Abstract：
BACKGROUND: This study aims to compare three commonly used energy devices for dissection during Video-Assisted Thoracoscopic Surgery (VATS) lobectomy: monopolar hook, advanced bipolar, and ultrasonic device, in terms of duration of the surgical procedure and clinical intra- and post-operative outcomes.
METHODS: In this prospective single-center study, 75 patients undergoing VATS lobectomy for non-small cell lung cancer between January 2022 and May 2023 were enrolled and divided into 3 groups based on the device used during the surgical procedure (Group 1: Ultrasonic Device, Group 2: Advanced Bipolar, Group 3: Monopolar Hook). The duration of the surgical procedure, daily pleural fluid production, post-operative pain, length of hospital stay, and occurrence of post-operative complications were compared for each group. In a subgroup of 20 patients (10 from Group 1 and 10 from Group 3), concentrations of inflammatory cytokines in pleural fluid at 3 h and 48 h post-surgery were analyzed.
RESULTS: Pleural fluid production on the first and second post-operative days was significantly lower in patients treated with the Ultrasonic device compared to the other two groups (p < 0.001). The duration of the surgical procedure was significantly shorter when using the Ultrasonic device (p < 0.001). There were no significant differences in length of hospital stay (p = 0.975), pain on the first and second post-operative days (p = 0.147 and p = 0.755, respectively), and blood hemoglobin levels on the first post-operative day (p = 0.709) and at discharge (p = 0.795). No differences were observed in terms of post-operative complications, although the incidence of post-operative cardiac arrhythmias was borderline significant (p = 0.096), with no cases of arrhythmias recorded in Group 1. IL-10 levels in pleural fluid of patients in Group 3 peaked at 3 h post-surgery, with a significant reduction at 48 h (p = 0.459).
CONCLUSIONS: The use of the ultrasonic device during VATS lobectomy may reduce pleural fluid production and shorten the duration of the surgical procedure compared to using a monopolar hook or advanced bipolar device. The choice of energy device may influence the local inflammatory response, although further studies are needed to confirm these results.
METHODS: In this prospective single-center study, 75 patients undergoing VATS lobectomy for non-small cell lung cancer between January 2022 and May 2023 were enrolled and divided into 3 groups based on the device used during the surgical procedure (Group 1: Ultrasonic Device, Group 2: Advanced Bipolar, Group 3: Monopolar Hook). The duration of the surgical procedure, daily pleural fluid production, post-operative pain, length of hospital stay, and occurrence of post-operative complications were compared for each group. In a subgroup of 20 patients (10 from Group 1 and 10 from Group 3), concentrations of inflammatory cytokines in pleural fluid at 3 h and 48 h post-surgery were analyzed.
RESULTS: Pleural fluid production on the first and second post-operative days was significantly lower in patients treated with the Ultrasonic device compared to the other two groups (p < 0.001). The duration of the surgical procedure was significantly shorter when using the Ultrasonic device (p < 0.001). There were no significant differences in length of hospital stay (p = 0.975), pain on the first and second post-operative days (p = 0.147 and p = 0.755, respectively), and blood hemoglobin levels on the first post-operative day (p = 0.709) and at discharge (p = 0.795). No differences were observed in terms of post-operative complications, although the incidence of post-operative cardiac arrhythmias was borderline significant (p = 0.096), with no cases of arrhythmias recorded in Group 1. IL-10 levels in pleural fluid of patients in Group 3 peaked at 3 h post-surgery, with a significant reduction at 48 h (p = 0.459).
CONCLUSIONS: The use of the ultrasonic device during VATS lobectomy may reduce pleural fluid production and shorten the duration of the surgical procedure compared to using a monopolar hook or advanced bipolar device. The choice of energy device may influence the local inflammatory response, although further studies are needed to confirm these results.
摘要：
背景：这项研究旨在比较三种常用的能量装置，用于在电视辅助胸腔镜手术（VATS）肺叶切除术中进行解剖：单极钩，晚期双极,和超声波装置，就外科手术的持续时间以及临床术中和术后结果而言。
方法：在这项前瞻性单中心研究中，纳入2022年1月至2023年5月期间接受VATS肺叶切除术治疗非小细胞肺癌的75例患者，并根据手术过程中使用的设备分为3组（第1组：超声设备，第2组：高级双极，第3组：单极钩）。外科手术的持续时间,每日胸膜积液产生量，术后疼痛,住院时间,比较各组术后并发症的发生情况。在20名患者的亚组中（第1组10名，第3组10名），分析术后3h和48h胸膜液中炎性细胞因子的浓度。
结果：与其他两组相比，使用超声设备治疗的患者在术后第一和第二天的胸膜液产量显着降低（p<0.001）。当使用超声装置时,外科手术的持续时间显著缩短(p<0.001)。住院时间没有显着差异（p=0.975），术后第一天和第二天的疼痛（分别为p=0.147和p=0.755），术后第一天（p=0.709）和出院时（p=0.795）的血液血红蛋白水平。在术后并发症方面没有观察到差异，尽管术后心律失常的发生率是临界显著的(p=0.096),在第1组中没有记录到心律失常的病例。第3组患者胸腔积液中IL-10水平在术后3小时达到峰值，在48小时显着减少（p=0.459）。
结论：与使用单极钩或先进的双极装置相比，在VATS肺叶切除术中使用超声装置可以减少胸膜积液的产生并缩短外科手术的持续时间。能量装置的选择可能会影响局部炎症反应，尽管需要进一步的研究来证实这些结果。
方法：在这项前瞻性单中心研究中，纳入2022年1月至2023年5月期间接受VATS肺叶切除术治疗非小细胞肺癌的75例患者，并根据手术过程中使用的设备分为3组（第1组：超声设备，第2组：高级双极，第3组：单极钩）。外科手术的持续时间,每日胸膜积液产生量，术后疼痛,住院时间,比较各组术后并发症的发生情况。在20名患者的亚组中（第1组10名，第3组10名），分析术后3h和48h胸膜液中炎性细胞因子的浓度。
结果：与其他两组相比，使用超声设备治疗的患者在术后第一和第二天的胸膜液产量显着降低（p<0.001）。当使用超声装置时,外科手术的持续时间显著缩短(p<0.001)。住院时间没有显着差异（p=0.975），术后第一天和第二天的疼痛（分别为p=0.147和p=0.755），术后第一天（p=0.709）和出院时（p=0.795）的血液血红蛋白水平。在术后并发症方面没有观察到差异，尽管术后心律失常的发生率是临界显著的(p=0.096),在第1组中没有记录到心律失常的病例。第3组患者胸腔积液中IL-10水平在术后3小时达到峰值，在48小时显着减少（p=0.459）。
结论：与使用单极钩或先进的双极装置相比，在VATS肺叶切除术中使用超声装置可以减少胸膜积液的产生并缩短外科手术的持续时间。能量装置的选择可能会影响局部炎症反应，尽管需要进一步的研究来证实这些结果。
