Background: Non-intubated, or awake, video-assisted thoracoscopic surgery has been implemented for non-anatomical lung resection and the results obtained were encouraging to consider the approach for anatomical pulmonary resection. This study was conducted to evaluate the perioperative outcomes of the non-intubated and intubated video-assisted thoracoscopic lobectomy in lung cancer in regards to feasibility and safety. Methods: A retrospective analysis of 62 consecutive video-assisted thoracoscopic lobectomies (31 lobectomies as non-intubated, 31 lobectomies as intubated) performed in Seoul St. Mary’s Hospital, The Catholic University of Korea between January and December 2016. Results: Both groups share comparable clinical characteristics including the age, sex, BMI, FEV1, DLCO, smoking history, lung lobes procedure, histological type and pathological staging. There was no difference in the mean of postoperative hospitalization period (6.9 versus 7.6 days, P=0.578) and the total chest tube duration (5.6 versus 5.4 days, P=0.943) between non-intubated and intubated lobectomy respectively. Both groups had a comparable surgical outcome for the anesthesia duration, operative time, blood loss and postoperative complications. The operative time required for lobe-specific surgery was shorter in the non-intubated group except for the LLL (mean 121.7 minutes for non-intubated group versus 118.3 minutes for the intubated group). The only statistically significant surgical outcome was for the number of dissected lymph nodes between both groups (the mean number of nodes for the non-intubated group was 12.6 versus 18.0 nodes for the intubated group, P=0.003). One patient in the non-intubated group required conversion to single lung intubation and mini-thoracotomy because of bleeding with no conversion in the intubated group. No mortality encountered in either group. Conclusions: The perioperative surgical outcomes for the non-intubated video-assisted thoracoscopic lobectomy are comparable to the intubated technique. Non-intubated video-assisted thoracoscopic lobectomy is safe and is technically feasible. However, further prospective randomized studies are needed for a better comparison between non-intubated and intubated VATS lobectomy.

Medical treatment of multiple drug resistant (MDR) pulmonary tuberculosis is generally quite unsuccessful. Recently, surgical management is increasing and shows promise. We analyzed our experience to identify the benefits and complications of pulmonary resection in MDR pulmonary tuberculosis. A retrospective review was performed in 27 patients undergoing pulmonary resection for MDR pulmonary tuberculosis between January 1994 and March 1998. Their average ages were 40 years and were diagnosed a median of 15 months before surgery. All patients had resistance to an average of 4.4 drugs including isoniazid and rifampin, and had received second line drugs selected according to drug sensitivity test preoperatively. Most patients (92.6%) had cavitary lesions. Bilateral lesions were also identified in 19 patients (70.4%), but the main focus was recognized in one side of the lung. Most patients were indicated to operation for those who could not achieve negative sputum despite adequate medical treatment (n = 16, 59.3%); or for negative patients who had significant pulmonary parenchymal lesion (n = 11, 40.7%) which would have had a high probability of recurrence. Pneumonectomy was done in nine patients, lobectomy in 16 and segmentectomy in two. There was no operative mortality. Morbidity occurred in seven patients (25.9%); prolonged air leakage in three patients, reoperation due to bleeding in two, bronchopleural fistula in one, and reversible blindness in one. The median follow up period was 15 months (range 3-45). Sputum negative conversion was achieved in 22 patients (81.5%) initially. However, continued postoperative chemotherapy could convert to negative in another four patients (14.8%). Only one pneumonectomy patient (3.7%) failed because of considerable contralateral cavity. For patients with MDR pulmonary tuberculosis which is localized, and with adequate pulmonary reserve function, surgical pulmonary resection combined with appropriate pre and postoperative anti-tuberculosis chemotherapy can achieve high success rate with acceptable morbidity.

Jang SH, et al. J Korean Med Assoc. 2015 Apr;58(4):291-301. http://dx.doi.org/10.5124/jkma.2015.58.4.291

In spite of its cosmetic benefits over open surgical techniques, endoscopic sympathectomy using 5 mm or larger instruments still has the problems of operative scar as well as pain on the trocar sites. Recently we have begun using 2 mm endoscopic instruments. The purpose of this study was to confirm the safety and feasibility of fine needle endoscopic instruments in thoracic sympathetic ablation. We have exclusively used 2 mm endoscopic instruments since January 1997, and from that time to May 1999 417 patients were underwent surgical procedures for hyperhidrosis. T2 or T2/T3 sympathectomy was performed for the first 56 patients, after June 1997, in 361 patients the interconnecting sympathetic trunk was divided instead of ganglion resection, and this procedure was named sympathicotomy. Palmar hyperhidrosis was presented in 375 patients (89.9%) and facial in 28 (6.7%) and axillary in 14 (3.4%). The level of division or resection of the ganglion differed according to the patient's symptoms. Sympathicotomy and sympathectomy were successful and all patients were satisfied with immediate dryness of affected sites. There were not any cases of bleeding or reoperation or hospital mortality. A large endoscope was required to eliminate the pleural adhesion in fourteen cases (7.7%). Thoracotomy conversion was required in two pleural adhesion cases. Minor complications were occurred in 17 patients (4.1%); such as closed thoracostomy in ten cases, peripheral nerve injury in three, pulmonary parenchymal injury in two, Horner's syndrome in two and atrial fibrillation in one. We have five cases of recurrent symptoms (1.2%). Our experience indicates that, for the treatment of hyperhidrosis, 2 mm ultra-thin needle endoscopic instruments are safe and effective to operate on palmar and facial hyperhidrosis patients.

Background: Recent studies have demonstrated that sublobar resection is not inferior to lobectomy for peripheral early lung cancer with ground-glass opacification. However, the effect of sublobar resection on solid-type early lung cancer is controversial. The aim of this study was to compare clinical outcomes of patients who have undergone sublobar resection or lobectomy for solid-type, early-stage, non-small cell lung cancer (NSCLC). Methods: This study was a retrospective review of the records of patients who underwent lobectomy or sublobar resection between March 2000 and September 2010 for clinical stage IA NSCL. Patients with pure ground-glass opacities or death within 30 days after surgery were excluded. Disease-free interval, survival, and prognostic factors were analyzed. Results: Thirty-one patients and 133 patients underwent sublobar resection and lobectomy, respectively. There were significant differences in age (P <0.001), cardiovascular disease (P = 0.001), and diffusing capacity of the lung for carbon monoxide (DLCO) (P <0.001). The patients with lobectomy had a significantly longer disease-free interval (P <0.001) and survival (P = 0.001). By multivariate analysis, sublobar resection (P = 0.011), lymphatic vessel invasion (P = 0.006), and number of positive lymph nodes (P = 0.028) were predictors for survival. Sublobar resection (P <0.001), visceral pleural invasion (P = 0.002), and lymphatic vessel invasion (P <0.001) were predictors for disease-free interval. Conclusions: Lobectomy should remain the standard surgical procedure for solid-type, clinical stage IA, NSCLC.