video-assisted thoracoscopic surgery

1. Pleural disease: spontaneous pneumothorax, hemothorax, empyema, chylothorax, pleural effusion caused by pleural tumor. 2. Lung disease: removal of pulmonary cysts, peripheral pulmonary nodules, stage I lung cancer, etc. 3. Esophageal diseases: esophageal leiomyomas, esophageal cancer, achalasia and so on. 4. Mediastinal disease; thymectomy for myasthenia gravis, mediastinal tumor and cystectomy. 5. Cardiovascular disease; pericardial effusion fenestration, closed end-closure of arterial catheter, and ventricular septal defect repair of coronary artery bypass graft. 6. Other: Remove foreign objects. Treatment of diseases: spontaneous pneumothorax, chest and chest achalasia Indication 1. Pleural disease: spontaneous pneumothorax, hemothorax, empyema, chylothorax, pleural effusion caused by pleural tumor. 2. Lung disease: removal of pulmonary cysts, peripheral pulmonary nodules, stage I lung cancer, etc. 3. Esophageal diseases: esophageal leiomyomas, esophageal cancer, achalasia and so on. 4. Mediastinal disease; thymectomy for myasthenia gravis, mediastinal tumor and cystectomy. 5. Cardiovascular disease; pericardial effusion fenestration, closed end-closure of arterial catheter, and ventricular septal defect repair of coronary artery bypass graft. 6. Other: Remove foreign objects. Preoperative preparation Partial resection of the sympathetic chain: 1. Instruments and instruments preparation: 2 high-resolution monitors, cameras, cold light sources, cables and thoracoscopes, and various endoscopic surgical instruments. Children with a 5mm diameter O-degree thoracoscope, adults generally have a diameter of 8-10mm, The anterior viewing angle is a degree of O and 30 degrees of thoracoscopy. Thoracoscopy and instruments are immersed and disinfected with ethylene oxide gas or chemicals. 2. Patient preparation: same as conventional thoracotomy: special circumstances, such as small nodules on the edge of the lungs, normal pleural surface, difficult to locate under video-assisted thoracoscopic surgery, then need to be injected with fine needles into the blue before surgery. Positioning. 3. Surgery staff preparation: Doctors who implement VATS must be familiar with intrathoracic anatomy and have extensive experience in thoracotomy. Before VATS, they must undergo rigorous training. They should also be trained and have a clear division of labor. The operation of the general thoracic surgery and the placement of the device are shown in the figure. Surgical procedure (a) lobectomy: 1. Lateral position. The exposed area of the skin at the incision should be appropriately larger to reveal the preset incision. 2. Place the thoracoscope: make a 1-1.5cm long skin incision in the selected area, use the vascular clamp to separate the muscles, intercostal muscles and puncture the parietal pleura into the pleural cavity, and probe into the fingers. No adhesion can be directly The cannula puncture needle is inserted into the pleural cavity, and an open cannula is placed. The thoracoscope is placed from the cannula to comprehensively examine the intrathoracic structure. Then, according to the needs of the operation, the second and third cannula incisions were made in the same way, and the surgical instruments such as the non-invasive grasping forceps, the electrocautery stripper, and the irrigation suction tube were placed under the thoracoscope monitoring. 3. Separation of interlobular fissures: Separation of adhesions and pleura by electrocautery separation; separation of interlobular insufficiency can be properly separated by electrocoagulation scissors, and the appropriate level can be found and then sutured with endoscopic suture incision (GIA). . 4. Treatment of pulmonary artery: 1 The ligature of the interlobular artery was separated by a small incision with a common long vascular clamp. 2 The artery was treated with GIA to suture the suture. 3 hilar vascular and bronchus are treated together. 4 metal clip processing method. 5. Treatment of pulmonary veins: treatment with pulmonary artery. 6. Bronchial treatment: sutured with GIA. 7. The surgery is over. After the operation device exits the pleural cavity, the incision is sutured, and then the chest drainage tube is taken out and fixed on the skin through an original cannula, and the water is sealed and the lung is re-expanded. (B) esophageal muscle incision: 1. Position: The right lateral position is slightly forward. 2. Incision: The first incision selects the 8th or 9th intercostal space of the left posterior iliac crest, and the 2nd, 3rd, and 4th incisions select the 6th intercostal anterior iliac crest line, the posterior tibial line, and the posterior scapula 2em. Each length is 10, 10, 5, 10cm. 3. Surgical operation: after entering the mirror, use the three-leaf claw to pull the left lower lobe, cut the mediastinal pleura between the aorta and pericardium; expose the esophageal muscle layer; use the right angle forceps to separate and bring a band to take the esophagus; Open the esophageal muscle layer; until the submucosal layer of the esophagus is seen, complete the esophageal myotomy. (C) mediastinal tumor resection (taking thymoma surgery as an example): 1. Position: Take the semi-recumbent position and the lateral position. 2. Incisions: 3-4. 3. Surgical operation: After entering the microscope, the normal thymus tissue near the tumor was clamped with endoscopic forceps, the capsule was cut open, the thymus artery was treated with a metal clip, and the whole tumor was separated by sharp and blunt endoscopy. All the adhesive tapes were used. After cutting with a metal clip, cut it until the tumor is removed. (four) arterial catheter ligation: 1. Position: right lateral position. 2. Incision: The first incision was made 2-3 cm between the 6th or 7th intercostal space; the third incision was made as the 2nd incision; the 3rd and 4th incision was made to the intercostal space of the arterial catheter. 3. Surgical operation: After the position of the arterial catheter is determined, the mediastinal pleura is cut, the tissue around the free arterial catheter is removed, and the recurrent laryngeal nerve is protected from injury. The arterial catheter is freed and placed in a clip holder to clamp the arterial catheter with a titanium clip. (5) pleural tumor resection: 1. Position: healthy lateral position. During the operation, the operating position can be changed according to the tumor site. 2. Incision: A conventional incision was made by thoracoscopic surgery. 3. Surgical operation: After entering the microscope, the pleura was cut along the edge of the tumor with an electric knife, and the tumor was lifted with a endoscopic grasping forceps. The tumor was gradually removed, the tumor was removed, and the operation was terminated by electrocautery.