• Journal of Chest Surgery
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• v.46 no.4
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• pp.241-248
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• 2013

Esophageal cancer has one of the highest malignant potentials of any type of tumor. The 3-field lymph node dissection is the standard procedure in Japan for surgically curable esophageal cancer in the middle or upper thoracic esophagus. Minimally invasive esophagectomy is being increasingly performed in many countries, and several studies report its feasibility and curability; further, the magnifying effect of the thoracoscope is another distinct advantage. However, few studies have reported that minimally invasive esophagectomy is more beneficial than open esophagectomy. A recent meta-analysis revealed that minimally invasive esophagectomy reduces blood loss, respiratory complications, the total morbidity rate, and hospitalization duration. A randomized study reported that the pulmonary infection rate, pain score, intraoperative blood loss, hospitalization duration, and postoperative 6-week quality of life were significantly better with the minimally invasive procedure than with other procedures. In the future, sentinel lymph node mapping might play a significant role by obtaining individualized information to customize the surgical procedure for individual patients' specific needs.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.39-47
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• 1987

The records of 268 patients, who were diagnosed as spontaneous pneumothorax during the period 1975 to 1984, treated at the department of thoracic and cardiovascular surgery, Hanyang University Hospital, were reviewed retrospectively to evaluate the effect of surgical intervention on each indications. Of these,.61 patients [22.8%] were taken operation to treat the pneumothorax after closed thoracostomy. We have classified the 61 patients to evaluate the therapeutic effect on each indications. And the therapeutic effect is based on the chest tube indwelling days. The results were as follows: 1. The chest tube indwelling days of the group who were taken closed thoracostomy only was average 14.13*9.17 days [range 5-66 days], and that of the group who were finally taken the thoracotomy after closed thoracostomy was 21.85*12.30 days [range 5-55 days]. 2. The indications of thoractomy were thoracoscopic findings, recurrence and continuous air leakage. 3. The chest tube indwelling day of the group who was taken thoracotomy by thoracoscopic findings was average 11.67*6.51 day, that was relatively short compared to those of the other groups. 4. The continuous air leakage group after closed thoracostomy was subdivided into three subgroups, continuous air leakage in 1st attack, thoracoscopic findings in 1st attack, and recurrence. 5. Of these, the chest tube indwelling day of the subgroup, who was taken operation by thoracoscopic findings, was 21.33e8.26, that was relatively short compared with those of the other subgroups. We use the thoracoscope as excellent diagnostic tool to detect the operation indication in the spontaneous pneumothorax patients. And we gain the benefits to shorten the chest tube indwelling days and admission days, and also to protect the recurrence.

• Journal of Chest Surgery
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• v.54 no.1
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• pp.59-64
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• 2021

Background: Diaphragmatic injuries following blunt or penetrating thoraco-abdominal trauma are rare, but can be life-threatening. Rib fractures are the most common associated injury in patients with a traumatic diaphragmatic injury (TDI). We hypothesized that the pattern of rib fracture injuries could dictate the likelihood of acute TDIs. Methods: A retrospective study was carried out between April 2014 and October 2018 to analyze patients with TDIs and rib fractures at a major trauma center in London, United Kingdom. Results: Over the study period, 1,560 patients had rib fractures, of whom 14 had associated diaphragmatic injuries. Left-sided diaphragmatic injuries were found in 8 patients (57%). A significant proportion of the rib fractures were located posterolaterally (44.9%). The highest frequency of fractures was found in ribs 5-10, which accounted for 74% of all the fractures. Ten patients underwent surgery, of whom 7 were diagnosed with a diaphragmatic injury intraoperatively after video-assisted thoracoscopic surgery assessment of the pleural cavity. Two patients died due to severe injuries of other organs and the remaining 2 patients were managed conservatively. Conclusion: Our series of patients demonstrates a relationship between significant rib fractures and diaphragmatic injuries in trauma patients, and the diagnostic difficulties in identifying the condition. We found that the location of the rib fractures and the pattern of injury in patients with TDIs were much lower and posterolateral in the chest wall without a preference for laterality. We suggest using a thoracoscope in patients undergoing chest wall surgery post-trauma to aid in diagnosing this condition.

• Journal of Chest Surgery
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• v.56 no.2
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• pp.120-125
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• 2023

Background: Multiple rib fractures are common in blunt chest trauma. Until recently, most surgical rib fixations for multiple rib fractures were performed via open thoracotomy. However, due to the invasive nature of tissue dissection and the resulting large wound, an alternative endoscopic approach has emerged that minimizes the postoperative complications caused by the manipulation of injured tissue and lung during an open thoracotomy. Methods: Our study concentrated on patients with multiple rib fractures who underwent surgical stabilization of rib fractures (SSRF) between June 2018 and May 2020. We found 27 patients who underwent SSRF using video-assisted thoracoscopic surgery. The study design was a retrospective review of the patients' charts and surgical records. Results: No intraoperative events or procedure-related deaths occurred. Implant-related irritation occurred in 4 patients, and 1 death resulted from concomitant trauma. The average hospital stay was 30.2±20.1 days, and ventilators were used for 12 of the 22 patients admitted to the intensive care unit. None of the patients experienced major pulmonary complications such as pneumonia or acute respiratory distress syndrome. Conclusion: Minimally invasive rib stabilization surgery with the assistance of a thoracoscope is expected to become more widely used in patients with multiple rib fractures. This method will also assist patients in a quick recovery.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.362-368
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• 2007

Background: Spontaneous pneumothorax patients with blebs or bullae are considered to be good candidates for operation, and various objective diagnostic modalities have been performed for detection of blebs and bullae. This study was performed to compare the efficacy of thoracoscopic examination with using a minimally invasive 2 mm thoracoscope with high-resolution computed tomography (HRCT) for treating primary spontaneous pneumothorax. Material and Method: From June 2001 to March 2002, 34 patients with spontaneous pneumothorax undewent study with 2 mm video-thoracoscopic examination and HRCT. We regarded a blob larger than 5 mm in diameter as significant. Standard thoracoscopic wedge resection was performed in 18 patients with significant blob via a 2 mm video-thoracoscopic examination. 1 patient incurred bleeding, and the remaining 15 patients were treated with pleural drainage. Result: Multiple or single blob lesions were detected by 2 mm video-thoracoscope in 52.9% (18/34) of the patients with primary pneumothorax. For a total of 19 patients who were operated on, the diagnostic accuracy of the 2 mm video-thoracoscopic examination for bullae and blob was 94.7% (18/19), which was superior to that of HRCT (73.7%, 14/19). At a mean follow-up of $30{\pm}3$ months, no recurrence occurred in both the operative group and the non-operative group. Conclusion: 2 mm video-thoracoscopic examination under local anesthesia has higher diagnostic accuracy than HRCT, and it is a useful alternative for determining the operative indications for spontaneous pneumothorax.

• Journal of Chest Surgery
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• v.29 no.7
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• pp.723-727
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• 1996

An adequate exposure is important in thoracoscopic procedures. The insufflation of $CO_2$has been demonstrated to aid in compressing lung parenchyma, and act as a retractor when combined with changes in patient's position. However, a recent study demonstrated that $CO_2$insufflation during thoracoscopy in the pig has adverse hemodynamic consequences. We prospectively studied 12 patients undergoing thoracoscopy to evaluate the effect of $CO_2$insufflation in the clinical setting. The mean arterial pressure, heart rate, central venous pressure, arterial oxygen saturation, and end-tidal $CO_2$pressure were monitored. Measurements were determined at baseline, at the initiation of one-lung ventilation, and at intrapleural pressure of 5, 10, 15 mmHg and following results were obtained. 1) The insufflation of 5 to 15 mmHg of $CO_2$had no significant effect on the mean arterial pressure, heart rate, arterial oxygen saturation. 2) The end-tidal $CO_2$pressure rose from 31.00$\pm$1.67 mmHg to 38.49$\pm$1.82 mmHg at an intrapleural pressure of 15 mmHg(p<0.05). 3) The central venous pressure rose from 7.75$\pm$0.76 mmHg to 12.83$\pm$1.64 mmHg and 16.16$\pm$l.97mmHg at an intrapleural pressure of 10 and 15 mmHg(p<0.05). 4) The low pressure (<10 mmHg) insufflation is a safe adjunct to the conduct of thoracoscopic surgical procedures.

• Journal of Chest Surgery
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• v.29 no.7
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• pp.769-776
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• 1996

The application of video-assisted thoracic surgery (VATS) in the examination of the thoracic cavity can be a new option in patients with mediastinal tumor because it provides outstanding visibility of the structures of the mediastinum. By clear viewing through the thoracoscope, a mediastinal tumor can be biopsied or resected, depending on the findings during an operation. We reviewed all patients who underwent curative or diagnostic operations from March 1990 to August 1995 under the impression of a mediastinal mass. The total number of patients were 113 with 59 males and 54 females. Group A underwent resection of tu or by thoracotomy(38 patients: 18 males, 20 females), and group B underwent resection of tumor by VATS (36 patients : 20 males and 16 females). Seven patients in group B were excluded because they underwent thoracotomy due to pleural adhesion or intra-operative bleeding ; therefore, the true VATS group numbered 29 cases. Group C underwent Iymph node biopsy by VATS(33 patients'16 males, 17 females), and group D(6 patients: 5 males, 1 female) underwent Iymph node biopsy through anterior mediastinotomy. The mean age in group A was 36.2 years compared to 41.3 years In group B. We compared operation time, frequency of injection for pain control, duration of chest tube insertion, postoperative hospital stay, and diagnostic yield. In group A, they were 164 minutes, 3.4 times, 5.2 days, and 11.3 days, respectively, in comparison to 152 minutes, 2 times, 4.7 days, and 8.3 days, respectively, in group B. These data revealed that the day of discharge was significantly shorter in group B (p valu : 0.03). In group C, the mean age was 45.8 years (range 1 ∼70). The operation time was from 30 to 335 minutes (mean 105), pain control was required from 0 to 15 times(mean 3.2), and a chest tube was needed for 1 to 36 days (mean 6.1). In group D, mean age was 53.3 years, operation time 121 minutes, pall control injec- tion frequency 2.6 times, and mean chest tube duration 10.5 days. The diagnostic yield in group C was 8 oyo compared to 100 oyo in group D although the number of patients in group D is small.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.568-572
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• 2008

Background: Minimally invasive surgery is currently popular, but this has been applied very sparingly to cardiac surgery because of some limitations. Our study evaluated the safety and efficacy of atrial septal defect (ASD) closure through a video-assisted mini-thoracotomy. Material and Method: Fifteen patients were analyzed. Their mean age was $31{\pm}6$ years. The mean ASD size was $24{\pm}5mm$ and there were 3 cases of significant tricuspid regurgitation. The working window was made through the right 4th intercostal space via a $4{\sim}5cm$ inframammary skin incision, CPB was conducted with performing peripheral cannulation. After cardioplegic arrest, the ASDs were closed with a patch (n=11) or direct sutures (n=4), and the procedures were assisted by using a thoracoscope. There were 3 cases of tricuspid repair and 1 case of mitral valve repair. The mean CPB time and aortic occlusion time were $160{\pm}47\;and\;70{\pm}26 $minutes, respectively. Result: There was no mortality, but there were 3 minor complications (one pneumothorax, one wound dehiscence and one arrhythmia). The mean hospital stay was $5.9{\pm}1.8$ days. The mean follow-up duration was $10.7{\pm}6.4$ months. The follow-up echocardiogram noted no residual ASD or significant tricuspid regurgitation. Three patients suffered from pain or numbness. Conclusion: This study showed satisfactory clinical and cosmetic results. Although the operative time is still too long, more experience and specialized equipment would make this technique a good option for treating ASD.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.586-590
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• 2008

Background: Non-small cell lung cancer (NSCLC) patients histologically proven to have stage N2 disease by media-stinoscope or thoracoscope underwent subsequent neoadjuvant chemoradiotherapy. This study was designed to find out if there were any differences in survival or recurrence rates between N2 positive and N2 negative patients. Material and Method: Between January 1998 and December 2005, we retrospectively analyzed 69 patients who were divided into three groups. Group A consisted of patients whose N stage was downstaged, group B of patients whose N stage was the same, and Group C of patients who could not undergo surgery because of disease progression during neoadjuvant chemoradiotherapy. We analyzed and compared the mean survival, three-year survival, mean disease-free survival, and three-year disease-free survival rates for the three groups. Result: There were no demographic differences among the groups. The mean survival was 58, 47, and 21 months for groups A, B, and C, respectively. The mean survival was longest in group A, but no statistically significant difference was found on A-B or B-C group comparison (p>0.05). However, a significant difference was noted between group A and group C (p : 0.01). Three-year survival rates were 67%, 41%, and 21.6% for groups A, B, and C, respectively, with a statistical difference similar to that seen in mean survival. The mean disease-free survival was 44 months in group A and 45 months in group B, with no statistically significant difference noted. No significant differences were noted in the three-year disease-free survival rates (55.1%, 46.8%). Conclusion: There were no significant differences in survival or recurrence rates with changes in N stage after neoadjuvant chemoradiotherapy. However, mean survival, three-year survival, and three-year disease-free survival rates tended to be higher in downstaged patients. Nevertheless, the difference was statistically insignificant, and therefore further studies with more patients and longer follow-up are necessary to clarify the positive effects on the survival and prognosis of downstaged patients.

• Journal of Chest Surgery
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• v.41 no.4
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• pp.469-475
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• 2008

Background: Video-assisted thoracic sympathicotomy is a definitive minimally invasive treatment for axillary hyperhidrosis. Different techniques exist for controlling axillary hyperhidrosis, but they are temporary and expensive. We compared the results after using two different levels of sympathicotomy for treating axillary hyperhidrosis: T3-T4 and T4. Material and Method: Between June 2002 and May 2007, 30 patients with isolated axillary hyperhidrosis underwent either T3-T4 or T4 thoracoscopic sympathicotomy in the Department of Thoracic & Cardiovascular Surgery at Wonkwang University Hospital. The patients were divided into two groups. Group I (n=15) was composed of patients who underwent T3-T4 sympathicotomy (thermal ablation), and Group II (n=15) was composed of patients who underwent T4 sympathicotomy (thermal ablation). The procedures were bilateral and simultaneous, involving the use of two 2-mm trocars and a 0-degree 2-mm thoracoscope under general anesthesia with single endotracheal intubation. Outcome parameters included satisfaction rate of treatment, degree of compensatory sweating, and postoperative complications. Patients were interviewed by telephone regarding satisfaction and compensatory hyperhidrosis. Result: There were no differences in age between group I and group II. The mean follow-up for the T3-T4 group was $38.7{\pm}2.3$ months, and the mean follow-up for the T4 group was $18.7{\pm}3.6$ months. The immediate therapeutic success rate (within 2 weeks postoperative) was 100% in both groups, and there were no recurrences in either group during the long-term follow-up period. The satisfaction rate was higher (93.3%) in the T4 group than in the T3-T4 group (53.3%), and the incidence of compensatory hyperhidrosis was lower in the T4 group (6.7%) than in the T3-T4 group (46.7%). Postoperative complications included one mild pneumothorax and two instances of intercostal neuralgia. Digital infrared thermographic imaging (DITI) correlated well with postoperative satisfaction. Conclusion: Both techniques proved effective for controlling isolated axillary hyperhidrosis. The T4 group had a higher satisfaction rate and lower severity of compensatory hyperhidrosis. Hence, thermal ablation of the lower interganglionic fibers of the third thoracic sympathetic ganglion on the fourth rib is a more practical and minimally invasive treatment than is the T3-T4 surgical method, according to the degree of compensatory sweating in isolated axillary hyperhidrosis.