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Wang L, Cao J, Feng Y, Jia R, Ren Y. Application of uniportal video-assisted thoracoscopic surgery for segmentectomy in early-stage non-small cell lung cancer: A narrative review. Heliyon 2024; 10:e30735. [PMID: 38742067 PMCID: PMC11089358 DOI: 10.1016/j.heliyon.2024.e30735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/26/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024] Open
Abstract
Uniportal video-assisted thoracoscopic surgery (UVATS) segmentectomy has emerged as an effective approach for managing early-stage non-small-cell lung cancer (NSCLC). Compared to conventional open and thoracoscopic surgeries, this minimally invasive surgical technique offers multiple benefits, including reduced postoperative discomfort, shorter hospital stays, expedited recovery, fewer complications, and superior cosmetic outcomes. Particularly advantageous in preserving lung function, UVATS segmentectomy is a compelling option for patients with compromised lung capabilities or limited pulmonary reserve. Notably, it demonstrates promising oncological results in early-stage NSCLC, with long-term survival rates comparable to those of lobectomies. Skilled thoracic surgeons can ensure a safe and effective execution of UVATS despite the potential technical challenges posed by complex tumor locations that may hinder visibility and maneuverability within the thoracic cavity. This study provided a comprehensive review of the literature and existing studies on UVATS segmentectomies. It delves into the evolution of the technique, its current applications, and the balance between its benefits and limitations. This discussion extends the technical considerations, challenges, and prospects of UVATS segmentectomy. Furthermore, it aimed to update advancements in segmentectomy for treating early-stage NSCLC, offering in-depth insights to thoracic surgeons to inform more scientifically grounded and patient-specific surgical decisions.
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Affiliation(s)
- Linlin Wang
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
| | - Jiandong Cao
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
| | - Yong Feng
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
| | - Renxiang Jia
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Tenth People's Hospital, Shenyang, Liaoning, China
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Nachira D, Bertoglio P, Ismail M, Napolitano AG, Calabrese G, Kuzmych K, Congedo MT, Sassorossi C, Meacci E, Petracca Ciavarella L, Chiappetta M, Lococo F, Solli P, Margaritora S. Are the Efficacy and Safety of Chest Tubes in Uniportal Video-Assisted Thoracic Surgery Related to the Level of Intercostal Space Insertion or to the Drain Type? A Prospective Multicenter Study. J Clin Med 2024; 13:430. [PMID: 38256564 PMCID: PMC10817031 DOI: 10.3390/jcm13020430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES The aim of this study is to evaluate if the efficacy and safety of chest tube placement are influenced by the level of intercostal space insertion (uniportal VATS vs. biportal VATS) or by the type of drain employed (standard vs. smart coaxial drain). METHODS Data on patients who underwent either uniportal or biportal VATS upper lobectomies with lymphadenectomy were prospectively collected in three European centers. The uniportal VATS group with a 28 Fr standard chest tube (U-VATS standard) was compared with the uniportal VATS group with a 28 Fr smart drain (U-VATS smart), and U-VATS smart was also compared with biportal VATS with a 28 Fr smart drain inserted in the VIII intercostal space (Bi-VATS smart). RESULTS When comparing the U-VATS standard group with the U-VATS smart, a higher fluid output was recorded in the U-VATS smart (p: 0.004) in the III post-operative day (p.o.) and overall (p: 0.027), with a lower 90-day re-admission in the U-VATS smart (p: 0.04). The Bi-VATS smart group compared to U-VATS smart showed a higher fluid output in the I p.o. (p < 0.001), with no difference in total fluid amount or hospitalization. The Bi-VATS smart recorded a lower incidence (p < 0.001) of residual pleural space or effusion (p: 0.004) at chest X-rays prior to drain removal but a higher level of pain and chronic intercostal neuralgia (p: 0.03). CONCLUSIONS Chest tube insertion through the same incision space in uniportal VATS seems to be safe and effective. Smart drains can improve the fluid output in uniportal VATS, as if the drainage were inserted in a lower space (i.e., biportal VATS), but with less discomfort.
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Affiliation(s)
- Dania Nachira
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Mahmoud Ismail
- Division of Thoracic Surgery, Klinikum Ernst von Bergmann, Academic Hospital of the Charité-Universitätsmedizin, Humboldt University Berlin, 14467 Potsdam, Germany;
| | - Antonio Giulio Napolitano
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Giuseppe Calabrese
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Khrystyna Kuzmych
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Maria Teresa Congedo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Carolina Sassorossi
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Elisa Meacci
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Leonardo Petracca Ciavarella
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Marco Chiappetta
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Piergiorgio Solli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
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