscopy, the patient was correctly diagnosed with a giant pulmonary bulla. Upon reviewing the patient's chest CT scan, we were able to identify key distinguishing features between giant pulmonary bullae and pneumothorax., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Yefei Zhan reports financial support was provided by Ningbo No.2 Hospital (Project No. 2023-Y06). Yefei Zhan reports financial support was provided by Ningbo Municipal Health Commission (Project No. 2022-F16). If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: To explore the safety and feasibility of HuaXi thoracoscopic anatomical lesion resection (HX-TALR) in the treatment of congenital lung malformations (CLMs) in children., Methods: A retrospective review of clinical data was conducted for patients who underwent HX-TALR and thoracoscopic lobectomy (TL) in our hospital from October 2017 to March 2023. Intraoperative and postoperative outcomes were compared between the HX-TALR and TL groups., Results: There were 485 patients in this study, 267 of whom underwent HX-TALR and 218 of whom underwent TL. All patients underwent thoracoscopic surgery without conversion to open surgery. No patients had major complications, including bronchopleural fistula, hemorrhage, atelectasis, recurrence or reoperation. The operative time, intraoperative bleeding volume, cases with thoracic drainage tubes, postoperative hospital stay, and cases with postoperative fever in HX-TALR were greater than those in TL (P < 0.05)., Conclusions: HX-TALR is safe, feasible, and retains all normal lung tissue while removing the lesion, which is expected to become the preferable operation for the treatment of CLMs. HX-TALR is a new and technically challenging procedure that needs to be carried out after training., Level of Evidence: Level IV., Competing Interests: Conflicts of interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To compare and analyze the clinical effects of thoracoscopic lobectomy and segmentectomy in stage I non-small cell lung cancer (NSCLC)., Method: This was a retrospective study. Eighty patients with stage I NSCLC treated in Cangzhou People's Hospital from December 2019 to January 2022 were randomly divided into the segmentectomy group and lobectomy group, with 40 cases in each group. Further comparative analysis was carried out focusing on perioperative indexes, maximum ventilation volume (MVV), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), VAS score of postoperative pain and complications., Result: There was no significant difference in the number of dissected lymph nodes and extubation time between the two groups (p>0.05). The operation time was longer, while intraoperative blood loss was less and the stay of stay in hospital was shorter in the segmentectomy group significantly than those in the lobectomy group (p<0.05). Furthermore, no significant difference was observed in MVV%, FVC% and FEV1% between the two groups before operation (p>0.05). Meanwhile, the segmentectomy group had evidently lower VAS scores at 1 d, 3 d and 5 d postoperatively than those in the lobectomy group (p<0.05). Besides, there was a much lower total incidence of complications in the segmentectomy group than that in the lobectomy group (p<0.05)., Conclusion: Compared with lobectomy, thoracoscopic segmentectomy is more effective in the treatment of stage I NSCLC, with less bleeding and mild pain, which can alleviate pulmonary function injury and reduce postoperative complications that is conducive to the improved prognosis of patients., Competing Interests: Conflicting of interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

Introduction: Thoracic musculoskeletal deformities are significant complications following open correction of esophageal atresia (EA) during long-term follow-up. We aimed to compare the frequency and severity of thoracic musculoskeletal deformities after open and thoracoscopic repair of EA. We hypothesized that fewer deformities would occur following the less invasive thoracoscopic approach., Methods: This retrospective study analyzed patients treated at two pediatric surgery departments in Poland between 2005 and 2021. The patient groups differed in surgical approach, operative techniques, indications for multi-staged surgery, and postoperative complications. The study encompassed all types of EA/TEF. The first group comprised 68 patients who underwent thoracoscopic esophageal atresia repair (Wroclaw), while the second group involved 44 patients who underwent open repair (Warsaw). Clinical data were retrospectively reviewed, with results considered significant at p < 0.05., Results: The median age at examination was 6 years in the thoracoscopy group and 5.5 years in the thoracotomy group. In the thoracoscopy group, 53 out of 68 patients (77.9%) and in the thoracotomy group - 35 out of 44 patients (79.5%) were treated in one stage. The incidence of thoracic musculoskeletal deformities was significantly lower in the thoracoscopy group (1.5%) compared to the thoracotomy group (34.1%, p < 0.001). Scoliosis occurred significantly more often after thoracotomy (13.6% vs 1.5%, p = 0.016). There was no rib fusion (0% vs 37.1%, p < 0.001) and no scoliosis of =>20° (0% vs 6.8%, p = 0.058) after thoracoscopy. The coincidence of rib fusion and scoliosis was significant (9.1%, p = 0.022) for the open approach. In the thoracotomy group, multi-staged surgery and more frequent reoperations due to major complications were significantly associated with an increased occurrence of deformities. None of the patients after thoracoscopic multi-stage or complicated EA/TEF repair developed scoliosis., Conclusions: The frequency and severity of thoracic musculoskeletal deformities were significantly lower after the thoracoscopic approach. Thoracoscopy may be a more advantageous and preferred surgical approach for the EA/TEF treatment, although further randomized, controlled studies are necessary. Post-thoracotomy scoliosis may progress to a severity requiring surgery., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Congenital diaphragmatic malformations include congenital diaphragmatic hernia (CDH) and eventration of the diaphragm. The clinical presentation is variable, and the prognosis depends on multiple factors. The coexistence of CDH and diaphragmatic eventration in the same patient is extremely unusual and has not been reported previously in the literature. We report this rare association in a 3-month-old male infant who was managed successfully by minimally invasive approach., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Indian Association of Pediatric Surgeons.)

Introduction: Medical thoracoscopy is a minimally invasive and safe procedure mostly performed for unexplained exudative pleural effusions but may be considered for pneumothorax (PNX)., Methods: This retrospective study included participants affected by PNX who underwent medical thoracoscopy with talc poudrage at a single academic hospital from 2008 to 2021. The primary endpoint was the observation of complete radiographical lung re-expansion and absence of air supply from the chest drain within 7 days of medical thoracoscopy. The secondary endpoint was achieving no recurrence of ipsilateral PNX at 24 months post-discharge., Results: A total of 95 patients affected by primary spontaneous PNX (PSP), secondary spontaneous PNX (SSP), iatrogenic, and traumatic PNX were enrolled. An additional procedure was required by 17.89% of patients, and only one patient with SSP required subsequent surgery. Recurrence of PNX occurred on the same side within 24 months after discharge in 9.47% of patients, with a median time to recurrence of 13.5 months. The PSP group was significantly more likely to achieve the primary endpoint. Pleural morphology was significantly associated with reaching the primary endpoint, while receiving a cumulative dose of talc greater than or equal to 4 g during hospitalization was associated with a lower risk of meeting it. Receiving a cumulative dose of talc greater than or equal to 4 g led in all cases to the achievement of the secondary endpoint. Patients with iatrogenic and traumatic PNX had an excellent prognosis in both the short- and long-term evaluation., Conclusion: Medical thoracoscopy is an effective procedure for treating PNX in the acute setting in selected cases while preventing long-term relapses. Large prospective clinical studies are needed to support and better define the role of medical thoracoscopy in current clinical practice., (© 2024. The Author(s).)

Abstract: Objective: This study explores how permissive hypercapnia, a key aspect of lung-protective ventilation, impacts postoperative delirium in elderly patients following thoracic surgery. Methods: A single-center trial at The Second Hospital of Anhui Medical University involved 136 elderly patients undergoing thoracoscopic esophageal cancer resection. Randomly assigned to maintain PaCO 2 35-45 mm Hg (group N) or 46-55 mm Hg (group H). Primary outcome: postoperative delirium (POD) incidence 1-3 days post-surgery. Secondary endpoints included monitoring rSO 2 , cardiovascular parameters (MAP, HR), pH, OI, and respiratory parameters (VT, RR, Cdyn, PIP) at specific time points. Perioperative tests assessed CRP/ALB ratio (CAR) and systemic inflammatory index (SII). VAS scores were documented for 3 postoperative days. Results: Postoperatively, group H showed significantly lower POD incidence than group N (7.4% vs. 19.1%, P = 0.043). Group H exhibited higher PaCO 2 and rSO 2 during surgery ( P < 0.05). Patients in group H maintained better cardiovascular stability with higher blood pressure and lower heart rate on T2-4 ( P < 0.05). Respiratory parameters were more stable in group H with lower TV, RR, and PIP, and higher Cdyn during OLV ( P < 0.05). Group H had lower pH and higher OI at T2-4 ( P < 0.05). CRP and CAR levels rose less in group H on the first day and 1 week later ( P < 0.05). Conclusions: Maintaining PaCO 2 at 46-55 mm Hg reduces POD incidence, possibly by enhancing rSO 2 levels and stabilizing intraoperative respiration/circulation., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by the Shock Society.)

Background: Due to the pauci-bacillary nature of tuberculous (TB) pleurisy, clinical diagnosis is common, but microbiological confirmation is necessary to determine drug resistance. This study aimed to investigate the diagnostic yield of medical thoracoscopy (MT) for microbiological confirmation of TB pleurisy., Methods: Medical records of patients diagnosed as TB pleurisy with microbiological or histologic evidence who underwent MT between May 2015 and July 2023 at Incheon St. Mary's Hospital were retrospectively reviewed. Sensitivities of microbiological results [acid-fast bacilli (AFB) culture or TB-polymerase chain reaction (PCR)] of pre-MT pleural fluid and those of targeted pleural washing fluid and pleural tissues obtained during MT were compared. Difference in sensitivity was verified with McNemar's test., Results: A total of 72 patients were enrolled. With pre-MT pleural fluid, sensitivities of AFB culture and TB PCR were 5.6% (4/72) and 1.4% (1/72), respectively. With targeted pleural washing fluid, sensitivities of AFB culture and TB-PCR were 23.6% (17/72) and 12.5% (9/72), respectively. With pleural tissues, sensitivities of AFB culture and TB-PCR were 18.1% (13/72) and 40.3% (29/72), respectively. MT showed an additional 27.8% [95% confidence interval (95% CI): 14.2-40.1%, P<0.001] of sensitivity gain in AFB culture and 40.3% (95% CI: 25.7-52.5%, P<0.001) of sensitivity gain in TB-PCR. With pleural washing, additional 19.4% (95% CI: 6.8-31.6%, P=0.001) of sensitivity gain in microbiological confirmation was identified, whereas additional 37.5% (95% CI: 22.6-50.2%, P<0.001) of sensitivity gain was identified with pleural biopsy., Conclusions: With MT, 44.4% of additional sensitivity gain in microbiological confirmation of TB pleurisy was identified. This underscores the role of MT in the diagnosis of TB pleurisy., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-143/coif). The authors have no conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)