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Our hospital successfully completes the first case of thoracoscopic resection of malignant tracheal tumor with spontaneous breathing under acupuncture-assisted anesthesia in China

Updated: Jun 11, 2020
From: Department of Anesthesia
Edited by: Liu Huiting

On June 3, the First Affiliated Hospital of Xi 'an Jiaotong University (XJTU) successfully carried out the first case of thoracoscopic resection of tracheal tumor with spontaneous breathing under acupuncture-assisted anesthesia. The patient was well recovered and discharged.

In June 1, a female patient, surnamed Chen, was admitted to Department of Thoracic Surgery of our hospital due to chest tightness, shortness of breath and dry cough for more than 2 months. Chest CT scan showed tracheal wall thickening and lumen stenosis. Fibrobronchoscopy detected a mass of 15 mm * 16 mm, 2.5 cm from the tracheal carina, which was highly fragile with a high risk of hemorrhage upon touching. Pathological biopsy confirmed the diagnosis of adenoid cystic carcinoma of the lower trachea. A multidisciplinary team (MDT) led by Department of Thoracic Surgery and Department of Anesthesia was rapidly established, and radical resection of tracheal tumors was determined after discussion.

After entering the operation room, under the guidance of Wang Qiang, Director of Department of Anesthesia, acupuncture anesthesia was performed via five acupoints of Hegu, Taichong, Qiuxu, Gongsun and Neiguan selected by the combined acupuncture methods of pericardium channel, liver channel of foot Jueyin and gallbladder channel of foot Shaoyang. The central vein catheter and epidural puncture catheter were inserted simultaneously, and then laryngeal mask was inserted. The patient's spontaneous breathing was maintained throughout the operation, and the patient was in a superficial sleep state. Subsequently, Director Fu Junke and Deputy Director Zhang Guangjian created three small ports on the chest wall. Under thoracoscope, the trachea was isolated free and the tumor was located by fiberoptic bronchoscopy. Radical resection of malignant tracheal tumor was successfully completed and the incisional margin was pathologically negative. Tracheal sleeve resection, end-to-end anastomosis and acupuncture-assisted anesthesia significantly shortened the operation time, mitigated surgical trauma and accelerated postoperative recovery. The patient restored consciousness and was transferred to the ward immediately after surgery, avoiding the incidence of postoperative infection and other complications, which was in accordance with the concept of enhanced recovery after surgery (ERAS).

Acupuncture anesthesia has been widely applied in thoracic surgery in the First Affiliated Hospital of XJTU. The types of surgery have developed from resection of lung bullous to radical resection of lung cancer. Currently, it has been successfully applied in thoracoscopic tracheal reconstruction, which is an extremely challenging thoracic surgery. The success of this operation signifies that Department of Thoracic Surgery and Department of Anesthesia of our hospital have achieved the leading level in the field of acupuncture anesthesia-assisted thoracic surgery throughout China. The teams led by Wang Qiang and Zhang Guangjian put forward the novel concept of "perioperative acupuncture (PA)" for the first time and illustrate the application value of acupuncture during perioperative period from a novel perspective. Relevant research results have received multiple scientific and technological awards.


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