Single-port Complete Thoracoscopic Lobectomy Feasibility

Single-port Complete Thoracoscopic Lobectomy Feasibility Clinical comparisons of single-port versus three-port complete thoracoscopic lobectomy for lung cancer patients Abstract Objective: To compare the feasibility and safety of single-port versus three-port complete thoracoscopic lobectomy for lung cancer patients. Methods: A retrospective study was conducted on 60 lung cancer patients from June 2014 to August 2014 in Department of Thoracic Surgery, Union Hospital, Fujian Medical University. There were 30 patients in single-port complete thoracoscopic lobectomy group (single-port group) and other 30 in three-port complete thoracoscopic lobectomy group (three-port group). Total lymph node harvest, mediastinal lymph node harvest, dissection of mediastinal lymph node groups, operation time, intraoperative blood loss, extubation time, postoperative hospital stay, visual analogue scale (VAS) one day after operation, and the complication rate were thoroughly compared between the two groups. Results: There were no significant differences in total lymph node harvest, mediastinal lymph node harvest, dissection of mediastinal lymph node groups, intraoperative blood loss, extubation time, postoperative hospital stay, and complication rate between the two groups (p> 0.05). However, the operation time of single-port group (209.0 ±45.5 min) was significantly longer than that of three-port group (154.5 ±30.9 min) (p Conclusion: For lung cancer patients, the feasibility and safety of single-port complete thoracoscopic lobectomy is similar to three-port complete thoracoscopic lobectomy. Compared with three-port complete thoracoscopic lobectomy, the operation time of single-port complete thoracoscopic lobectomy is longer, but its postoperative pain is gentler. As the experience accumulating, single-port complete thoracoscopic lobectomy should be popularized with its merits of minimal invasiveness. Keywords: single-port, three-port, lobectomy, lung cancer. Introduction: Currently, lobectomy is the prior intervention to treat early-stage non-small cell lung cancer (NSCLC) [1]. As a minimally invasive technique, thoracoscopic lobectomy has been widely used in current thoracic department [2]. Although single-port complete thoracoscopic lobectomy has been introduced to treat NSCLC, no literature was available to compare its feasibility and safety with three-port complete thoracoscopic lobectomy. Therefore, we conducted a retrospective comparison study in lung cancer patients enrolled from June 2014 to August 2014 to investigate the feasibility and safety of single-port complete thoracoscopic lobectomy. 1. Methods and materials 1.1 General information A total of 60 lung cancer patients from June 2014 to August 2014 in Department of Thoracic Surgery, Fujian Medical University Union Hospital were included in this retrospective study. There were 30 patients in single-port complete thoracoscopic lobectomy group (single-port group) and other 30 in three-port complete thoracoscopic lobectomy group (three-port group). All patients underwent associated examination such as thoracic computed tomography (CT), cerebral magnetic resonance imaging (MRI), skeletal emission computed tomography (ECT), and abdominal and cervical color Doppler ultrasound (CDU). Positron emission tomography-CT (PET-CT) might also need to be conducted to exclude metastasis if necessary. Electrocardiogram, cardiac CDU, and pulmonary function test were conducted to assess cardiopulmonary function. The inclusion criteria include: 1) patients with stage I-II (cTNM classification) peripheral lung cancer; 2) no thoracic surgery history; 3) lobectomy can be tolerated by card iopulmonary function; 4) preoperative complications have been stably controlled. 1.2 Anesthesia and surgical procedure Double-lumen endobronchial tubes (DLT) were used for intubation for the two groups, and the healthy lung received ventilation. All patients underwent thoracoscopic lobectomy under general anesthesia. For single-port group, a 3.5-4.5cm incision was made from the 4th intercostal space to the 5th intercostal space along the anterior axillary line. The patients underwent thoracoscopic lobectomy with video assistance. For three-port group, a 1.5cm observation port was made on the cross point of midaxillary line and the 7th intercostal space, and a 2-4cm operation port was made on the cross point of anterior axillary line and the 4th/5th intercostal space. A 1.5-2.5cm operation-aided port was made on the cross point of the 7th intercostal space and infrascapular line. For peripheral lung cancer, pulmonary wedge resection was conducted to remove the focus. Once the resection samples were confirmed as malignant tumor by fast frozen pathology, the following standard lobectomy and mediastinal lymphadenectomy would be employed. For central lung cancer, standard lobectomy was conducted. Once the resection samples were confirmed as malignant tumor by fast frozen pathology, the following mediastinal lymphadenectomy would be employed. Electrocautery and ultrasonic scalpel were used to distract the vessels and bronchus. Suture clamps were used to fix great vessels such as pulmonary veins, pulmonary artery and so on. Hemolock, titanium clip, electrocautery, ultrasonic scalpel and silk ligation were used to handle small vessels. No definite order was made to conduct the lobectomy, which mostly depended on the development of interlobar fissure. Specimen bag was used to extract the removals preventing from contaminating the cuts, and analgesia pumps were used for the two groups. Indications for removing the drain included: 24h drainage flow was less than 100mL; postoperative lung recruitment was favorable without pleural effusion. 1.3 Observation parameters The observation parameters included: 1) parameters during perioperative period: operation time, intraoperative blood loss, postoperative drainage flow, postoperative thoracic cavity drainage time, visual analogue scale (VAS) one day after operation, postoperative hospital stay, death rate during perioperative period, complications during perioperative period. 2) parameters related to tumor resection: total lymph node harvest, node-positive number, node-positive rate, N1 lymph nodes, N2 lymph nodes, N2 lymph node rate, and N2 lymph node groups. 1.4 Statistical methods Statistical software SPSS 16.0 was conducted to analyze the data. Quantitative data was showed as x ±s, and independent t-test was used to test the group comparisons. Enumeration data was presented as rate, and χà ¯Ã‚ ¼Ã¢â‚¬â„¢ test was used to test group comparisons. Statistical significance was set as P 2. Results 2.1 Clinical characteristics There were no significant differences in sex, age, tumor location, postoperative pathological type, tumor invasion, visceral pleura invasion, and tumor classification, respectively (P> 0.05) (Table 1). In addition, there were no significant differences in total lymph node harvest, positive lymph node number, total mediastinal lymph node harvest, and dissection of mediastinal lymph node groups (P> 0.05) (Table 2). Table 1. Comparisons of pathological information between single-port group and three-port group. Single-port group (n=30) Three-port group (n=30) P value Gender 0.183 Male 9 11 Female 21 19 Age (year)* 25-77(61) 45-70(58) 0.583 Tumor location 0.096 Left upper lobe 8 4 Left inferior lobe 5 3 Right upper lobe 8 9 Right middle lobe 3 4 Right inferior lobe 6 10 Tumor type 0.341 Adenocarcinoma 25 22 Squamous carcinoma 2 6 Others 3 2 Tumor invasion 0.583 Carcinoma in situ 2 0 Micro invasion 5 6 Invasion 23 24 Visceral pleura invasion 0.799 No 22 21 Yes 8 9 TNM classification 0.989 Stage 0 1 1 Stage Ia 14 10 Stage Ib 6 10 Stage IIa 2 3 Stage IIb 3 2 Stage IIIa 4 4 *age:extreme value (median). Table 2. Comparisons of lymph node harvest between single-port and three-port group. Single-port group (n=30) Three-port group (n=30) P value Total lymph node harvest 23.6 ±11.2 25.4 ±7.3 0.737 Positive lymph nodes 1.5 ±3.1 1.9 ±4.9 0.971 Total mediastinal lymph node harvest 16.2 ±9.2 17.2 ±6.5 0.731 Dissection of mediastinal lymph node groups 4.4 ±1.0 4.4 ±0.8 0.637 2.2 Perioperative information All operations were under the video-assistance of total thoracoscopic lobectomy without other assisted endoscope incision. There were no deaths during preoperative period. However, there were a total of five cases with complications, two cases (1 case of arrhythmia; 1 case of systemic infections) in single-port group (6.7%), and another three cases (1 case of arrhythmia; 1 case of air leakage; 1 case of chylothorax) in three-port group (10.0%). There was no significant difference in complications between the two groups (P>0.05). Additionally, no significant differences in intraoperative blood loss, postoperative extubation time and postoperative hospital stay were observed (P>0.05). However, operation time in single-port group (209.0 ±45.5 min) was longer than that in three-port group (154.5 ±30.9min) (P Table 3. Comparisons of perioperative outcomes between single-port and three-port group Single-port group (n=30) Three-port group (n=30) P value Operation time (min) 209.0 ±45.5 154.5 ±30.9 0.000 Intraoperative blood loss (ml) 90.6 ±49.3 79.5 ±45.2 0.840 Postoperative extubation time (d) 4.0 ±1.5 5.4 ±3.7 0.256 Postoperative VAS 3.6 ±0.7 5.5 ±1.0 0.000 Postoperative hospital stay (d) 6.9 ±4.0 8.5 ±11.8 0.441 Postoperative complications 2 3 0.799 Arrhythmia 1 1 Systemic complications 1 0 Air leakage 0 1 Chylothorax 0 1 3. Discussions Single-port thoracoscopic technique was first reported to diagnose and treat non-complicated pleura-related disease in 2003[7]. In 2004, it was used in pulmonary wedge resection by Rocco et al.[8]. Seven years later, single-port thoracoscopic technique was reported to conduct lobectomy and lymphadenectomy by Gonzalez et al[9]. Since then, it was applied gradually in segment resection of lung [10], total pneumonectomy [11], bronchial sleeve resection [12] and angioplasty of pulmonary arteries [13]. However, most available literature focused on the feasibility and safety of single-port thoracoscopic lobectomy, and no studies compared it with three-port thoracoscopic lobectomy. The presented study retrospectively investigated the differences of clinical outcomes between single-port thoracoscopic lobectomy and three-port thoracoscopic lobectomy for lung cancer. Jiang et al. [14] compared 160 cases of thoracoscopic lobectomy and 247 cases of conventional open surgery and found no signific ant differences in perioperative death (0.6% vs. 2.8%) and complication rate (9.4% vs. 11.7%) (P>0.05). It is indicated that thoracoscopic lobectomy was technically safe to treat NSCLC. Similarly in our study, the complication rates were 6.7% and 10.0% for single-port group and three-port group, respectively. However, there were no deaths during perioperative period in our study. Therefore, our study indicated that single-port lobectomy was at least technically safe compared with three-port group. The vital factor for radical resection of lung cancer by single-port thoracoscopic lobectomy was the dissection of lymph nodes. Jiang et al. [14] found no significant differences in dissection of lymph node groups (2.4 ±1.5 vs. 2.6 ±1.6) and lymph node harvest (9.8 ±6.2 vs. 9.9 ±5.9) between thoracoscopic lobectomy group and conventional open surgery group (P> 0.05). Similarly, Zhang et al.[15] found no significant differences in lymph node harvests (14.6 ±7.5 vs. 15.2 ±4.5) between video-assisted thoracoscopic surgery group and video-assisted micro thoracoscopy group. That was to say, the lymph node dissection by thoracoscopic lobectomy was at least equivalent to that by open surgery. In the presented study, there were no significant differences in total lymph node harvest (23.6 ±11.2 vs.25.4 ±7.3), mediastinal lymph node harvest (16.2 ±9.2 vs. 17.2 ±6.5), dissection of mediastinal lymph node groups (4.4 ±1.0 vs. 4.4 ±0.8) between the single-port group and th ree-port group. These results suggested that the lymph node harvest was at least equivalent to the previous studies. In other words, the dissection of lymph nodes by single-port thoracoscopic lobectomy was feasible in respect of radical removal of tumors. However, the long-term outcomes need further follow-up to confirm in the future. The incision of single-port thoracoscopic lobectomy was located at the cross point of anterior axillary line and the 4th/5th intercostal spaces, which, unlike conventional three-port thoracoscopy, did not have observation port or assisted-operation port. The 4th/5th intercostal spaces were wider with less muscle and less bleeding, which might have little impact on the postoperative recover with less pain. After comparing 20 cases of three-port thoracoscopic lobectomy and 10 cases of single-port thoracoscopic lobectomy in treating interstitial lung disease, Chen et al.[16] found that postoperative one-day VAS in single-port group (4.95 ±0.39) was significantly lower than that in three-port group (4.5 ±0.7) (P=0.03). Similarly in our study, postoperative one-day VAS in single-port group (3.6 ±0.7) was significantly lower than that in three-port group (5.5 ±1.0) (P In the presented study, the operation time (209.0 ±45.5 min) in single-port group was significantly lower than that in three-port group (154.5 ±30.9 min). The reasons included 1) all the operating instruments and thoracoscopy went through the single port, which might interfere each other, especially when the focus was near the dorsal cavity and diaphragm. 2) single-port thoracoscopic lobectomy had a strict skill requirement of qualified camera assistant. The camera assistant was supposed to know how to cooperate with the operator, how to allocate the location within the incision, and how to keep the camera stable. Our operation team launched the single-port-thoracoscopic lobectomy since May 2014, and we believed that the operation time would be shortened as we optimized our technique gradually. In summary, the feasibility and safety of single-port thoracoscopic lobectomy were similar to three-port thoracoscopic lobectomy for lung cancer patients. With the development of instruments, the optimization of surgical procedure, and the accumulation of surgical experience, the operation time would likely be shortened gradually. Therefore, single-port complete thoracoscopic lobectomy was supposed to be popularized with its merits of minimal invasiveness.

Analytical essay on Primo Levi’s “If This Is a Man” Essay

Primo Levi’s book ‘If This Is a Man’ is a novel about a German concentration camp, one among many novels on the same subject. However, this book is exceptional as Levi never ‘raises his voice, complains, or attributes blame’. ‘If This Is a Man’ is an objective story told in a detached tone using scientific language, which sometimes makes this book not a confession but an analysis. Nevertheless, distant tone and unemotional language bring the horrifying message across with even greater impact on readers. The saddest, the most powerful, and the most ironic chapter of the book is the central ninth chapter, called ‘The Drowned and the Saved’. Here the author’s talent as well as his training as chemist comes through in unique manner. Instead of telling the story, Levi analyses the reasons, the methods, and the effects of German concentration camps. The result is more like an essay or even lab report rather than a part of a novel. The diction of the chapter is sharply contrasted with its content, emphasizing the terrifying events described. Already the first sentence of the chapter (â€Å"What we have so far said and will say concerns the ambiguous life of the Lager.† P. 102) reveals a lot. This sentence is the first step in building up the emotionless tone through technical diction. The first person point of view used throughout previous chapters is suddenly replaced by the pronoun â€Å"we† as it is used in official documents. With every following sentence, the dryness of expression grows gradually: â€Å"To this question we feel that we have to reply in the affirmative.† (p. 102), â€Å"†¦the Lager was presumably a gigantic biological and social experiment.† (p. 102), â€Å"But another fact seems to us worthy of attention†¦Ã¢â‚¬  (p. 103). Read Also:  Analytic Rubric for Essay The impact of language is reinforced by the structure of the chapter. As Primo Levi names the Lager to be an experiment, he writes his analysis of the reasons and effects of the concentration camp in the form of a lab report. One can clearly distinguish statement of purpose, method statement, hypothesis, observations, conditions, and conclusion – all the important parts of a lab report. However, as said before the detachedness of the structure is in sharp contrast with the content. For example, the â€Å"method  statement† (â€Å"Thousands of individuals†¦ are enclosed within barbed wire: there they live a regular, controlled life which is identical for all and inadequate to all needs†¦Ã¢â‚¬  p. 102) describes plainly and understatedly terrifying conditions of the camp. Levi does not complain, he just says that the conditions are â€Å"inadequate to all needs† but the underestimation brings the message across more powerfully, especially when compared to previous chapters. Similarly, the author writes: â€Å"And one must take into account a definite cushioning effect exercised both by the law, and by the moral state which constitutes a self-imposed law;† (p. 103), a statement, describing the conditions of â€Å"the experiment†, implying that there is no law or sense of morality in the camps. However, yet again, there are no protests or grumbles, and the reader has to find the meaning behind the statement himself. â€Å"Variables† in the experiment are two categories of men – the saved and the drowned. Sudden change of tone – from official to poetic and back to official – is used to accentuate the difference among the prisoners, to bring it across for the reader that in the Lager the only choice was either to survive or to die. Everyone struggles to survive and in this brutal exertion, all means are justified. â€Å"If some Null Achtzehn vacillates, he will find no one to extend a helping hand; on the contrary, someone will knock him aside†¦Ã¢â‚¬  (p. 103). With this line author clearly states the moral of the camps: if I’m not for myself, who will be for me? With bitter irony Levi avers that the law â€Å"to he that has will be given; to he that has not will be taken away.† (p. 104) is openly at work in the camp and to obey this law is the only possible way to survive. Thus, the morality of the Lager is the antithesis of morality of normal life the way the concentration camp itself is antithesis of normal world. This passage is even more sarcastic when the fact that Primo Levi himself was not particularly strong and capable prisoner but rather a ‘muselman’. However, as it has been mentioned in the beginning of this essay, Primo Levi’s book is different from other novels on the same topic. All the writers have shown the brutal morality, or rather immorality of the Lager and deduced from it that â€Å"the Hà ¤ftling is†¦ a man without inhibitions† (p.  103) thus giving up on the humankind. Levi’s attitude is different. He believes that humanity of the prisoners is still hidden deep in their souls waiting for an opportunity to recover. (â€Å"†¦in the face of driving necessity and physical disabilities many social habits and instincts are reduced to silence.† p. 103) and as it becomes evident in the end of the book, he proves to be right. Another fact worth mentioning about this chapter is that the title â€Å"The Drowned and the Saved† used to be also the title of the English translation of the novel, indicating hence the importance of the chapter. As a conclusion it can be said that the novel ‘If This is a Man’ by Primo Levi and especially the ninth chapter is a unique account of the horrifying actions carried out in German concentration camps as it tells the story unemotionally using scientific diction to accentuate the seriousness of matter discussed. Analysis of the reasons behind setting up the Lager, methods used to break down human soul and the effects of the actions carried out by SS officials gives an appalling insight to one of the most horrifying events of the 20th century.

Lawyers, Scientists Urge Ethics in Biological Advances

In this news article, the concerns of scientists toward an amoral approach to the advances of biological sciences and engineering are examined. Much of the article centers on a keynote address delivered by Harvard Law School professor Einer Elhauge where the professor states â€Å"The issue is that people tend not to focus on the consequences of certain forms of human re-engineering.†The professor goes on to comment that the great strides in biological science may yield a great number of advances in helping humanity overcome a number of diseases and afflictions, but he also acknowledges that there is great potential for abuse. Examples of such abuse include issues such as altering the sex of a child in the womb or even a deaf family biologically engineering the deafness of their offspring.Ultimately, the Elhuage’s focus is to convince the scientific community that, even though it has biological technology to alter evolution, it should use ethical standards before embark ing on the proverbial â€Å"playing God† concept that Mary Shelly warned science about 250+ years ago.To a great degree, the article is accurate in terms of its presentation and call for moral and ethical consciousness. Just because science reaches the technological or biological advances of a highly evolved society does not mean that science can now re-orchestrate what is considered morally acceptable in the hearts and minds of the population. As such, science should understand the limits of ethical and moral behavior and not approach advancements with total mindlessness and amorality.Congressman Calls out Tech Firms on China Ethics.The bulk of the purpose of this article is to put the onus on American and international businesses to reconsider their actions when empowering China by conducting extensive business with the nation.In the article, it is reported that Congressman Chris Smith has taken internet companies such as Yahoo, Google, Sysco Systems, etc to task for going along with China’s internet censorship program. This may not seem like an entirely important issue, but one needs to keep in mind that China is primarily a military-industrial complex dictatorship that has a horrible record for human rights violations. As Smith points out, when American businesses work in tandem with nations with such abominable track records they enable such dictatorships and help perpetuate significant human rights violations.Furthermore, it is noted that journalists in China have been censured and punished and imprisoned for exercising their free speech. Smith suggests that American businesses that contribute to such a scenario should be fined and sanctioned.What Smith is essentially doing here is he is compelling American companies to conform to ethical standards of behavior and that is commendable. However, these companies have limited ability in terms of being able to shape domestic Chinese law. Furthermore, in such a highly competitive international bu siness environment, it is difficult to impose ethics as defined by one nation onto another nation, no matter how noble the cause. Smith’s statements are commendable, but it is not entirely clear if they will be successful.Ethics board fines Dow for giving state workers airplane rideAs the title of the article infers, the center of the ethics controversy this article deals with is a fine levied at Dow Chemicals to the tune of $2,500.00 for flying three state college employees to an out of state training program. At the time of the issue of contention, Dow was launching a co-operative training program with the state college (Louisiana Community and Technical College) and provided free airline tickets to employees for meeting purposes. This, however, was a violation of state ethic laws, hence the fine.This scenario strikes one as, well, silly. For Dow to compensate the airline tickets of three state workers so all parties can hash out a co-operative venture hardly seems like une thical behavior, although it is defined as such under state ethics laws. While the whole scenario comes off as much ado about nothing (actually, $2500 to a multi-billion dollar company such as Dow is basically nothing), it technically is a violation of state laws and the levied fine is valid. However, it does not seem like any real, serious ethical violations actually took place.If anything, the situation appears more like an error as the result of an oversight as opposed to a deliberate ethical violation. Oversights, however, are not an excuse for not following directions. In that regard, the decision against Dow was valid and the fine levied justified.BibliographyAnon. (2007, February 9) Ethics board fines Dow for giving state workers airplane ride.The Associated Press.   Retrieved February 12, 2007 fromhttp://money.aol.com/news/ articles/_a/ethics-board-fines-dow-for-giving-state/n20070209095709990003Schwankert, Steven.   (2007, February 12) Congressman Calls out Tech Firms o nChina Ethics. IDG News Service, Retrieved February 12, 2007, fromhttp://www.infoworld.com//07/02/12/HNcongressmanchinaethics_1.html/article/ sourcedomain =www.dailyfreepress.com&MIIHost=media.collegepublisher.comZerey, Ralpha. (2007, February 12) Lawyers, Scientists Urge Ethics in BiologicalAdvances. The Daily Free Press. Retrieved February 12, 2007, fromhttp://media.www.dailyfreepress.com/media/storage/paper87/news/2007/02/12/News/Lawyers.Scientists.Urge.Ethics.In.Biological.Advances-2712941.shtml?

Junior Reserve Officer Training Corps - 848 Words

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