Kamiyoshihara M, Nagashima T, Igai H, Ohtaki Y, Atsumi J, Shimizu K, Takeyoshi I
Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Maebashi, Japan.
Asian J Endosc Surg. 2012 May;5(2):69-77. doi: 10.1111/j.1758-5910.2011.00122.x. Epub 2011 Dec 30.
Most thoracic surgeons encounter atypical cases or unexpected situations that usually lead them to convert minimally invasive surgery to open thoracotomy. But are there other options besides open surgery? The purpose of this study was to suggest a video-assisted thoracic surgery (VATS) classification system and present tips for the application of VATS to atypical cases or unexpected situations. We have categorized VATS procedures for atypical cases or unexpected situations into two groups: the modification of techniques/instruments and the creation of additional access incisions.
We retrospectively reviewed VATS with optional additional techniques. We used direct visualization or monitoring as the situation demanded, switching back and forth between the monitor and direct vision.
Of the 33 cases we reviewed, 27 patients had malignant lung disease and 6 had benign lung disease. All patients underwent lobectomies including one or more of the following: bronchoplasty (n = 12), control of the main pulmonary artery (n = 9), total adhesiotomy (n = 7), combined resection with the diaphragm (n = 3), and separation of totally fused fissures (n = 2). The mean length of the skin incision was 8 cm, the mean total operating time was 208 min, and the mean blood loss was 173 mL No operative or hospital deaths occurred.
Veteran surgeons can instinctively deal with intraoperative variance, but we frequently see inexperienced surgeons panic and change the course of their procedures. A VATS classification system may have educational benefits for newer surgeons. We believe that the creation of a categorized coping plan will help inexperienced surgeons deal with unanticipated problems.
大多数胸外科医生都会遇到非典型病例或意外情况，这通常会导致他们将微创手术转为开胸手术。但除了开放手术之外还有其他选择吗？本研究的目的是提出一种电视辅助胸腔镜手术（VATS）分类系统，并介绍将VATS应用于非典型病例或意外情况的技巧。我们将非典型病例或意外情况的VATS手术分为两组：技术/器械的改进和增加额外的切口。
我们回顾性分析了采用可选附加技术的VATS手术。根据情况需要，我们使用直接可视化或监测，在显示器和直视之间来回切换。
在我们回顾的33例病例中，27例患者患有恶性肺部疾病，6例患有良性肺部疾病。所有患者均接受了肺叶切除术，包括以下一项或多项：支气管成形术（n = 12）、控制主肺动脉（n = 9）、完全粘连松解术（n = 7）、与膈肌联合切除术（n = 3）以及完全融合裂的分离（n = 2）。皮肤切口的平均长度为8 cm，平均总手术时间为208分钟，平均失血量为173 mL。无手术或医院死亡病例发生。
经验丰富的外科医生能够本能地应对术中变化，但我们经常看到经验不足的外科医生惊慌失措并改变手术进程。VATS分类系统可能对新外科医生具有教育意义。我们相信制定一个分类应对计划将有助于经验不足的外科医生处理意外问题。
