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BACKGROUND: The field of robotic-assisted surgery is rapidly growing as many robotic surgical devices are in development and about to enter the market. Currently, there is no universally accepted language for labeling the different robotic systems. To facilitate this communication, we created what is, to our knowledge, the first classification of surgical robotic technologies that organizes and classifies surgical robots used for endoscopy, laparoscopy and thoracoscopy. METHODS: We compiled a list of surgical robots intended to be used for endoscopy, laparoscopy, and/or thoracoscopy by searching United States, European, Hong Kong, Japan, and Korean databases for approved devices. Devices showcased at the 2023 Annual Meeting for the Society of Robotic Surgery were added. We also systematically reviewed the literature for any existing surgical robotic classifications or categorizations. We then created a multidisciplinary committee of 8 surgeons and 2 engineers to construct a proposed classification of the devices included in our search. RESULTS: We identified 40 robotic surgery systems intended to be used for endoscopy, laparoscopy and/or thoracoscopy. The proposed classification organizes robotic devices with regard to architecture, port design, and configuration (modular carts, multi-arm integrated cart, table-attachable or arm-table integration). CONCLUSION: This 3-level classification of robotic surgical devices used for endoscopy, laparoscopy and/or thoracoscopy describes important characteristics of robotic devices systematically.

Background: Esophageal gastrointestinal stromal tumors (GISTs) are relatively rare, accounting for 2–5% of all GISTs. Typically, the treatment is surgery in nature. However, no standard procedure established for esophageal GISTs, and in many cases, subtotal esophagectomy or local resection via thoracoscopy or mediastinoscopy is performed. Thoracoscopic and endoscopic cooperative surgery (TECS) is a surgical approach similar to laparoscopic and endoscopic cooperative surgery used for gastric GIST; however, no reports of its use for esophageal GIST have been published to date. We herein report such a case along with a review of past literature. Case presentation: The patient was a 60-year-old man. Upper gastrointestinal contrast imaging revealed a subepithelial lesion in the esophagus. An 18 × 17 mm subepithelial lesion was identified in the left wall, 35 cm from the upper incisors, during upper gastrointestinal endoscopy, and was diagnosed as a GIST through endoscopic ultrasound-guided fine needle biopsy. TECS was therefore performed. The patient was placed in a prone position with his face to the left. After confirming the lesion under endoscopy and left thoracoscopy, the periesophageal area of the lesion was dissected under thoracoscopy. Subsequently, an endoscopic full-layer resection was performed. Finally, the excision site of the lesion was sutured under thoracoscopy. The operation took a total of 3 h and 22 min, with a blood loss of 50 mL. Conclusions: The appropriate surgical procedure for esophageal GIST should be considered according to the location and size of the lesion. TECS ensures that the resection margins are secured using an endoscopic or thoracoscopic approach. Furthermore, TECS is minimally invasive, avoiding esophagectomy and reconstruction, which makes it a potential surgical option for esophageal GISTs. [ABSTRACT FROM AUTHOR]

Simple Summary: Following technological advancements, there has been a rise in the early detection of pulmonary nodules, with more patients found to have multiple lesions. These lesions may indicate benign or malignant stages, each requiring careful evaluation and management. Multiple treatment strategies can be followed while ensuring patient comfort and minimizing complications. Thus, our study aims to provide an example of single-stage management for multiple lung lesions, using percutaneous ablation and thoracoscopic resection in a hybrid operating room (HOR). These combined procedures in a single stage and setting allows for a minimally invasive experience for patients, with minimal complications and a shorter operation time. In addition to personalized therapy, there is more flexibility for managing complications in the HOR. Thus, these initial results indicate a feasible and safe single-stage workflow and an alternative way to manage multiple pulmonary lesions in patients. Background: Different approaches are required in treating patients with multiple pulmonary lesions. A multistage procedure may increase the risk of complications and patient discomfort. This study reports an initial experience with single-stage management of multiple lung lesions using percutaneous ablation with thoracoscopic resection in a hybrid operating room (HOR). Methods: We retrospectively evaluated patients who underwent combined ablation and resection in an HOR between May 2022 and July 2024. All patients received a single anesthesia via endotracheal tube intubation. The clinical data, operative findings, and pathological characteristics of the lung nodules were recorded. Results: A total of 22 patients were enrolled in this study. Twenty patients underwent unilateral procedures, while the other two patients underwent bilateral procedures. Ablations were performed before lung resection in 21 patients; only 1 patient underwent surgery first. The median global operating room time was 227.0 min. The median total radiation dose (dose area product) was 14,076 μGym2. The median hospital postoperative length of stay was 2 days. Conclusions: The single-stage procedure of percutaneous ablation with thoracoscopic resection under general anesthesia in an HOR is feasible and safe. This procedure is an alternative method for managing multiple pulmonary lesions. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

OBJECTIVES This single-centre prospective observational study aimed to investigate reasons for prolonged hospitalization [over the median length of stay (LOS)] after enhanced recovery thoracoscopic [ERAS 3-port video-assisted thoracoscopic surgery (VATS)] wedge resection. METHODS All patients were evaluated twice-daily by an investigator for reasons of hospitalization. Each reason was analysed individually. Predictors for prolonged hospitalization were identified using a multivariable backward stepwise logistic regression model. RESULTS A total of 150 consecutive patients (lymphadenectomy 8.7%) were included from November 2022 to December 2023, with a median LOS of 1 (interquartile range 1–2) day. Of these, 55 patients (36.7%) experienced prolonged hospitalization. The main reasons included postoperative pain (16.0%), air leak (14.7%) and social factors (14.7%), followed by oxygen dependency (7.3%), gastrointestinal factors (5.3%), urinary factors (4.7%), pneumonia (1.3%), pleural effusion (1.3%), chylothorax (0.7%), atrial fibrillation (0.7%), confusion (0.7%) and fatigue (0.7%). Multivariable analysis revealed that an increase in the percentage of predicted forced expiratory volume in 1 s (FEV1%pre) by 1% [odds ratio (OR) 0.41, P = 0.023) and percentage of predicted diffusing capacity for carbon monoxide (DLCO%pre) by 1% (OR 0.95, P = 0.002) decreased likelihood of prolonged hospitalization. Conversely, each additional pack-year (OR 1.01, P = 0.028) and living alone (OR 3.55, P = 0.005) increased the risk of prolonged hospitalization. CONCLUSIONS Prolonged hospitalization (LOS > 1 day) after ERAS 3-port VATS wedge resection, with 8.7% lymphadenectomy, was mainly due to pain, air leak and social factors. Smokers with decreased FEV1%pre or DLCO%pre and patient living alone were at increased risk. Clinical trial registration number ClinicalTrials.gov: NCT06118593 (https://clinicaltrials.gov/study/NCT06118593?cond=why%20in%20hospital&rank=2). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Malignant pleural effusion (MPE) is a common cancer complication. Clinical and economic implications of different recurrent MPE treatment pathways have not been evaluated fully. What clinical outcomes, complications, health care resource use, and costs are associated with various rapidly recurrent MPE treatment pathways? 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. 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. Early definitive treatment was associated with fewer subsequent procedures and lower costs in patients with rapidly recurrent MPE. [Display omitted] [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Pleural effusion is the most prevalent pleural disorder. One third of pleural effusions are caused by lung cancer. Thoracoscopy is regarded as the most reliable diagnostic method for the evaluation of suspected pleural malignancy. Aim and objectives: To assess visible pleural characteristics of abnormalities and their locations for malignant and benign pathologies as well as to determine the incidence of malignancy in the apparent normal pleura. Patients and methods: This was a descriptive, observational, and cross-sectional research that was performed on 36 cases with undiagnosed exudative pleural effusions prepared for medical thoracoscopy and on whom the cytological analysis was inconclusive, at the thoracoscopic Unit Department of Chest Diseases, Faculty of Medicine Zagazig University, from December 2023 to May 2024. Results: The apparent normal pleura and adhesions were significantly greater in benign effusions than in malignant effusions (p = 0.019 and p = 0.04, respectively), while nodular effusion was significantly greater in malignant effusions than in benign effusions (p = 0.003). Bleeding was significantly greater in malignant effusions than in benign effusions (p = 0.019). As regards the thoracoscopic findings, 24 (66.7%) patients showed nodular patterns, 14 (38.9%) patients showed adhesions, and two (5.6%) patients had pus, while six (16.7%) patients had apparent normal pleura. The costal pleura was the most frequently affected site (88.9%) followed by the visceral pleura (55.6%) then the diaphragmatic pleura (38.9%). Conclusion: Medical thoracoscopy (MT), a minimally invasive and a generally safe treatment, enables the interventional pulmonologist to access the pleural cavity directly and obtain pleural samples under direct view helping in predicting the pathology. [ABSTRACT FROM AUTHOR]

Background: Thoracoscopic surgery is a primary treatment for lung cancer, with lobectomy and mediastinal lymph node dissection being the predominant surgical approaches for invasive lung cancer. While many thoracic surgeons can proficiently perform lobectomy, thorough and standardized lymph node dissection remains challenging. This study aimed to explore a safer and more efficient surgical method for mediastinal lymph node dissection in lung cancer. Methods: A prospective randomized controlled study was conducted, involving 100 patients with right lung cancer who were admitted to our hospital from January 2021 to April 2024 and met the inclusion criteria. These patients were randomly divided into an observation group (tissue pneumoperitoneum technique around lymph nodes group) and a control group (conventional surgery group). Thoracoscopic lobectomy and mediastinal lymph node dissection were performed. Intraoperative and postoperative related indicators were observed to validate the effectiveness and safety of the tissue pneumoperitoneum technique around lymph nodes. Results: The observation group showed a significantly shorter lymph node dissection surgery time compared to the control group, with a statistically significant difference (p < 0.05). The number of lymph nodes dissected in the observation group was significantly higher than that in the control group, with a statistically significant difference (p < 0.05). Although the observation group had slightly more mediastinal lymph node stations dissected than the control group, the difference was not statistically significant (p > 0.05). The total drainage volume within three days postoperatively was comparable between the two groups, with no statistically significant difference (p > 0.05). The observation group had shorter chest tube indwelling time and postoperative hospital stay than the control group, with statistically significant differences (p < 0.05). The incidence of surgical complications was similar between the two groups, and there were no perioperative deaths. Conclusion: The tissue pneumoperitoneum technique around lymph nodes is a more efficient method for mediastinal lymph node dissection in lung cancer, demonstrating safety and feasibility, and is worthy of promotion. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Thoracoscopy has gained extensive utilization in managing pleural disorders, and enhanced recovery after surgery (ERAS) can improve patients' prognosis and expedite post-surgical recovery. This study aimed to investigate the knowledge, attitudes, and practices (KAP) towards ERAS among patients underwent thoracoscopy surgery. Methods: This cross-sectional study was conducted between September 2022 and August 2023, among patients underwent thoracoscopy surgery in 6 Secondary or Tertiary hospitals in the author's area. Demographic characteristics and KAP scores were collected by questionnaires, and clinical data were extracted from medical records. Results: A total of 309 valid questionnaires were collected, with 165 (53.40%) males and 202 (65.37%) aged ≤65 years old. The mean scores for KAP were 28.92±7.21 (possible range: 9–45), 53.60±6.73 (possible range: 13–65), and 43.45±5.50 (possible range: 10–50), respectively. SEM confirmed the positive associations between knowledge and attitude (β = 0.108, P = 0.019), knowledge and practice (β = 0.096, P = 0.004), and attitude and practice (β = 0.438, P<0.001). However, the KAP were found not associated with prognosis. Conclusion: Patients underwent thoracoscopy surgery showed moderate knowledge, positive attitude, and appropriate practice towards ERAS. Preoperative education, personalized counseling, peer support groups, peer support groups, and follow-up care were recommended in further clinical practice. [ABSTRACT FROM AUTHOR]

The present study was undertaken to evaluate the anaesthetic effect of propofol isoflurane and propofol sevoflurane in twelve dogs with history of chronic cough, dyspnoea, laboured breathing, nasal discharge, exercise intolerance which were presented to the Department of Surgery and Radiology, Mumbai Veterinary College and Bai Sakarbai Dinshaw Petit Hospital for Animals, Parel, Mumbai. These dogs were randomly divided into two equal groups. In both the groups dogs were premedicated with acepromazine (0.04 mg/kg b.wt.) intravenously, and atropine sulphate (0.04 mg/kg b.wt.) and dexamethasone sodium (0.025 mg/kg b.wt.) SC 10 min before induction of anaesthesia. In both the groups, anaesthesia was induced with propofol (5 mg/kg b.wt.) intravenously. In group I anaesthesia was maintained using 2.5% isoflurane and in group II, 2.5% sevoflurane along with oxygen at a flow rate ranging from 500 to 1200 mL/min. History, physiological parameters, anaesthetic parameters were recorded at different time intervals during the study period. The present study findings suggest that induction with propofol and maintenance with isoflurane and sevoflurane proved best anaesthetic technique for thoracoscopy in dogs. [ABSTRACT FROM AUTHOR]

Ranked high in worldwide growing health issues, pleural diseases affect approximately one million people globally per year and are often correlated with a poor prognosis. Among these pleural diseases, malignant pleural mesothelioma (PM), a neoplastic disease mainly due to asbestos exposure, still remains a diagnostic challenge. Timely diagnosis is imperative to define the most suitable therapeutic approach for the patient, but the choice of diagnostic modalities depends on operator experience and local facilities while bearing in mind the yield of each diagnostic procedure. Since the analysis of pleural fluid cytology is not sufficient in differentiating historical features in PM, histopathological and morphological features obtained via tissue biopsies are fundamental. The quality of biopsy samples is crucial and often requires highly qualified expertise. Since adequate tissue biopsy is essential, medical or video-assisted thoracoscopy (MT or VATS) is proposed as the most suitable approach, with the former being a physician-led procedure. Indeed, MT is the diagnostic gold standard for malignant pleural pathologies. Moreover, this medical or surgical approach can allow diagnostic and therapeutic procedures: it provides the possibility of video-assisted biopsies, the drainage of high volumes of pleural fluid and the administration of sterile calibrated talcum powder under visual control in order to achieve pleurodesis, placement of indwelling pleural catheters if required and in a near future potential intrapleural therapy. In this context, dedicated diagnostic pathways remain a crucial need, especially to quickly and properly diagnose PM. Lastly, the interdisciplinary approach and multidisciplinary collaboration should always be implemented in order to direct the patient to the best customised diagnostic and therapeutic pathway. At the present time, the diagnosis of PM remains an unsolved problem despite MDT (multidisciplinary team) meetings, mainly because of the lack of standardised diagnostic work-up. This review aims to provide an overview of diagnostic procedures in order to propose a clear strategy. [ABSTRACT FROM AUTHOR]

Objective: To compare and analyze the clinical effects of thoracoscopic lobectomy and segmentectomy in stage I nonsmall 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. [ABSTRACT FROM AUTHOR]

Background The best surgical treatment strategy for coexisting coronary artery disease (CAD) and lung cancer (LC) remains controversial. This study analyzed the safety and efficacy of a simultaneous minimally invasive procedure for patients with CAD and LC. Methods Patients who underwent simultaneous minimally invasive off-pump coronary artery bypass grafting and lung resection from January 2016 to December 2021 were retrospectively analyzed. The procedure was performed in the fourth intercostal space through a small left anterolateral minithoracotomy. Harvesting of the left internal mammary artery (LIMA) and sewing of the anastomoses were performed under direct vision. Lung resections were performed with or without the assistance of a thoracoscope. Results Sixteen patients were included with a mean age of 67.13 ± 10.61 years. Procedural success occurred in all patients with a mean operative time of 366.88 ± 94.48 minutes. All patients received at least one coronary artery bypass LIMA graft. Pneumonectomy, lobectomy, segment resection, and wedge resection were performed in one (6.25%), eight (50%), two (12.5%), and five (31.25%) patients, respectively. There were no perioperative deaths or new myocardial infarctions. Complications included one case of postoperative bleeding, two lung infections, two cases of atelectasis, one case of pleural effusion, and one case of cardiac arrhythmia. All the patients were followed up for 1 to 57 months, cancer recurrence occurred in two patients, and one patient died. The remaining patients showed no evidence of tumor recurrence or myocardial infarction. Conclusion This simultaneous minimally invasive procedure is safe and effective for selected patients with CAD and LC. [ABSTRACT FROM AUTHOR]

Background There are few studies on continuous intercostal nerve block after single operation hole thoracoscopic surgery, that is, two-port thoracoscopic surgery. Objective To evaluate the analgesic effect of continuous intercostal nerve block after thoracoscopic surgery. Methods A total of 80 patients who underwent single operation hole thoracoscopic surgery in our hospital between September 2020 and June 2021 were enrolled and divided into two groups. Based on basic analgesia, an intercostal catheter was placed during the operation for continuous intercostal block analgesia after the operation in the experimental group (group A, n = 40). The control group (group B, n = 40) was treated with sufentanil intravenous analgesia after surgery, which is namely "basic analgesia." The postoperative pain scores, restlessness during the recovery period, effect on reducing opioid use, postoperative chest complications, patient satisfaction, etc., were compared between the two groups. Results The pain scores of patients in group A were significantly lower compared with those in group B at 12, 24, 36, and 48 hours after surgery (3.325 ± 1.163 vs. 4.550 ± 1.176, 2.650 ± 1.001 vs. 4.000 ± 1.038, 2.325 ± 0.917 vs. 3.700 ± 0.966, and 1.775 ± 1.050 vs. 3.150 ± 1.075, p < 0.001, respectively). Sufentanil consumption in group A was significantly lower than in group B at 48 hours after surgery (98.625 ± 4.158 vs. 106.000 ± 7.228, p < 0.001). Conclusion Multimodal analgesia is ideal for early pain control after thoracotomy. A continuous intercostal nerve block can effectively reduce postoperative pain in patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

To explore the safety and feasibility of HuaXi thoracoscopic anatomical lesion resection (HX-TALR) in the treatment of congenital lung malformations (CLMs) in children. 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. 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). 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 IV. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. What is currently known about this topic? • Patients after open repair of EA/TEF are at considerable risk of thoracic musculoskeletal deformities • The incidence of scoliosis following open EA/TEF surgery ranges from 3% to 67% • Thoracic musculoskeletal abnormalities may contribute to reduced physical activity and tend to progress over time What new information is contained in this article? • Thoracoscopy may be associated with significantly reduced incidence of thoracic musculoskeletal deformities development, including scoliosis and rib fusion • Thoracoscopy as minimally invasive access may be worthwhile approach especially with the requirement for multi-stage repair in the newborn period [ABSTRACT FROM AUTHOR]

Abstract 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 (P0.05). 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.

Background Before thoracoscopic surgery, diagnosing tuberculous (TB) pleurisy was a medical challenge. Thoracoscopy is the most accurate but expensive method for TB pleurisy diagnosis. TB is common in low-income countries, where financial limitations prevent the use of thoracoscopy, motivating the search for a cheaper alternative. Patients and methods A prospective study was done from January 2019 to January 2023 to evaluate diagnostic methods for patients with exudative pleural effusions (PE) of unknown etiologies. The demographic, radiological, procedural, and histological data of exudative PE patients were analyzed. All patients were examined for adenosine deaminase (ADA) and lymphocyte/neutrophil ratio in pleural fluid. Ultrasound-guided Abrams needle biopsy and video-assisted thoracoscopic surgery pleural biopsies were obtained, and histopathological results were assessed. Results Of 250 patients with PE, 161 (64%) had TB PE, 72 (28.8%) had malignant PE, and 17 (6.8%) had idiopathic PE. Sensitivity of ADA (≥40 U/l) was 88%, lymphocyte/neutrophil ratio (≥0.75) was 86.1%, and their overall sensitivity was 91%. They had 93.2, 86.3, and 100% specificity, respectively. For ultrasound-guided Abrams needle biopsy, the sensitivity of histopathology, culture, and combined histopathology/culture was 66, 46.5, and 78.4%, respectively. All were 100% specific. For thoracoscopic biopsy, the sensitivity of histopathology, culture, and combined histopathology/culture was 100, 86.6, and 100%, respectively. All were 100% specific. The assay sensitivity of pleural fluid and tissue Xpert Mycobacterium tuberculosis/rifampin resistance was 12.5 and 49.7%, respectively. Both were 100% specific. Combining ADA more than or equal to 40 U/l, lymphocyte/neutrophil ratio more than or equal to 0.75, and an ultrasound-guided Abrams needle biopsy yielded 92.4% sensitivity and 100% specificity. Conclusion Combining pleural fluid ADA more than or equal to 40 U/l, lymphocyte/neutrophil ratio more than or equal to 0.75, and ultrasound-guided Abrams needle biopsy can accurately detect TB PE in high-TB populations. It may be an affordable alternative to thoracoscopy in countries with limited resources.

Abstract 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.

Abstract 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

Abstract 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

Abstract 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.

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.

The objective was to analyze the literature on modern approaches to the choice of regional anesthesia method for thoracoscopic surgical interventions. Materials and methods. A review of the most common approaches to the choice of regional anesthesia method for thoracoscopic surgical interventions was carried out.Results. The analysis of the literature has shown that to date, in the practice of an anesthesiologist and intensivist, there is no single standard for anesthesia of patients during and after thoracoscopic operations, but the use of regional anesthesia methods can increase the positive effects of minimally invasive methods, which include video-assisted thoracoscopic surgeries (VATS). Further studies comparing the efficacy of regional anesthesia methods in thoracic surgery are needed.Conclusion. At the moment, the evidence collected in the world specialized literature confirms that thoracic epidural analgesia (TEA), paravertebral block, erector spinae plane block, and serratus anterior plane block can be considered comparatively effective methods of regional anesthesia in VATS. Meanwhile, high-quality comparative clinical studies that allow us to choose the most effective and safe method of regional anesthesia are limited.

Abstract 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.

Abstract We developed a surgical support system that visualises important microanatomies using artificial intelligence (AI). This study evaluated its accuracy in recognising the thoracic nerves during lung cancer surgery. Recognition models were created with deep learning using images precisely annotated for nerves. Computational evaluation was performed using the Dice index and the Jaccard index. Four general thoracic surgeons evaluated the accuracy of nerve recognition. Further, the differences in time lag, image quality and smoothness of movement between the AI system and surgical monitor were assessed. Ratings were made using a five-point scale. The computational evaluation was relatively favourable, with a Dice index of 0.56 and a Jaccard index of 0.39. The AI system was used for 10 thoracoscopic surgeries for lung cancer. The accuracy of thoracic nerve recognition was satisfactory, with a recall score of 4.5 ± 0.4 and a precision score of 4.0 ± 0.9. Though smoothness of motion (3.2 ± 0.4) differed slightly, nearly no difference in time lag (4.9 ± 0.3) and image quality (4.6 ± 0.5) between the AI system and the surgical monitor were observed. In conclusion, the AI surgical support system has a satisfactory accuracy in recognising the thoracic nerves.

Abstract Background Enterococcus gallinarum is an infrequently intestinal symbiotic pathogen associated with nosocomial infection in immunocompromised individuals. To date, rare cases of pulmonary infection attributable to Enterococcus gallinarum were reported. Herein, we presented the first case of empyema resulting from Enterococcus gallinarum infection. Case presentation An 81-year-old male presented with fever and dyspnea upon admission. Chest CT scan and thoracic ultrasonography confirmed the presence of right pleural effusion. Thoracoscopy revealed extensive adhesion, purulent fluid, and necrotic materials within the thoracic cavity. Enterococcus gallinarum was identified through pleural effusion culture. The patient underwent an intrathoracic injection of urokinase along with thoracic drainage. Following surgery, He took oral linezolid for over one month. Undergoing comprehensive treatment, the patient exhibited favorable recovery. Conclusions We reported the first case of empyema due to Enterococcus gallinarum infection. It should be suspected in patients with impaired immune function and invasive therapies, without responding to conventional anti-infectious treatment.

Abstract Objective In this study, we compared the analgesic effects of intercostal nerve block (ICNB), ultrasound-guided paravertebral nerve block (PVB), and epidural block (EB) following single-port thoracoscopic lung surgery. Method A total of 120 patients who underwent single-hole thoracoscopic lung surgery were randomly and equally divided into three groups: ICNB group, the PVB group, and the EB group. ICNB was performed under direct thoracoscopic visualization before the conclusion of the surgery in the ICNB group, while PVB and EB were performed after general anesthesia in the PVB and EB groups, respectively. Patient-controlled intravenous analgesia (PCIA) was used following the surgery in all the groups. The following indicators were recorded: Intraoperative sufentanil dosage, anesthesia awakening time, postoperative intubation time, nerve block operation time, postoperative visual analog scale (VAS) pain scores during resting and coughing at regular intervals of 0, 2, 4, 8, 24, and 48 h, the time until first PCIA, number of effective compressions within 24 h postoperatively, number of rescue analgesia interventions, and the side effects. Results In comparison to the ICNB group, the PVB and EB groups had a lower intraoperative sufentanil dosage, significantly shorter anesthesia awakening time, and postoperative intubation time, but longer nerve block operation time, lower VAS scores when resting and coughing within 24 h postoperatively (all p-values less than 0.05). Conversely, there were no statistically significant differences in VAS scores during resting and coughing after 24 h (all p-values greater than 0.05). Time to first PCIA, number of effective compressions and number of rescue analgesia at the 24-hour mark postoperatively were significantly better in the PVB and EB groups than that in the ICNB group (P

Aim: Robotic-assisted surgery has demonstrated safety and feasibility in numerous pediatric cases. Nevertheless, there is a scarcity of literature regarding advanced pediatric thoracic robotic surgery (APTRS). The objective of this study was to present our experiences with APTRS in 31 patients. Materials and Methods: From October, 2020 to December, 2023, a total of 31 APTRS procedures were conducted at our institution. A retrospective analysis was carried out, encompassing demographics, indications for surgery, console time, complication rates, length of hospital stay, and postoperative complications. Results: Twenty-one patients (M/F: 13/17) underwent robotic-assisted surgery, with procedures including thoracic mass excision in 17 cases, esophageal surgery in 8 cases, and various other pathologies in 5 patients. The average age at the time of surgery was 8.4±5.2 years (10 months-17 years), and the average weight was 29.6±18.4 kg (10-65 kg). The mean console time was 165.6±124.8 minutes, with no instances of conversion. The median length of hospital stay was 3.5 days (1-30 days). Postoperative complications occurred in eight patients (25.8%). Conclusion: Our experience in pediatric robotic thoracic surgery reinforces its suitability even for complex cases. Robotic thoracic surgery appears to offer benefits, particularly in posterior mediastinal mass excision and esophagectomy for corrosive esophageal strictures, when compared to thoracoscopy.

Purpose: Previous studies have shown a higher recurrence rate and longer operative times for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) compared to open repair (OR). An updated meta-analysis was conducted to re-evaluate the surgical outcomes of TR. Methods: A comprehensive literature search comparing TR and OR in neonates was performed in accordance with the PRISMA statement (PROSPERO: CRD42020166588). Results: Fourteen studies were selected for quantitative analysis, including a total of 709 patients (TR: 308 cases, OR: 401 cases). The recurrence rate was higher [Odds ratio: 4.03, 95% CI (2.21, 7.36), p < 0.001] and operative times (minutes) were longer [Mean Difference (MD): 43.96, 95% CI (24.70, 63.22), p < 0.001] for TR compared to OR. A significant reduction in the occurrence of postoperative bowel obstruction was observed in TR (5.0%) compared to OR (14.8%) [Odds ratio: 0.42, 95% CI (0.20, 0.89), p = 0.02]. Conclusions: TR remains associated with higher recurrence rates and longer operative times. However, the reduced risk of postoperative bowel obstruction suggests potential long-term benefits. This study emphasizes the importance of meticulous patient selection for TR to mitigate detrimental effects on patients with severe disease. [ABSTRACT FROM AUTHOR]

We developed a surgical support system that visualises important microanatomies using artificial intelligence (AI). This study evaluated its accuracy in recognising the thoracic nerves during lung cancer surgery. Recognition models were created with deep learning using images precisely annotated for nerves. Computational evaluation was performed using the Dice index and the Jaccard index. Four general thoracic surgeons evaluated the accuracy of nerve recognition. Further, the differences in time lag, image quality and smoothness of movement between the AI system and surgical monitor were assessed. Ratings were made using a five-point scale. The computational evaluation was relatively favourable, with a Dice index of 0.56 and a Jaccard index of 0.39. The AI system was used for 10 thoracoscopic surgeries for lung cancer. The accuracy of thoracic nerve recognition was satisfactory, with a recall score of 4.5 ± 0.4 and a precision score of 4.0 ± 0.9. Though smoothness of motion (3.2 ± 0.4) differed slightly, nearly no difference in time lag (4.9 ± 0.3) and image quality (4.6 ± 0.5) between the AI system and the surgical monitor were observed. In conclusion, the AI surgical support system has a satisfactory accuracy in recognising the thoracic nerves. [ABSTRACT FROM AUTHOR]

Background: Salvage esophagectomy for residual tumor and localized relapses after definitive chemoradiotherapy (dCRT) for patients with esophageal cancer is associated with a high rate of postoperative complications and in-hospital mortality. In addition, there are many controversial issues associated with salvage esophagectomy, such as the acceptability of minimally invasive surgery and the need for prophylactic dissection of mediastinal lymph nodes. The aim of this study was to evaluate the safety and usefulness of thoracoscopic salvage esophagectomy with prophylactic mediastinal lymph node dissection. Methods: The study included 31 patients who underwent thoracoscopic salvage esophagectomy with prophylactic mediastinal lymph node dissection after dCRT between 2013 and 2022 (salvage patients) and 610 nonsalvage patients who underwent conventional thoracoscopic esophagectomy during the same time period. Results: Differences between the median ages and sexes of the 2 patient groups were not significant. The dominant location of tumors in the salvage patients was the upper thoracic esophagus. More salvage patients had clinical T4 disease. The salvage patients had a lower median number of retrieved mediastinal lymph nodes than the nonsalvage patients. The differences between the rates of R0, postoperative complications, and in-hospital deaths in the 2 patient groups were not significant. The 3-year overall survival (OS) rates for the salvage patients were 73%, with 3-year OS rates for R0 vs non-R0 of 81% vs 0%, p < 0.01 and pN0 vs pN1-3 of 89% vs 49%, p < 0.01. Conclusion: Regarding short-term outcomes, prophylactic mediastinal lymph node dissection for patients undergoing thoracoscopic salvage esophagectomy was as safe as prophylactic dissection for patients undergoing conventional thoracoscopic esophagectomy. R0 surgery and pN0 are important factors for long-term survival in patients undergoing thoracoscopic salvage esophagectomy. [ABSTRACT FROM AUTHOR]

Image-guided or assisted needle biopsies and the increasing use of medical thoracoscopy (MT) have increased the diagnostic accuracy of pleural diseases significantly. However, no consensus exists regarding which patients with pleural effusion should undergo MT and which patients should undergo image-guided or assisted needle biopsy as the first procedure to ensure greater diagnostic accuracy. Which biopsy method is more appropriate for which patient to provide the highest diagnostic accuracy in the diagnosis of pleural effusion? This prospective, randomized, parallel study included 228 patients with undiagnosed exudative pleural effusion. Patients were divided into two groups based on CT scan findings. Group 1 included patients with pleural effusion only. Group 2 included patients with pleural thickening or lesion in addition to pleural effusion. Patients in each group were assigned randomly to an image-assisted Abrams needle pleural biopsy (IA-ANPB) or MT arm. The diagnostic sensitivity, reliability, and safety were determined for both groups. The false-negative rate was 30.3% for the IA-ANPB arm and 3.1% for the MT arm in group 1. The same rates were 11.9% for IA-ANPB and 4.7% for MT in group 2. In group 1, the sensitivity for the IA-ANPB arm was 69.7%, and the negative likelihood ratio was 0.30. The same rates for the MT arm were 96.9% and 0.03 (P =.009). In group 2, these values were 88.1% and 0.12 for the IA-ANPB arm and 95.4% and 0.05 for the MT arm (P =.207). The rate of complications between the two biopsy methods was not different (8.5% and 15.8%, respectively; P =.107). MT showed a high diagnostic success in all patients with pleural fluid. However, IA-ANPB showed similar diagnostic success as MT in patients with pleural effusion and associated pleural thickening or lesions. Therefore, in the latter case, IA-ANPB could be preferable to MT. ClinicalTrials.gov; No.: NCT05428891 ; URL: www.clinicaltrials.gov [Display omitted] [ABSTRACT FROM AUTHOR]

The current gold standard of scoliosis correction procedures is still posterior spinal fusion, an extensively studied procedure. anterior vertebral body tethering is a newer surgical technique for the correction of scoliotic curves. Consequently, best practices have yet to be determined. A single-institution, retrospective, review of all patients diagnosed with adolescent idiopathic scoliosis who underwent two row anterior vertebral body tethering between June 2020 and April 2022 was performed. Over the study period, 95 patients met inclusion: 79 females (83.2%) and 16 males (16.8%), age 14.4 ± 2.5 years, with a body mass index of 20.0 ± 2.9, and an average of 8.4 ± 2.1 levels treated. 28 (29.5%) procedures were for double curves and 67 (70.5%) for single curves. After tethering, a chest tube was positioned in each corrected side. A total of 123 chest tubes were analyzed, including 67 single curves and 28 double curves. The average chest tube duration was 2.5 ± 1.1 days and the average length of stay was 5.0 ± 2.0 days. The average chest tube output eight hours prior to removal was 61.1 ± 45.6 mL. There was no significant difference in average length of stay for patients who underwent correction of a single curve versus a double curve nor was there a difference in average length of stay or chest tube duration for revisions compared to primary procedures. For the entire cohort, the 30-day emergency department visit rate was 7.4% (n = 7) and the readmission rate was 4.2% (n = 4). This early review of a 2-year two row vertebral body tethering postoperative experience provides a report of a safe and effective approach to chest tube management at a single academic center. [ABSTRACT FROM AUTHOR]

Background: Enterococcus gallinarum is an infrequently intestinal symbiotic pathogen associated with nosocomial infection in immunocompromised individuals. To date, rare cases of pulmonary infection attributable to Enterococcus gallinarum were reported. Herein, we presented the first case of empyema resulting from Enterococcus gallinarum infection. Case presentation: An 81-year-old male presented with fever and dyspnea upon admission. Chest CT scan and thoracic ultrasonography confirmed the presence of right pleural effusion. Thoracoscopy revealed extensive adhesion, purulent fluid, and necrotic materials within the thoracic cavity. Enterococcus gallinarum was identified through pleural effusion culture. The patient underwent an intrathoracic injection of urokinase along with thoracic drainage. Following surgery, He took oral linezolid for over one month. Undergoing comprehensive treatment, the patient exhibited favorable recovery. Conclusions: We reported the first case of empyema due to Enterococcus gallinarum infection. It should be suspected in patients with impaired immune function and invasive therapies, without responding to conventional anti-infectious treatment. [ABSTRACT FROM AUTHOR]

Introduction: Patients frequently suffer from debilitating chronic postsurgical pain (CPSP) subsequent to thoracoscopic surgery. The impact of postoperative dexmedetomidine infusion on CPSP remains elusive. This study aimed to scrutinize the effect of dexmedetomidine on both 1-year incidence of CPSP and the quality of recovery after thoracoscopic pulmonary nodule surgery. Methods: This retrospective analysis encompassed clinical and follow-up data from 1148 patients undergoing thoracoscopic pulmonary nodule surgery at our institution between September 2021 and August 2022. Depending on whether dexmedetomidine was infused intravenously or not on the first night after surgery, patients were stratified into the dexmedetomidine group or the control group, with propensity score matching applied to harmonize baseline characteristics. Comparative analysis sought to delineate distinctions of CPSP and recovery quality 1 year after surgery. Results: Following propensity score matching, a cohort of 258 patients in each group underwent analysis. Comparisons after matching revealed no statistically significant disparities in 1-year CPSP incidence [76/258 (29.5%) versus 78/258 (30.2%), P = 0.847], moderate-to-severe pain occurrence [17/76 (22.4%) versus 22/78 (28.2%), P = 0.405], neuropathic pain occurrence [11/76 (14.5%) versus 11/78 (14.1%), P = 0.948], and postoperative recovery quality assessed by 12-Item Short Form Health Survey (SF-12) score (113.1 [107.2, 116.0] versus 113.0 [107.4, 116.0], P = 0.328). Multivariate logistic regression analysis encompassing the entire cohort identified being female [odds ratio (OR) 2.10, 95% confidence interval (CI) 1.59–2.79, P < 0.001) and postoperative rescue analgesia (OR 1.47, 95% CI 1.09–1.96, P = 0.010) as risk factors for CPSP, while intraoperative fentanyl dosage (OR 0.92, 95% CI 0.87–0.98, P = 0.006) emerged as a protective factor. Conclusion: The prolonged administration of dexmedetomidine did not yield discernible amelioration in either 1-year CPSP or the recovery quality after thoracoscopic surgery. Noteworthy risk factors for CPSP encompassed female sex, postoperative rescue analgesia, and diminished fentanyl dosage intraoperatively. [ABSTRACT FROM AUTHOR]

Background Robot-assisted minimally invasive oesophagectomy and conventional minimally invasive oesophagectomy are superior to open techniques. However, few studies have directly compared the outcomes of the two minimally invasive approaches. Methods A retrospective study of patients from six medical centres with oesophageal squamous cell carcinoma who underwent minimally invasive oesophagectomy between 2015 and 2022. Perioperative outcomes were compared after applying inverse probability of treatment weighting. Results The study included 577 patients (robot-assisted minimally invasive oesophagectomy: 206; conventional minimally invasive oesophagectomy: 371). After applying inverse probability of treatment weighting, robot-assisted minimally invasive oesophagectomy was found to yield a higher number of mediastinal nodes compared with conventional minimally invasive oesophagectomy (14.86 versus 12.66, P = 0.017). Robot-assisted minimally invasive oesophagectomy was notably effective in retrieving upper mediastinal left recurrent laryngeal nerve nodes, averaging 1.97 nodes versus 1.14 nodes harvested by conventional minimally invasive oesophagectomy (P < 0.001). This was coupled by a significant decrease in nerve palsy rates (13.9% versus 22.8%, P = 0.020). A significantly larger percentage of patients in the robot-assisted minimally invasive oesophagectomy group had an uncomplicated postoperative course (51.8% versus 34%, P < 0.001). Robot-assisted minimally invasive oesophagectomy also led to a reduction in pneumonia rates (8.6% versus 15.2%, P = 0.041) and was linked to a shorter length of stay (length of stay; 16.64 versus 21.14 days, P = 0.007). The advantage of robot-assisted minimally invasive oesophagectomy in reducing the length of stay was especially pronounced in patients with a high Charlson co-morbidity index (≥2, mean difference 8.46 days; P = 0.0069) and those who underwent neoadjuvant therapy (mean difference 5.63 days; P < 0.001). Conclusion In oesophageal squamous cell carcinoma, the use of robot-assisted minimally invasive oesophagectomy led to fewer cases of pneumonia and faster recovery compared with conventional minimally invasive oesophagectomy. Additionally, robot-assisted minimally invasive oesophagectomy significantly improved the feasibility and safety of performing lymph node dissection along the recurrent laryngeal nerve. [ABSTRACT FROM AUTHOR]

Objective This study aims to investigate the feasibility and safety of Da Vinci robotic-assisted thoracoscopy for resecting mediastinal tumors in pediatric patients. Methods From November 2020 to June 2023, a total of 80 pediatric patients undergoing mediastinal tumor resection at Wuhan Children's Hospital were randomly assigned into two groups, with each group consisting of 40 participants. The control group underwent conventional thoracoscopy, while the observation group underwent Da Vinci robotic-assisted thoracoscopy. This study aimed to compare perioperative indicators between the two groups and establish learning curves based on surgical duration and intraoperative blood loss. Additionally, it assessed levels of pain mediators and stress response markers before surgery and at 24 hours post-surgery, as well as postoperative complications. Inflammatory marker levels were evaluated one month after surgery, and the children's quality of life was measured using the Pediatric Quality of Life Inventory(PedsQL) Generic Core Scales before surgery and one month post-surgery. Results The surgical duration for the observation group and the control group was(1.76 ± 0.33) hours and(2.82±0.62) hours, respectively, and the intraoperative blood loss was(49.83 ± 6.39) mL and(71.55 ± 8.19) mL, respectively. Furthermore, the post-operative drainage time, drainage volume, and hospital stay for the observation group were all lower than those for the control group(P < 0.05). After surgery, the levels of BK, 5-HT, NPY, and PGE2 in the observation group were(8.06 ± 1.06) mg/L, (170.20 ± 13.21) ng/L, (201.82 ± 13.52) mg/L, and(241.82 ± 15.32) ng/L, respectively, indicating lower levels of pain mediators, stress response markers, and inflammatory factors compared to the control group(P < 0.05). he overall incidence of complications was 2.50% in the observation group as opposed to 20.00% in the control group. Moreover, there was a statistically significant improvement in quality of life after surgery within the observation group when compared to that within the control group(P < 0.05). Conclusion Da Vinci robotic-assisted thoracoscopy demonstrates enhanced feasibility and safety in pediatric mediastinal tumor resection, thereby justifying its clinical promotion. [ABSTRACT FROM AUTHOR]

The most common method surgical treatment of pectus excavatum (PE) is thoracoplasty according by D.Nuss at the moment. But serious complications associated with trauma to the pericardium, blood vessels, and bleeding are known. Objective. Development of a modified technology surgical correction of pectus excavatum, which involves exclusively extrapleural passage of the plate, according to the individual size and shape of the deformation of the patient's chest, in order to prevent intraoperative complications. Methods. 81 patients aged 10 to 17 years were involved in the study. A modified technology of extrapleural surgical correction of PE was performed. The plate was carried level of the VI-VII sternocostal joints through the formed through submuscular-extrapleural retrosternal tunnel from right to left under control of right-sided thoracoscopy. The plate was modeled according by individual de-formation parameters chest. The analysis was carried out according to the following criteria: age, gender, type of deformity, Haller index, duration of surgery, intraoperative and early postoperative complications according by Clavien-Dindo classification. Results. The median age of patients was (13.8 ± 1.9) years, of which there were 65 (85.25 %) boys, 16 (19.75 %) girls. 48 (59.3 %) children were diagnosed with type I (symmetric) deformity, and 33 (40.7 %) with type II (asymmetric) according to the classification. The median Haller was (4.07 ± 0.62), which corresponds to 2-3 degrees. Differences in the degree of deformation in children of different sexes were not determined (р = 0.828). Impaired lung function was diagnosed in 55.55 % (n = 45), impaired heart function -- 40.74 % (n = 33). The duration of the operation was on average (70.6 ± 15.4) minutes, from 50 to 110 minutes. Early postoperative complications were found in 5 (6.17 %) patients classified as grade I (mild) according to the Clavien-Dindo classification, which did not require additional medical or surgical correction. After the operation, the correction of chest deformation was on average (2.35 ± 0.22) according by Haller index, which was statistically significantly (р = 0.001) different from the initial level. Conclusions. The use of modified technology surgical correction of PE meets safety requirements and minimizes postoperative complications. [ABSTRACT FROM AUTHOR]

Objective: In this study, we compared the analgesic effects of intercostal nerve block (ICNB), ultrasound-guided paravertebral nerve block (PVB), and epidural block (EB) following single-port thoracoscopic lung surgery. Method: A total of 120 patients who underwent single-hole thoracoscopic lung surgery were randomly and equally divided into three groups: ICNB group, the PVB group, and the EB group. ICNB was performed under direct thoracoscopic visualization before the conclusion of the surgery in the ICNB group, while PVB and EB were performed after general anesthesia in the PVB and EB groups, respectively. Patient-controlled intravenous analgesia (PCIA) was used following the surgery in all the groups. The following indicators were recorded: Intraoperative sufentanil dosage, anesthesia awakening time, postoperative intubation time, nerve block operation time, postoperative visual analog scale (VAS) pain scores during resting and coughing at regular intervals of 0, 2, 4, 8, 24, and 48 h, the time until first PCIA, number of effective compressions within 24 h postoperatively, number of rescue analgesia interventions, and the side effects. Results: In comparison to the ICNB group, the PVB and EB groups had a lower intraoperative sufentanil dosage, significantly shorter anesthesia awakening time, and postoperative intubation time, but longer nerve block operation time, lower VAS scores when resting and coughing within 24 h postoperatively (all p-values less than 0.05). Conversely, there were no statistically significant differences in VAS scores during resting and coughing after 24 h (all p-values greater than 0.05). Time to first PCIA, number of effective compressions and number of rescue analgesia at the 24-hour mark postoperatively were significantly better in the PVB and EB groups than that in the ICNB group (P < 0.05). However, there was a higher incidence of side effects observed in the EB group (P < 0.05). Conclusion: The analgesic effect of PVB and EB following single-port thoracoscopic lung surgery is better than that of ICNB. PVB causes fewer side effects and complications and is safer and more effective. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive esophagectomy is the first-line approach for esophageal cancer; however, there has recently been a paradigm shift toward robotic esophagectomy (RE). We investigated the clinical outcomes of patients who underwent RE compared with those of patients who underwent conventional minimally invasive thoracoscopic esophagectomy (TE) for locally advanced cT3 or cT4 esophageal cancer using a propensity-matched analysis. Methods: Overall, 342 patients with locally advanced cT3 or cT4 esophageal cancer underwent transthoracic esophagectomy with total mediastinal lymph node dissection between 2018 and 2022. The propensity-matched analysis was performed to assign the patients to either RE or TE by covariates of histological type, tumor location, and clinical N factor. Results: Overall, 87 patients were recruited in each of the RE and TE groups according to the propensity-matched analysis. The total complication rate and the rates of the three major complications (recurrent laryngeal nerve paralysis, anastomotic leakage, and pneumonia) were not significantly different between the RE and TE groups. However, the peak C-reactive protein concentration on postoperative day 3, rate of surgical site infection, and intensive care unit length of stay after surgery were significantly shorter in the RE group than in the TE group. No significant differences were observed in the harvested total and mediastinal lymph nodes. The total operation time was significantly longer in the RE group, while the thoracic operation time was shorter in the RE group than in the TE group. There was no significant difference between the two groups in the recurrence rate of oncological outcomes after surgery. Conclusion: RE may facilitate early recovery after esophagectomy with total mediastinal lymph node dissection and has the same technical feasibility and oncological outcomes as TE. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Our study analyzed the main manifestations of tuberculous pleurisy (TBP) in children under medical thoracoscopy (MT). This article aimed to explore the clinical application value of MT in the diagnosis and treatment of TBP in children. METHODS: In our study, we selected 23 TBP patients diagnosed in our hospital. We analyzed the clinical data and thoracoscopic morphology of these patients. At the same time, we also observed the pathological manifestations, acid-fast staining, and treatment effects of the patient's diseased tissue under MT. RESULTS: The MT clinical findings of TBP patients include pleural hyperemia and edema, miliary nodules, scattered or more white nodules, simple pleural adhesion, wrapped pleural effusion, massive cellulose exudation, yellow-white caseous necrosis, pleural hyperplasia and hyperplasia, and mixed pleural necrosis. The positive rate of pleural biopsy was 73.91% and that of acid-fast staining was 34.78%. The main pathologic types of these patients were tuberculous granulomatous lesions (16 cases), caseous necrosis (5 cases), and fibrinous exudative, multinucleated giant cell and other inflammatory cell infiltration lesions (13 cases). The average time of diagnosis of the 23 patients was 8.32 days (5.0-16.0 days), and they were transferred to specialized hospitals for treatment after diagnosis. The mean time of chest drainage was 3.0-5.0 days after treatment. The average time for their body temperature to return to normal was 3.31 days (2.0-5.0 days). CONCLUSION: Thoracoscopic lesions of TBP in children are varied. The use of MT is not only helpful for the early diagnosis and treatment of TBP. It also protects and improves lung function. Therefore, the use of MT has high clinical value. [ABSTRACT FROM AUTHOR]

Introduction. One of the most common pathologies of the pericardium is pericarditis, which can present as acute, subacute or chronic pericarditis, pericardial effusion, cardiac tamponade or constrictive pericarditis. However, it is a rare condition in the pediatric population. Methods. A series of cases of patients with pericarditis who were taken to pericardiotomy, pericardial drainage and anterior partial pericardiectomy, between July 2014 and June 2023 is presented. Demographic and clinical variables were collected, microbiological isolates and the management received were evaluated. Results. A total of 12 patients underwent minimally invasive surgical management; of these, 58% belonged to indigenous communities and lived in rural areas. Half had associated pneumonia. In most cases, no microbiological isolation was obtained. Conclusion. The need for surgical management is determined by the impact on the hemodynamic variables related to the effusion and pericardial compromise. Partial pericardiectomy by thoracoscopy is an alternative in these cases. [ABSTRACT FROM AUTHOR]

Background: Bronchogenic cysts result from a congenital anomalous budding of the tracheobronchial tree. Resection is usually recommended to avoid complications. Mediastinal bronchogenic cysts present a unique challenge due to their proximity to vital structures. The purpose of this study is to review our experience with mediastinal bronchogenic cysts. Methods: A single-institution retrospective review evaluated all mediastinal bronchogenic cyst excisions between January 2012 and November 2022. Patient demographics were assessed, including age at diagnosis, presenting symptoms, imaging workup, and cyst characteristics. Operative approach, complications, and surgical pathology were reported. Results: Five patients were identified. Age at diagnosis ranged from 18 to 27 months. No patient was diagnosed prenatally. All patients had symptoms at the time of diagnosis, including cough, wheezing, and respiratory distress. Three cysts were paratracheal, and two were paraesophageal. Age at surgery ranged from 26 to 30 months. All bronchogenic cysts were successfully resected thoracoscopically. Individual technical challenges included narrowing of the mainstem bronchus preventing lung isolation, significant mediastinal inflammation, the necessity for cyst evacuation to delineate the extent of the cyst, adherence of cyst wall to bronchus or trachea requiring cold dissection, and a stalk of tissue with an intimate connection to the carina that was amputated. No intraoperative or postoperative complication occurred. Surgical pathology was consistent with a bronchogenic cyst in all cases. Median length of hospital stay was two days. Conclusion: Thoracoscopy is a safe and effective procedure for mediastinal bronchogenic cyst excision in children. Certain technical maneuvers are highlighted, which may facilitate resection. [ABSTRACT FROM AUTHOR]