scholarly journals Three-dimensional CT Angiography Facilitates Uniportal Thoracoscopic Anatomic Lung Resection for Pulmonary Sequestration

Author(s):  
Wenlong Zheng ◽  
Miao Zhang ◽  
Wenbin Wu ◽  
Hui Zhang ◽  
Zhang Xinhui

Abstract BackgroundPulmonary sequestration (PS) is a rare lesion with independent blood supply from an anomalous systemic artery. A timely resection is considered the best treatment for PS, but the optimal approach is controversial. Three-dimensional computed tomography angiography (3D-CTA) has been widely utilized for precise thoracic surgery. This study aimed to investigate the safety of uniportal video-assisted thoracoscopic surgery (VATS) for PS assisted with preoperative 3D-CTA. MethodsThe data of patents with PS who underwent VATS anatomic lung resection between April 2011 and May 2021 in a single centre were retrospectively reviewed. They were divided into uniportal and tow-port groups according to the initial surgical plan. The perioperative parameters including the incidence of conversion to open thoracotomy, operation time, blood loss, complications and chest tube duration were analyzed. ResultsTwenty consecutive patients (9 in uniportal group and 11 in two-port group) underwent VATS for PS, including 12 female and 8 male patients, with a mean age of 45 years old (range, 24-60 years). Nine cases demonstrated recurrent febrile, cough, or hemoptysis; whereas the other 11 patients were asymptomatic. The 3D-CTA was utilized for all patients in the uniportal group and 1 patient in the two-port group. Eighteen (90.0%) intralobar and 2 extralobar PS were confirmed; and 18 (90.0%) lesions were located in the left thorax. The feeding vessels originated from the thoracic aorta in 16 patients (80.0%), the abdominal aorta in 3 (15.0%) and the inferior phrenic artery in 1 patient (5.0%). Thirteen lobectomies, 5 segmentectomies and 2 mass excisions were performed. There was no major bleeding or 30-day mortality. No conversion was needed in the uniportal group; whereas 6 (54.5%) conversions (4 to multiple-port and 2 to thoracotomy) occurred in the two-port group, indicating a significant difference (P=0.008). In addition, the operation time in the uniportal VATS group was significantly shorter than those in the two-port VATS group ([110.6 ± 25.5] min vs. [148.6 ± 42.1] min, P = 0.029). The other perioperative variables were similar between the two groups. During the follow-up of 5-75 months, no recurrence of hemoptysis was recorded. ConclusionPreoperative 3D-CTA facilitates the safe performance of uniportal VATS anatomic lung resection for PS, which might be associated with shorter operation time and lower conversion to thoracotomy.

Author(s):  
Yuan-Wei Zhang ◽  
Xin Xiao ◽  
Wen-Cheng Gao ◽  
Yan Xiao ◽  
Su-Li Zhang ◽  
...  

Abstract Background This present study is aimed to retrospectively assess the efficacy of three-dimensional (3D) printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. Material and methods Twenty-five patients (15 males and 10 females) with the cubitus varus deformity from June 2014 to December 2017 were included in this study and were enrolled into the conventional group (n = 11) and 3D printing group (n = 14) according to the different surgical approaches. The operation time, intraoperative blood loss, osteotomy degrees, osteotomy end union time, and postoperative complications between the two groups were observed and recorded. Results Compared with the conventional group, the 3D printing group has the advantages of shorter operation time, less intraoperative blood loss, higher rate of excellent correction, and higher rate of the parents’ excellent satisfaction with appearance after deformity correction (P < 0.001, P < 0.001, P = 0.019, P = 0.023). Nevertheless, no significant difference was presented in postoperative carrying angle of the deformed side and total complication rate between the two groups (P = 0.626, P = 0.371). Conclusions The operation assisted by 3D printing osteotomy guide plate to correct the adolescent cubitus varus deformity is feasible and effective, which might be an optional approach to promote the accurate osteotomy and optimize the efficacy.


2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110285
Author(s):  
Kai Xiao ◽  
Bo Xu ◽  
Lin Ding ◽  
Weiguang Yu ◽  
Lei Bao ◽  
...  

Objective To assess the outcomes of traditional three-dimensional (3D) printing technology (TPT) versus mirror 3D printing technology (MTT) in treating isolated acetabular fractures (IAFs). Methods Consecutive patients with an IAF treated by either TPT or MTT at our tertiary medical centre from 2012 to 2018 were retrospectively reviewed. Follow-up was performed 1, 3, 6, and 12 months postoperatively and annually thereafter. The primary outcome was the Harris hip score (HHS), and the secondary outcomes were major intraoperative variables and key orthopaedic complications. Results One hundred fourteen eligible patients (114 hips) with an IAF (TPT, n = 56; MTT, n = 58) were evaluated. The median follow-up was 25 months (range, 21–28 months). At the last follow-up, the mean HHS was 82.46 ±14.70 for TPT and 86.30 ± 13.26 for MTT with a statistically significant difference. Significant differences were also detected in the major intraoperative variables (operation time, intraoperative blood loss, number of fluoroscopic screenings, and anatomical reduction number) and the major orthopaedic complications (loosening, implant failure, and heterotopic ossification). Conclusion Compared with TPT, MTT tends to produce accurate IAF reduction and may result in better intraoperative variables and a lower rate of major orthopaedic complications.


2020 ◽  
Author(s):  
Feiya Yang ◽  
Lianjie Mou ◽  
Nianzeng Xing

Abstract Objective To explore the feasibility of laparoscopic partial nephrectomy(LPN) in the treatment of renal hilar tumors. Methods Clinical data of 290 patients undergoing laparoscopic partial nephrectomy from January 2013 to August 2019 were retrospectively analyzed, including 27 patients with renal hilar tumors and 263 patients with non-hilar renal tumors. Perioperative data and follow-up results were compared between the two groups. Results Tumor size in Group A is smaller(2.97±0.88 vs 3.55±1.46,p<0.05), R.E.N.A.L. nephrometry score of Group A is higher(8.4±1.3 vs 6.5±1.7,p<0.01).The operation time, WIT and intraoperative blood loss in the Group A were slightly higher, but with no statistical difference (p>0.05). There was no significant difference between the two groups in intraoperative ultrasound rate, collection system repair rate, drainage time,postoperative hospital stay, and eGFR changes (p>0.05).The median follow-up period was 40 months. One patient with postoperative pathologic report of angiomyolipoma was found tumor recurrence and was currently undergoing regular reexamination. Conclusion Three-dimensional laparoscopic partial nephrectomy for renal hilar tumors is safe and feasible after detailed preoperative evaluation of the tumor and selection of appropriate surgical strategies.


2016 ◽  
Vol 40 (2) ◽  
pp. 201-205 ◽  
Author(s):  
C. J. Daly ◽  
J. M. Bulloch ◽  
M. Ma ◽  
D. Aidulis

Sophisticated three-dimensional animation and video compositing software enables the creation of complex multimedia instructional movies. However, if the design of such presentations does not take account of cognitive load and multimedia theories, then their effectiveness as learning aids will be compromised. We investigated the use of animated images versus still images by creating two versions of a 4-min multimedia presentation on vascular neuroeffector transmission. One version comprised narration and animations, whereas the other animation comprised narration and still images. Fifty-four undergraduate students from level 3 pharmacology and physiology undergraduate degrees participated. Half of the students watched the full animation, and the other half watched the stills only. Students watched the presentation once and then answered a short essay question. Answers were coded and marked blind. The “animation” group scored 3.7 (SE: 0.4; out of 11), whereas the “stills” group scored 3.2 (SE: 0.5). The difference was not statistically significant. Further analysis of bonus marks, awarded for appropriate terminology use, detected a significant difference in one class (pharmacology) who scored 0.6 (SE: 0.2) versus 0.1 (SE: 0.1) for the animation versus stills group, respectively ( P = 0.04). However, when combined with the physiology group, the significance disappeared. Feedback from students was extremely positive and identified four main themes of interest. In conclusion, while increasing student satisfaction, we do not find strong evidence in favor of animated images over still images in this particular format. We also discuss the study design and offer suggestions for further investigations of this type.


2021 ◽  
Author(s):  
Panpan Zhang ◽  
Dan Liu ◽  
Dong Luo ◽  
Fuli Pang

Abstract Background To investigate the effects of modified subxiphoid thoracoscopic surgery and traditional surgery on pain mediators and pain stress levels in patients with anterior mediastinal teratoma. Method Eighty patients with anterior mediastinal teratoma who underwent surgery in our hospital from May 2019 to May 2021 were selected as the subjects of this prospective study. According to the random residue grouping method, they were divided into a control group and observation group with 40 cases each. Among them, the control group underwent traditional surgery, and the observation group underwent modified subxiphoid thoracoscopic surgery. Observe and compare the surgical indicators, pain-causing mediators, and pain stress levels of the two groups of patients. Result The intraoperative blood loss, postoperative extubation time, and total drainage volume of the observation group were significantly lower than those of the control group, while the operation time was significantly higher than that of the control group, which was statistically significant (P < 0.05). There was no statistically significant difference in the pain-causing mediators of the two groups before surgery (P > 0.05), while the NPY, PGE2 and 5-HT at 1 day after surgery were significantly different, and the observation group was better than the control group. The comparison was statistically significant. Significance (P < 0.05). There was no statistically significant difference in pain stress levels between the two groups before surgery (P > 0.05), while NO, IL-6, and IL-β 1 day after surgery were significantly different, and the observation group was better than the control group. Statistically significant (P < 0.05). Conclusion The modified subxiphoid thoracoscopic surgery has a significant effect, reduces the level of peripheral blood pain-causing factors, relieves the pain of the patient, and promotes the recovery of the patient. It provides a certain reference for the mediastinal teratoma before the clinical operation.


2020 ◽  
Vol 68 (06) ◽  
pp. 533-539
Author(s):  
Saisai Sun ◽  
Kaichao Liu ◽  
Xiang Gao ◽  
Binhui Ren ◽  
Lei Sun ◽  
...  

Abstract Background The localization of small pulmonary nodules (SPNs) during video-assisted thoracoscopic surgery (VATS) is challenging thoracic surgeon, especially in patients with severe pleural adhesion or visceral pleura pigmentation due to low success rate and future conversion to thoracotomy. This study aims to compare the efficacy and safety between modified microcoil and methylene blue in preoperative localization of small nodules, particularly patients with severe pleural adhesion or visceral pleura pigmentation. Materials and Methods From January 2018 to February 2019 in our institute, 342 patients who underwent computed tomography-guided localization of SPN were recruited in this retrospective cohort study and divided into the modified microcoil group (n = 239) and the methylene blue group (n = 103) according to the localization method. Clinical characteristics and perioperative complications were collected to analyze. Results All SPNs were successfully marked in both groups. Location-related complications, the duration of localization procedure, and the length of hospital stay were not different between the two groups. The operation time of modified microcoil and the duration of removal of nodule in operation were both shorter than the methylene blue (p = 0.014 and p = 0.047). The analysis stratified by gender showed that similar results were found in male patients (p = 0.01 and p = 0.00), while in female patients, no significant difference was found. Additionally, in senior patients (older than 60 years), the operation time in modified microcoil groups was less than methylene blue group (p = 0.024). Conclusion Compared with methylene blue, modified microcoil achieved a shorter operation time of removal of nodule in VATS, especially for patients with pleural adhesion and the pigmentation of the lung surface as well as the male patients and the patients older than 60 years.


2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Haijiao Mao ◽  
Haiqing Wang ◽  
Jiyuan Zhao ◽  
Linger Wang ◽  
Liwei Yao ◽  
...  

AbstractThe purpose of this study was to provide an initial assessment of treatment for talar posterior process fractures using open reduction and internal fixation (ORIF) through posteromedial approach and percutaneous screw fixation. From January 2014 to December 2018, 12 cases with displaced fracture of talar posterior process were treated in our department. The clinical and radiological results were assessed after 4 and 12 months of operation with Visual Analog Scale (VAS) pain and American Orthopedic Foot and Ankle Society (AOFAS) scores. ORIF was performed in four of the cases and percutaneous screw fixation was performed in eight of the cases. The average follow-up period was 13 months. Complications such as wound infection, nerve injury, screw loosening, malunion or nonunion of fracture were absent. For clinical assessment, considerable mprovements were observed for the AOFAS and VAS scores at 4 and 12 months postoperatively for both techniques. There was no significant difference for AOFAS scores and VAS scores between the two techniques (p > 0.05). Both techniques showed good functional outcome and were performed for posterior talar process fracture following the fracture displacement guidelines. Percutaneous screw fixation treatment with computer-assisted three-dimensional evaluation shortened the operation time and reduced incidences of surgical complications.


2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Rika Tobita ◽  
Ryota Nakamura ◽  
Yoshihisa Inage

Abstract It is essential to understand individual pulmonary anatomy, and the relationship between the tumor and surrounding organ, when lung resection is conducted. Recently, many anomalous pulmonary venous variations have been detected using three-dimensional computed tomography (3D-CT). Herein, we report the case of a 62-year-old women with lung cancer and an anomalous right upper lobe pulmonary vein that drained into the left atrium between the pulmonary artery and bronchus. Preoperative 3D-CT clearly demonstrated the anomalous pulmonary vein, and we safely performed lung resection by thoracoscopic surgery. Therefore, 3D-CT images can help ensure the safety of patients with aberrant vasculature during lung resection.


2021 ◽  
Author(s):  
Xiao Duqing ◽  
Wang Gefei ◽  
Liang Yalun ◽  
Yu Gang ◽  
Wu Zhaohong

Abstract Objective: This study aims to identify the difference between patients who have been diagnosed with either intralobar sequestration (ILS) or extralobar sequestration (ELS).Methods: In this clinical study, 29 children with pulmonary sequestration (PS), diagnosed via physical examination and imaging at our hospital between January 2019 and January 2020, were enrolled. We compared whether statistical differences existed in the blood loss, operative time, and post-operative hospital stay between the two groups (ILS and ELS) after thoracoscopic pulmonary wedge resection.Results: There were no significant differences in gender, operative age, preoperative weight, and isolated lung position between the ILS and ELS groups (p > 0.05). There was significantly more intra-operative bleeding in children with ILS than those with ELS (p < 0.05), and the operation time and postoperative hospitalization times were significantly longer for those with ILS(p < 0.05). Upon microscopic evaluation after surgery, we found the appearance of ILS and ELS to be similar.Conclusion: Different types of congenital PS have different influences onnewborns during and after operation. For children with ILS, surgery is more difficult and the postoperative recovery is slower than for children with ELS. For this reason, we suggest that more attention should be paid to the clinical treatment of children with ILS. Although ILS and ELS present with different manifestations, we found no evidence of a significant difference in the postoperative microscopy of the two conditions.


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