What is thoracoscopic surgery? Thoracoscopy has been hailed as one of the major breakthroughs in thoracic surgery in the last century and is a representative procedure of minimally invasive thoracic surgery. Thoracoscopic surgery (VATS) is a new minimally invasive thoracic surgery technique that uses modern television camera technology and high-tech surgical instrumentation to perform complex intrathoracic surgery under the chest wall trocar. It is usually performed under three to four small 37.5px chest wall incisions. The surgeon is looking at the TV monitor to complete the surgery using special surgical instruments, which is the same as extending the surgeon’s eyes into the patient’s chest cavity for surgical operation. Therefore, the surgical field of view, lesion appearance, scope of surgical resection and safety are even better than those of open-heart surgery. TV thoracoscopic surgery has higher and more stringent requirements for the surgeon, who must undergo rigorous training in thoracoscopic surgery and be able to correctly deal with all kinds of unexpected situations encountered during surgery that are different from those encountered during open thoracotomy. What are the advantages of thoracoscopic surgery? Traditional open-heart surgery has a large traumatic area, more bleeding, more obvious postoperative pain, potential complications, and obvious healing scar of the surgical incision. From the perspective of human mechanics, it also destabilizes the human thorax, and in serious cases, the incision may even be dehiscent, causing a certain degree of physical and psychological burden to the patient. Thoracoscopic surgery solves all these defects. What are the advantages of thoracoscopic surgery? 1, small surgical trauma: ordinary open-chest surgery is very traumatic, the incision is above 625px, cutting off all layers of chest wall muscles, serious chest wall damage, and also forcibly propping open the intercostal area 10-500px, post-operative pain has been difficult to solve. Thoracoscopic surgery is generally done by making several small 37.5px long incisions on the chest wall, without forcing open the intercostal space. 2, postoperative pain is light: ordinary open chest surgery due to chest wall trauma, more than a week after surgery to get out of bed, chest pain can last for months to years, most of the loss of physical labor ability. After thoracoscopic surgery, patients can get out of bed within 24 hours, and can participate in physical activities 2-4 weeks after surgery. 3.Less postoperative complications: there is less interference with patients during thoracoscopic surgery, and the postoperative effect on cardiopulmonary function is not significant, which is safer for elderly patients. 4.Aesthetics: the wound is small and most patients, especially young women, are happy to accept it. What kind of thoracoscopic surgery can our hospital perform at present? TV thoracoscopy is widely used in general thoracic surgery, but its surgical indications should be strictly controlled. What are the indications for TV thoracoscopic surgery? The indications for surgery include: 1. Diagnostic surgery indications: it can be applied to a variety of thoracic diseases including pleural, pulmonary, mediastinal and thoracic trauma diagnosis. The lesion can be clearly displayed on the TV, photographed and videoed, and histopathological examination can be obtained. 2. Indications for therapeutic surgery: ① Pleural diseases: abscess chest, pleural mesothelioma, metastases, traumatic hemothorax, spontaneous pneumothorax, celiac disease, benign and malignant pleural effusion, etc. ② Pulmonary diseases: resection of benign lung masses, lung cancer, pulmonary decompensation for end-stage emphysema, etc. ③ Esophageal diseases: esophageal smooth muscle tumor, esophageal diverticulum, cardia incontinentia, esophageal cancer, etc. ④ Mediastinal diseases: thymectomy, mediastinal tumor, giant mediastinal cyst, etc. ⑤ Others: foreign body removal, intercostal nerve severance, partial excision of sympathetic nerve chain for hand sweating, etc. At present, most of the above procedures have been successfully carried out in our hospital, such as pulmonary herpes resection, radical lung cancer surgery, radical esophageal cancer surgery, thoracic duct ligation, partial sympathetic nerve chain resection and so on. Among them, radical esophageal cancer surgery is difficult to operate under thoracoscopy due to the tedious operation steps, and only a few large hospitals in China can carry out it at present. With the assistance of anesthesia department and operation room, our department successfully completed the first thoracoscopic radical esophageal cancer surgery in Zaozhuang area in July this year, which marked that our minimally invasive technology has reached the provincial and even domestic advanced level.