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Objective To analyze and compare the clinical application value of three-dimensional reconstruction and computed tomography (CT)-guided Hook-wire localization for row lung segment resection of pulmonary nodules. Methods Retrospective analysis of the clinical data of 204 patients suffering from pulmonary nodules admitted to the Department of Thoracic Surgery of Gansu Provincial People’s Hospital from June 2016 to December 2022. According to the preoperative positioning method, the group was divided into a 3D reconstruction group (98 cases) and a Hook-wire group (106 cases), respectively. The two groups of patients were propensity score matching (PSM) to compare their perioperative outcomes. Results All patients in both groups underwent successful surgeries without perioperative deaths. After PSM, 79 patients were successfully matched in each group. Two cases of pneumothorax, three cases of hemothorax, and four cases of decoupling occurred in the Hook-wire group; no complications of pneumothorax, hemothorax, and decoupling occurred in the 3D reconstruction group. Compared to the Hook-wire group, the 3D reconstruction group has shorter operative time (P = 0.001), less intraoperative bleeding (P P = 0.003), shorter postoperative tube placement time (P = 0.001), shorter postoperative hospital stay (P = 0.026), and postoperative complications (P = 0.035). There was no statistically significant difference between the two groups in terms of pathological type, TNM staging, and number of lymph node dissection. Conclusion Three-dimensional reconstruction and localization of pulmonary nodules enables safe and effective individualized thoracoscopic anatomical lung segment resection with a low complication rate, which has good clinical application value.

Objective To compare the efficacy and safety of robotic-assisted thoracoscopic surgery (RATS) with video-assisted thoracoscopic surgery (VATS) in the treatment of mediastinal cysts. Methods Retrospective analysis on clinical data of 70 cases of minimally invasive surgery for mediastinal cysts completed in the Department of Thoracic Surgery, Gansu Provincial People’s Hospital from April 2014 to December 2022. There were 34 cases in the RATS group with a cyst diameter of (3.70 ± 1.16) cm and 36 cases in the VATS group with a cyst diameter of (4.07 ± 1.20) cm. All cysts were evaluated preoperatively using magnetic resonance imaging (MRI) or chest computed tomography (CT) localization. Surgery-related indices were compared among the two groups. Results All patients in two groups successfully completed resection of mediastinal cysts without perioperative deaths. Compared with the VATS group, the RATS group possessed shorter operative time [(75.32 ± 17.80) min vs. (102.22 ± 19.80) min, P P = 0.009], shorter postoperative chest drainage time [2 (1.00, 6.00) ml vs. 3 (2.00, 6.50) ml, P = 0.006] and shorter postoperative hospital stay [3 (2.00, 6.50) d vs. 4 (3.00, 7.50) d, P = 0.001]. There was no statistically significant discrepancy in intermediate openings and complications in both groups (P > 0.05). Conclusion Compared with VATS, RATS is safety and effectivity in the treatment of mediastinal cysts and thus has advantages in operative time, intraoperative bleeding, postoperative chest drainage time and postoperative hospital stay.

Background To compare the near and long-term outcomes of endoscopic thoracic sympathectomy (ETS) for palmar, axillary and plantar hyperhidrosis. Methods We retrospectively analyzed the clinical data of 218 patients with hyperhidrosis who were admitted to the Department of Thoracic Surgery of Gansu Provincial People’s Hospital for surgical treatment from April 2014 to August 2021. The patients were divided into three groups according to the method of ETS and the perioperative clinical data and postoperative follow-up data were collected to compare the near and long term outcomes of the three groups. Results There were 197 eligible patients at follow-up, 60 patients in the R4 cut-off group, 95 patients in the R3 + R4 cut-off group and 42 patients in the R4 + R5 cut-off group. There were no statistically significant differences in baseline indicators such as sex, age and positive family history among the three groups (P > 0.05). There was no statistically significant difference between the three groups in terms of operative time (P = 0.148), intraoperative bleeding (P = 0.308) and postoperative hospital stay (P = 0.407). Postoperatively, all three groups showed significant relief of palmar hyperhidrosis symptoms, with the R3 + R4 group having an advantage in terms of relief of axillary hyperhidrosis symptoms, patient satisfaction and quality of life index at 6 months postoperatively and the R4 + R5 group having an advantage in terms of relief of plantar hyperhidrosis symptoms. The difference in compensatory hyperhidrosis at 12 months postoperatively was not statistically significant among the three groups (P = 0.867), but the incidence was higher in the R3 + R4 and R4 + R5 groups than that in the R4 group. Conclusion Patients with simple palmar hyperhidrosis can first consider R4 cut-off treatment; R3 + R4 cut-off is more effective in treating palmar hyperhidrosis combined with axillary hyperhidrosis; R4 + R5 cut-off is more effective in treating palmar hyperhidrosis combined with plantar hyperhidrosis. However, patients need to be informed that R3 + R4 and R4 + R5 dissection may increase the risk of severe compensatory hyperhidrosis after surgery.

Background To compare the difference of short-term curative effect between the use of Maryland forceps (MF) and electrocoagulation hooks (EH) in da Vinci robot-assisted thoracoscopic mediastinal tumor resection. Methods Analyze retrospectively 84 patients with mediastinal tumors treated with robot-assisted thoracoscopic surgery (RATS) at the Department of Thoracic Surgery of Gansu Provincial Hospital from February 2019 to February 2023. Two groups were divided according to the intraoperative use of energy devices, including 41 cases in the MF group and 43 cases in the EH group. Perioperative clinical data were collected to compare the recent outcomes of patients in both groups. Results There were no statistically significant differences between the two groups in terms of baseline indicators such as sex, age, and tumor size. Compared with the EH group, patients in the MF group have lower operative time, intraoperative bleeding, postoperative hospital stay and the levels of IL-6, IL-8, TNF-α, and cortisol were lower in the MF group than that in the EH patients, with statistically significant differences (P

Objective A meta-analysis was conducted to assess the impact of miRNAs in circulation on diagnosing benign and malignant pulmonary nodules (BPNs and MPNs). Methods Electronic databases such as Embase, PubMed, Web of Science, and The Cochrane Library were utilized for diagnostic tests of circulating miRNAs to diagnose BPNs and MPNs from the library creation to February 2023. Meta-analysis of the included literature was performed using Stata 16, Meta-Disc 1.4, and Review Manager 5.4 software. This study determined the combined sensitivity, specificity, diagnostic ratio (DOR), positive/negative likelihood ratios (PLR/NLR), as well as value of area under the receiver operating characteristic (ROC) curve. Results This meta-analysis included 14 publications and 17 studies. According to our findings, the pooled sensitivity for miRNA in diagnosing benign and malignant pulmonary nodules was 0.82 [95% CI (0.74, 0.88)], specificity was 0.84 [95% CI (0.79, 0.88)], whereas the DOR was 22.69 [95% CI (13.87, 37.13)], PLR was 5.00 [95% CI (3.87, 6.46)], NLR was 0.22 [95% CI (0.15, 0.32)], and an area under the subject working characteristic curve (AUC) of 0.89 [95% CI (0.86, 0.91)]. Conclusion Circulating miRNAs could be used with sensitivity, specificity, DOR, PLR, NLR, and AUC as biomarkers to diagnose pulmonary nodules (PNs). However, because of the significant heterogeneity of the studies included, more research is needed to determine the optimum miRNA combinations for diagnosing PNs.

Objective: To compare the efficacy of robot-assisted thoracoscopic surgery (RATS) with video-assisted thoracoscopic surgery (VATS) in lymph node dissection for radical lung cancer. Methods: Retrospective analysis of 262 minimally invasive surgically treated lung cancer patients who underwent radical lung cancer surgery via RATS (n=122) or VATS (n=140) completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People’s Hospital from August 2019 to August 2022. Propensity score matching (PSM) analysis was performed to compare the procedure-related information of the two groups of patients. Results: All patients in both groups successfully completed radical lung cancer surgery with no perioperative deaths. There are 100 patients in each group after PSM. The RATS group had an advantage in terms of intraoperative bleeding, postoperative drainage time, postoperative hospital stay, number of lymph nodes cleared (6, 10, 11 stations), number of lymph nodes cleared, and escalation of lymph node pathological stage (cN0 to pN1). In terms of total postoperative chest drainage and hospital costs, the VATS group was more advantageous. There was no statistically significant difference between the two groups in terms of operative time, postoperative complications and intraoperative intermediate chest opening (P>0.05). Conclusion: RATS has technical and short-term efficacy advantages, especially in lymph node dissection, but has the disadvantage of expensive.

Objective: To compare the efficacy and safety of robotic-assisted thoracoscopic surgery (RATS) with video-assisted thoracoscopic surgery (VATS) in the treatment of mediastinal cysts. Methods: Retrospective analysis on clinical data of 70 cases of minimally invasive surgery for mediastinal cysts completed in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from April 2014 to December 2022. There were 34 cases in the RATS group with a cyst diameter of (3.70±1.16) cm and 36 cases in the VATS group with a cyst diameter of (4.07±1.20) cm. All cysts were evaluated preoperatively using MRI or chest CT localization. Surgery-related indices were compared among the two groups. Results: All patients in both two groups successfully completed resection of mediastinal cysts without perioperative deaths. Compared with the VATS group, the RATS group possessed shorter operative time [(75.32±17.80) min vs. (102.22±19.80) min, PP=0.004], and shorter postoperative hospital stay [(3.26±1.36) d vs. (4.64±1.13) d, P=0.001]. There was no statistically significant discrepancy in intermediate openings and complications in both two groups (P>0.05). Conclusion: Compared with VATS, RATS is safer and more effective in the treatment of mediastinal cysts and thus has advantages in operative time, intraoperative bleeding, postoperative chest drainage time and postoperative hospital stay.

Objective To assess the impact of da Vinci robot versus thoracoscopic surgery on body trauma and lymphocyte subsets in lung cancer patients. Methods Retrospective analysis of 352 patients with lung cancer treated by minimally invasive surgery completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from October 2019 to October 2022. The patients were divided into a robotic-assisted thoracic surgery(RATS) group (n = 159) and a video-assisted thoracoscopic surgery group(VATS) (n = 193) according to the surgical procedure. Propensity score matching analysis (PSM) was performed in both groups, and perioperative indicators were recorded. Levels of inflammatory markers (C-reactive protein, CRP; interleukin-6, IL-6) and lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) were measured 1 day before surgery, 1, 3 and 5 days after surgery, respectively. To compare the effects of the two surgical procedures on the trauma and lymphocyte subsets of the patient's organism. Results 138 patients in each group after PSM. The operative time, intraoperative bleeding, postoperative drainage time, and drainage flow were all lower in the RATS group than in the VATS group, with statistically significant differences (P P

ObjectiveTo compare the clinical results of the modified Ivor-Lewis procedure, which preserves the azygous vein, thoracic duct and surrounding tissues, with the traditional Ivor-Lewis procedure, which removes these tissues, for treating esophageal squamous cell carcinoma, and evaluating whether the azygous vein, thoracic duct and surrounding tissues are required to be removed for the surgery of esophageal cancer.MethodsTo retrospectively analyze the clinical data of patients suffering from esophageal cancer treated by thoracic-laparoscopic Ivor-Lewis procedure admitted to the Department of Thoracic Surgery of Gansu Provincial People’s Hospital from September 2017 to September 2019. According to the surgical method, they were divided into the modified thoracolaparoscopic Ivor-Lewis (modified group) and the traditional thoracolaparoscopic Ivor-Lewis (traditional group). Propensity score matching analysis (PSM) was applied to reduce the selection bias of confounding factors.ResultsA total of 245 patients who suffered from esophageal cancer and underwent thoracic-laparoscopic Ivor-Lewis were enrolled in the study. There were 124 cases in the modified group and 121 cases in the traditional group. The discrepancies in the age and T-stage among patients in the traditional and modified groups were statistically significant. After PSM, the above-mentioned factors became statistically insignificant. There were 86 patients in each group after PSM. Compared with the traditional group, the modified group has shorter operative time (p=0.007), less intraoperative bleeding (p=0.003) and less postoperative 3 days chest drainage(p=0.001), with a statistically significant difference. No significant difference in local recurrence (p=0.721) and distant metastasis (p=0.742) after surgery were found in the two groups, and the difference was not statistically significant. There was also no statistically significant difference in the 3-year postoperative survival rate (44.2% vs. 41.9%, p=0.605) between the modified and traditional groups.ConclusionThe modified Ivor-Lewis procedure, which preserves the azygous vein, thoracic duct, and surrounding tissue, reduces surgical trauma in esophageal cancer, has not increased postoperative recurrent metastases, while achieved the same long-term outcomes as expanded surgery.

Background The purpose of this study was to compare the perioperative efficacy and safety of da Vinci robot-assisted thoracoscopic surgery (RATS) for treating anterior mediastinal tumors through the subxiphoid and lateral thoracic approaches under the anesthesia of nontracheal intubation (i.e., laryngeal mask airway). Methods We retrospectively analyzed the clinical data of 116 patients with anterior mediastinal tumors treated by RATS under laryngeal mask anesthesia completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People’s Hospital, from October 2016 to October 2022. There were a total of 52 patients including 24 males and 28 females, with an average age of 45.40±4.94 years, in the subxiphoid approach (subxiphoid group). On the other hand, there were a total of 64 patients including 34 males and 30 females, with a mean age of 46.86±5.46 years in the lateral thoracic approach (lateral thoracic group). Furthermore, we have detailedly compared and analyzed the operating time, intraoperative bleeding, and total postoperative drainage in the two groups. Results All patients in both groups successfully completed resection of the anterior mediastinal tumor without occurring perioperative death. Compared with the lateral thoracic group, the subxiphoid group has more advantages in terms of total postoperative drainage (P=0.035), postoperative drainage time (P=0.015), postoperative hospital stay (P=0.030), and visual analog scale (VAS) pain on postoperative days 2 (P=0.006) and 3 (P=0.002). However, the lateral thoracic group has more advantages in the aspect of docking time (P=0.020). There was no statistically significant difference between the two groups in terms of operative time (P=0.517), total operative time (P=0.187), postoperative day 1 VAS pain score (P=0.084), and postoperative complications (P=0.715). Conclusion The subxiphoid approach of RATS under laryngeal mask anesthesia is safe and feasible for resecting anterior mediastinal tumors. Compared with the lateral thoracic approach, the subxiphoid approach has advantages in terms of rapid postoperative recovery and postoperative patient pain, and patient acceptance is also higher and thus is worth promoting in hospitals where it is available.

Background: To compare the near and long-term outcomes of endoscopic thoracic sympathicotomy (ETS) for palmar hyperhidrosis, axillary hyperhidrosis, and plantar hyperhidrosis. Methods: We retrospectively analyzed the clinical data of 218 patients with hyperhidrosis who were admitted to the Department of Thoracic Surgery of Gansu Provincial People's Hospital for surgical treatment from April 2014 to August 2021. The patients were divided into three groups according to the method of ETS, and the perioperative clinical data and postoperative follow-up data were collected to compare the near and long term outcomes of the three groups. Results: There were 197 eligible patients at follow-up, 60 patients in the R4 cut-off group, 95 patients in the R3+R4 cut-off group, and 42 patients in the R4+R5 cut-off group. There were no statistically significant differences in baseline indicators such as sex, age and positive family history among the three groups (P>0.05). There was no statistically significant difference between the three groups in terms of operative time (P=0.148), intraoperative bleeding (P=0.308), and postoperative hospital stay (P=0.407). Postoperatively, all three groups showed significant relief of palmar hyperhidrosis symptoms, with the R3+R4 group having an advantage in terms of relief of axillary hyperhidrosis symptoms, patient satisfaction and quality of life index at 6 months postoperatively, and the R4+R5 group having an advantage in terms of [1] relief of plantar hyperhidrosis symptoms. The difference in compensatory hyperhidrosis at 12 months postoperatively was not statistically significant among the three groups (P=0.867), but the incidence was higher in the R3+R4 and R4+R5 groups than in the R4 group. Conclusion: Patients with simple palmar hyperhidrosis can first consider R4 cut-off treatment; R3+R4 cut-off is more effective in treating palmar hyperhidrosis combined with axillary hyperhidrosis; R4+R5 cut-off is more effective in treating palmar hyperhidrosis combined with plantar hyperhidrosis. However, patients need to be informed that R3+R4 and R4+R5 dissection may increase the risk of severe compensatory hyperhidrosis after surgery.

Background: The present research is designed to evaluate the short-term outcome of robot-assisted thoracoscopic surgery (RATS) for the treatment of posterior mediastinal neurogenic tumours. Methods: We retrospectively analyzed clinical data on 35 consecutive patients with mediastinal neurogenic tumors after RATS treatment completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from January 2016 to June 2022. There were 19 males and 16 females with a mean age of (34.9±7.1) years in this analysis report. The tumor of the patients were localized and evaluated preoperatively using magnetic resonance imaging (MRI) or enhanced CT. Results: All 35 patients successfully underwent the resection of posterior mediastinal neurogenic tumors under RATS, and no conversion to thoracotomy occurred during the operations. The average operative time was (62.3±18.0) min, the average docking time was (10.3±2.6) min, the average intraoperative bleeding was (33.9±21.6) ml, the average 24-hour postoperative chest drainage was (69.0±28.9) ml, the average postoperative chest drainage time was (2.2±1.4) days and the average post-operative hospital stay was (3.2±1.3) days. Postoperative complications occurred in 3 patients, including 2 patients with transient Honor syndrome after surgery and 1 patient with transient anhidrosis of the affected upper limb after surgery. [1]Conclusion: RATS for posterior mediastinal neurogenic tumours is safe, effective, feasible and bring the superiority of robotic surgical system into full play.1The First Clinical Medical College of Gansu University of Chinese Medicine, Gansu Provincial Hospital, Lanzhou, China

Background The present research is designed to evaluate the short-term outcome of robot-assisted thoracoscopic surgery (RATS) for the treatment of posterior mediastinal neurogenic tumors. Methods We retrospectively analyzed clinical data on 39 consecutive patients with mediastinal neurogenic tumors after RATS treatment completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from January 2016 to September 2022. There were 22 males and 17 females with a mean age of (35.1 ± 6.9) years in this analysis report. The tumors of the patients were localized and evaluated preoperatively using magnetic resonance imaging (MRI) or enhanced CT. Results All 39 patients successfully underwent the resection of posterior mediastinal neurogenic tumors under RATS, and no conversion to thoracotomy occurred during the operations. The average operative time was (62.1 ± 17.2) min, the average docking time was (10.1 ± 2.5) min, the average intraoperative bleeding was (32.8 ± 19.5) ml, the average 24-h postoperative chest drainage was (67.4 ± 27.9) ml, the average postoperative chest drainage time was (2.2 ± 1.3) days and the average post-operative hospital stay was (3.2 ± 1.3) days. Postoperative complications occurred in 3 patients, including 2 patients with transient Horner's syndrome after surgery and 1 patient with transient anhidrosis of the affected upper limb after surgery. Conclusion RATS for posterior mediastinal neurogenic tumors is safe, effective, feasible and bring the superiority of robotic surgical system into full play.