Robot-Assisted Thoracic Surgery in Non-small Cell Lung Cancer

이준희,홍정인,김현구 대한흉부외과학회 2021 Journal of Chest Surgery (J Chest Surg) Vol.54 No.4

Lobectomy is the standard treatment for early non-small cell lung cancer. Various surgical techniques for lobectomy have been developed, and minimally invasive thoracic surgery, such as video-assisted thoracic surgery or robot-assisted thoracic surgery, has been con- sidered as an alternative to conventional open thoracotomy. The recently robotic lobec- tomy technique has developed since the first case series was published in 2002. Several studies have reported that robotic lobectomy has comparable oncologic and periopera- tive outcomes to those of video-assisted thoracic surgery lobectomy and open lobecto- my. However, robotic lobectomy remains a challenge for surgeons because of the steep learning curve, reduced tactile sensation, difficulty in port placement, and challenges in cooperation between the surgeon and assistant. Many studies have reported on robotic lobectomy, but few have presented surgical techniques for robotic lobectomy. In this arti- cle, the surgical techniques and optimal performance of robotic lobectomy are described in detail for all 5 types of lobectomy for surgeons beginning with robotic lobectomy.

Effects of Isthmus Preservation on Postoperative Hypothyroidism after Lobectomy

전영산,김완욱 대한갑상선학회 2023 International Journal of Thyroidology Vol.16 No.1

Background and Objectives: Many patients experience hypothyroidism after lobectomy. The purpose of this study was to investigate the effects of the extent of surgery (isthmus-saving lobectomy vs. isthmus-removing lobectomy) on postoperative hypothyroidism after lobectomy. Materials and Methods: In total, 144 consecutive benign or low-risk papillary thyroid cancer patients with euthyroid status were retrospectively enrolled from January 2016 to June 2018; 100 patients underwent isthmus-saving lobectomy (IS group), and 44 patients underwent isthmus-removing lobectomy (IR group). Thyroid function tests (TSH) were performed at 3, 6, 12, and 24 months after surgery. Levothyroxine was administered to patients with overt hypothyroidism and those with subclinical hypothyroidism who complained of obvious symptoms of hypothyroidism. Results: The TSH level was significantly lower in the IS group at 3 and 6 months after surgery (p=0.049 and 0.026, respectively). Among patients with TSH <2 μIU/mL preoperatively, 17 patients (17/66=25.8%) in the IS group had significantly maintained TSH levels at <2 μIU/mL compared with 2 patients (2/21=9.5%) in the IR group even after surgery (p=0.039). Postoperative overt hypothyroidism was found in 5 patients (5.0%) in the IS group and 6 patients (13.6%) in the IR group (p=0.048), and the numbers of patients who took medication after the surgery, 10 (10%) and 14 (31.8%), were significantly lower in the IS group (p=0.001). Conclusion: Isthmus-saving lobectomy in patients with euthyroid status reduced the incidence of postoperative hypothyroidism and thyroid hormone replacement and helped in maintaining a low TSH level when compared with isthmus-removing lobectomy.

Learning Curve of a Young Surgeon’s Video-assisted Thoracic Surgery Lobectomy during His First Year Experience in Newly Established Institution

나용준,안효영,김민수 대한흉부외과학회 2012 Journal of Chest Surgery (J Chest Surg) Vol.45 No.3

Background: The purpose of this paper is to present a guideline for beginning video-assisted thoracic surgery (VATS) lobectomy to junior surgeons, and to review the first year experience of a new surgeon performing VATS lobectomies who had not performed a VATS lobectomy unassisted during his training period. Materials and Methods: A young surgeon opened a division of general thoracic surgery at a medical institution. The surgeon had performed about 100 lobectomies via conventional thoracotomy during his training period, but had never performed a VATS lobectomy unassisted while under the supervision of an expert. After opening the division of general thoracic surgery, the surgeon performed a total of 38 pulmonary lobectomies for various pulmonary diseases from March 2009 to February 2010. All data were collected retrospectively. Results: There were 14 lobectomies via thoracotomy, 14 VATS lobectomies, and 10 cases of attempted VATS lobectomies that were converted to open thoracotomies. The number of VATS lobectomies increased from the second quarter (n=0) to the third quarter (n=5). The lobectomies that were converted from VATS into thoracotomies decreased from the second quarter (n=5) to the third quarter (n=1) (p=0.002). Conclusion: It can take 6 months for young surgeons without experience in VATS lobectomy in their training period to be able to reliably perform a VATS lobectomy.

Pre- and post-operative cardiac evaluation of dogs undergoing lobectomy and pneumonectomy

Meriç Kocatürk,Hakan Salci,A. Sami Bayram,Jørgen Koch,Zeki Yilmaz 대한수의학회 2010 Journal of Veterinary Science Vol.11 No.3

This study aimed to assess the influence of lobectomy and pneumonectomy on cardiac rhythm and on the dimensions and function of the right-side of the heart. Twelve dogs undergoing lobectomy and eight dogs undergoing pneumonectomy were evaluated preoperatively and one month postoperatively with electrocardiography and Doppler echocardiography at rest. Pulmonary artery systolic pressure (PASP) was estimated by the tricuspid regurgitation jet (TRJ) via the pulse wave Doppler velocity method. Systemic inflammatory response syndrome criteria (SIRS) were also evaluated based on the clinical and hematological findings in response to lobectomy and pneumonectomy. Following lobectomy and pneumonectomy, we predominantly detected atrial fibrillation and varying degrees of atrioventricular block (AVB). Dogs that died within seven days of the lobectomy (n = 2) or pneumonectomy (n = 1) had complete AVB. Preoperative right atrial, right ventricular, and pulmonary artery dimensions increased gradually during the 30 days (p<0.05) following pneumonectomy, but did not undergo significant changes during that same period after lobectomy. Mean PASP was 56.0 ± 4.5 mmHg in dogs having significant TRJ after pneumonectomy. Pneumonectomy, but not lobectomy, could lead to increases (p<0.01) in the SIRS score within the first day post-surgery. In brief, it is important to conduct pre- and postoperative cardiac evaluation of dogs undergoing lung resections because cardiac problems are a common postoperative complication after such surgeries. In particular, complete AVB should be considered a lifethreatening complication after pneumonectomy and lobectomy. In addition, pneumonectomy appears to increase the likelihood of pulmonary hypertension development in dogs.

폐암에서의 흉강경 폐엽절제술 치험 133예

김형렬,조정수,장희진,최은석,전상훈,이상철,성숙환 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.5

Background: We evaluated the feasibility and the efficacy of Video-Assisted Thoracic Surgery (VATS) lobectomy for treating patients with non-small cell lung cancer (NSCLC) and we compared the outcomes of VATS lobectomy with those of open lobectomy. Material and Method: From 2003 to March 2008, 133 NSCLC patients underwent VATS lobectomy. The patients were selected on the basis of having clinical stage I disease on the chest CT and PET scan. The outcomes of 202 patients who underwent open lobectomy (OL group) for clinical stage I NSCLC were evaluated to compare their results with those of the patients who underwent VATS lobectomy (the VL group). Result: The number of females and the number of patients with adenocarcinoma and stage IA disease were greater in VL group (p<0.05). There was no operative mortality or major complications in the VL group. Conversion to thoracotomy was needed in 8 cases (6%), which was mostly due to bleeding. The chest tube indwelling time and the length of the postoperative hospital stay were significantly shorter in the VL group (p<0.001). The number of dissected lymph nodes and the size of tumor were significantly smaller in the VL group (p<0.001). For the pathologic stage I patients, there was no significant difference in the three-year survival rates between the two groups (p=0.15). Conclusion: VATS lobectomy is a safe procedure with low operative mortality and morbidity. VATS lobectomy is feasible for early stage NSCLC and it provides outcomes that are comparable to those for open lobectomy. Further long-term data are needed. 배경: 흉강경 수술이 점차 확대되고 있으며 폐암에서의 적용도 늘어나고 있다. 본 연구에서는 폐암 환자에서 시행한 흉강경 폐엽절제술의 안정성을 평가해보고, 개흉 폐엽절제술과의 성적과 비교해 보았다. 대상 및 방법: 2003년 5월부터 2008년 3월까지 임상적 I기 폐암으로 흉강경 폐엽절제술을 시행받은 133명과 개흉 폐엽절제술을 시행받은 202명을 후향적으로 분석하였다. 임상적 I기 폐암은 수술 전 컴퓨터단층촬영과 양성자방출단층촬영 등을 포함한 진단 방법으로 결정되었다. 흉강경 폐엽절제술은, 초기에는 장경 3 cm 미만, 2006년 이후에는 4∼5 cm의 병변까지 확대하였으며, 2개 혹은 3개의 포트와 늑골 벌림 없는 3∼6 cm의 작업창을 이용하였다. 병리학적으로 I기로 확진된 환자들을 2009년 2월까지 추적관찰하여, 흉강경 폐엽절제술군과 개흉 폐엽절제술군의 생존률과 무병생존률을 비교하였으며, 흉강경 수술 중 개흉술로 전환한 8명은 양군의 비교분석에서 제외되었다. 결과: 흉강경 폐엽절제술군의 평균 연령은 61.8±9.8세로 개흉 폐엽절제술군의 평균 연령(64.6±9.6세)보다 유의하게 낮았다(p=0.008). 흉강경 폐엽절제술군에서 여성과 선암의 비율이 통계적으로 유의하게 높았고, 수술 후 IA로 확진된 환자가 유의하게 많았다(p<0.001). 수술 사망은 없었고, 32명의 환자에서 34예의 합병증이 발생하였으며 이중 50%가 5일 이상 지속된 공기누출이었다. N1 림프절 전이, 폐문부위의 종괴, 폐동맥 손상으로 인한 출혈, 석회화된 림프절 및 심한 유착 등으로 총 8명의 환자에서 흉강경을 시도하였다가 개흉술로 전환하였다. 흉강경 폐엽절제술군에서 흉관 유지 기간(p=0.031) 및 술 후 재원 일수(p<0.001)가 통계적으로 유의하게 짧았고, 절제된 림프절 수(p<0.001)와 병리학적 종괴의 크기(p<0.001)가 작았다. 병리학적 병기 I기에서의 3년 생존율은 두 군 간에 차이가 없었으나(p=0.15), 무병생존율은 개흉술을 시행 받은 군에서 통계적으로 유의하게 낮았다(p<0.001). 결론: 폐암에 대한 흉강경 폐엽절제술은 합병증이나 사망률, 생존률 및 무병생존률에서 개흉 폐엽절제술과 비교하여 비슷하거나 좋은 결과를 얻을 수 있었고, 초기 폐암에서 안전하게 시행될 수 있을 것으로 사료된다.

측경부 최소침습절개술을 이용한 갑상선 일엽절제술의 효용성

강선미,이해경,강성수,허민희,고승상,윤찬석,강태호,김세원,Sun Mi Kang,Hae Kyung Lee,Seong Soo Kang,Min Hee Hur,Seung Sang Ko,Chan Seok Yoon,Tae Ho Kang and Se Won Kim 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.4

Purpose: Minimal invasive open thyroidectomy is one option for minimal invasive surgery. The population of planned unilateral lobectomy is on the rise in parallel to the increased incidence of confined papillary thyroid microcarcinomas in Korea. In contrast to other minimal invasive modalities, few studies have examined the surgical outcome of minimal invasive open thyroidectomy. This study compared the lateral minimal invasive open thyroid lobectomy with conventional surgery and endoscopic surgery in terms of the feasibility and safety. Methods: A retrospective study was performed on 197 patients undergoing a thyroid lobectomy between January 2001 and December 2010. One hundred and three patients underwent a lateral minimal invasive open thyroid lobectomy, 42 patients underwent conventional surgery, and 44 patients underwent endoscopic surgery. Results: The hospitalization period with endoscopic surgery was 6.2 days, which was longer than the 5.3 days with a lateral minimal invasive open thyroid lobectomy (P=0.000). The surgical time was lower in those who underwent a lateral minimal invasive open thyroid lobectomy (88.2 minutes) than in those who underwent conventional surgery (107 minutes, P=0.000) or endoscopic surgery (124.1 minutes, P=0.000). In the patients with a diagnosis of malignancy, the mean number of retrieved LNs was similar in the three groups. Conclusion: A lateral minimal invasive open thyroid lobectomy offers advantages, such as a shorter surgical time and hospitalization period than others. This procedure can be a feasible alternative to the conventional or endoscopic approach in selected patients undergoing thyroid lobectomy.

Trainees Can Safely Learn Video-Assisted Thoracic Surgery Lobectomy despite Limited Experience in Open Lobectomy

유우식,정경영,이창영,이석기,김도정 대한흉부외과학회 2015 Journal of Chest Surgery (J Chest Surg) Vol.48 No.2

Background: The aim of this study was to establish whether pulmonary lobectomy using video-assisted thoracicsurgery (VATS) can be safely performed by trainees with limited experience with open lobectomy. Methods: Datawere retrospectively collected from 251 patients who underwent VATS lobectomy at a single institution betweenOctober 2007 and April 2011. The surgical outcomes of the procedures that were performed by three trainee surgeonswere compared to the outcomes of procedures performed by a surgeon who had performed more than 150VATS lobectomies. The cumulative failure graph of each trainee was used for quality assessment and learningcurve analysis. Results: The surgery time, estimated blood loss, final pathologic stage, thoracotomy conversion rate,chest tube duration, duration of hospital stay, complication rate, and mortality rate were comparable between theexpert surgeon and each trainee. Cumulative failure graphs showed that the performance of each trainee was acceptableand that all trainees reached proficiency in performing VATS lobectomy after 40 cases. Conclusion: Thisstudy shows that trainees with limited experience with open lobectomy can safely learn to perform VATS lobectomyfor the treatment of lung cancer under expert supervision without compromising outcomes.

Efficacy of Single-Port Video-Assisted Thoracoscopic Surgery Lobectomy Compared with Triple-Port VATS by Propensity Score Matching

송경섭,박창권,김재범 대한흉부외과학회 2017 Journal of Chest Surgery (J Chest Surg) Vol.50 No.5

Background: In recent years, single-port video-assisted thoracoscopic surgery (VATS) for lobectomy in non-small cell lung cancer (NSCLC) patients has become increasingly common. The objective of this study was to compare the feasibility and safety of single-port and triple-port VATS lobectomy. Methods: A total of 73 patients with NSCLC who underwent VATS lobectomy from December 2011 to August 2016 were retrospectively reviewed, including 47 in the triple-port group and 26 in the single-port group. Statistical analysis was performed after propensity score matching. Patients were matched on a 1-to-1 basis. Results: Operative time and intraoperative blood loss in the triple-port group and the single-port group were similar (189.4±50.8 minutes vs. 205.4±50.6 minutes, p=0.259; 286.5±531.0 mL vs. 314.6±513.1 mL, p=0.813). There were no cases of morbidity or mortality. No significant differences in complications or the total number of dissected lymph nodes were found between the 2 groups. In the single-port group, more mediastinal lymph nodes were dissected than in the triple-port group (1.7±0.6 vs. 1.2±0.5, p=0.011). Both groups had 1 patient with bronchopleural fistula. Chest tube duration and postoperative hospital stay were shorter in the single- port group than in the triple-port group (8.7±5.1 days vs. 6.2±6.6 days, p=0.130; 11.7±6.1 days vs. 9.5±6.4 days, p=0.226). However, the differences were not statistically significant. In the single-port group, the rate of conversion to multi-port VATS lobectomy was 11.5% (3 of 26). The rates of conversion to open thoracotomy in the triple-port and single-port groups were 7.7% and 3.8%, respectively (p=1.000). Conclusion: In comparison with the triple-port group, single-port VATS lobectomy showed similar results in safety and efficacy, indicating that single-port VATS lobectomy is a feasible and safe option for lung cancer patients.

Lobectomy versus Sublobar Resection in Non-Lepidic Small-Sized Non-Small Cell Lung Cancer

남궁민,문영규,박재길 대한흉부외과학회 2017 Journal of Chest Surgery (J Chest Surg) Vol.50 No.6

Background: Recently, many surgeons have chosen sublobar resection for the curative treatment of lung tumors with ground-glass opacity, which is a hallmark of lepidic lung cancer. The purpose of this study was to evaluate the oncological results of sublobar resection for non-lepidic lung cancer in comparison with lobectomy. Methods: We conducted a retrospective chart review of 328 patients with clinical N0 non-small cell lung cancer sized ≤2 cm who underwent curative surgical resection from January 2009 to December 2014. The patients were classified on the basis of their lesions into non-lepidic and lepidic groups. The survival rates following lobectomy and sublobar resection were compared within each of these 2 groups. Results: The non-lepidic group contained a total of 191 patients. The 5-year recurrence-free survival rate was not significantly different between patients who received sublobar resection or lobectomy in the non-lepidic group (80.1% vs. 79.2%, p=0.822) or in the lepidic group (100% vs. 97.4%, p=0.283). Multivariate analysis indicated that only lymphatic invasion was a significant risk factor for recurrence in the non-lepidic group. Sublobar resection was not a risk factor for recurrence in the non-lepidic group. Conclusion: The oncological outcomes of sublobar resection and lobectomy in small-sized non-small cell lung cancer did not significantly differ according to histological type.

A Meta-Analysis Comparing Lobectomy versus Segmentectomy in Stage I Non-Small Cell Lung Cancer

임태윤,박샘이나,강창현 대한흉부외과학회 2019 Journal of Chest Surgery (J Chest Surg) Vol.52 No.4

Lobectomy is considered the standard strategy for early-stage non-small cell lung cancer (NSCLC). However, sublobar resection for NSCLC has recently received increased attention. The objective of this study was to compare 5-year survival, recurrence-free survival, postoperative mortality, and postoperative morbidities in patients who received segmentectomy versus those who received lobectomy through a meta-analysis. Sixteen studies were included and the combined hazard ratios or odds ratios were calculated. The results revealed that the 5-year survival rate after segmentectomy was comparable to that of lobectomy for stage IA NSCLC. However, segmentectomy for stage I NSCLC had lower rates of postoperative mortality and morbidities than lobectomy.