Use of Unfolded Gauze in Video-Assisted Thoracoscopic Surgery

Oxidized regenerated cellulose for a clear thoracoscopic view: a single-centre randomized trial

OBJECTIVES

During video-assisted thoracoscopic surgery (VATS), blood oozing from the surface of the access port wound can hamper the surgical view. Although this oozing is difficult to prevent, it can be decreased by placing a wound edge protector with oxidized regenerated cellulose (ORC) on the surface of the access port wound, thereby improving the surgical outcomes and safety of VATS.

METHODS

We conducted a prospective, single-centre, open-label, randomized clinical trial to evaluate the operative outcomes of VATS when using the ORC (ORC group) compared with operative outcomes without using the ORC (non-ORC group). The primary end point was interruption of the operation as a result of blood oozing from the surface of the access port wound. The secondary end points were the other intraoperative and postoperative outcomes.

RESULTS

A total of 108 patients were divided into the ORC group (n = 54) and the non-ORC group (n = 54). Compared with the non-ORC group, the ORC group had fewer patients with an interruption in the operation (11.1% vs 51.8%; P < 0.001), less need for wound haemostasis of the access ports during wound closure (44.4% vs 72.2%; P = 0.003), similar rates of postoperative deaths and complications and a tendency for shorter operation times (149.3 vs 168.8 min, respectively; P = 0.083).

CONCLUSION

The use of an ORC sheet around a wound edge protector for haemostasis can ensure a clear view during VATS.

CLINICAL TRIAL REGISTRATION NUMBER

UMIN000031112.

Glove-Finger Extraction Technique in Uniportal Video-Assisted Thoracoscopic Surgery

BACKGROUND

Uniportal video-assisted thoracoscopic surgery (VATS) is increasingly being performed worldwide. During the operation, specimen extraction from a small incision less than or equal to 2 cm can be challenging without the use of a commercial specimen retrieval device. There have been no reports regarding the use of the glove-finger technique in uniportal VATS. The aim of this study was to assess the feasibility of the alternative specimen retrieval method by glove-finger technique.

METHODS

We retrospectively investigated 50 patients with peripheral lung lesions who underwent uniportal VATS wedge resection with a 2-cm incision at Kaohsiung Medical University Hospital between August 2015 and December 2016. The cut end of the glove-finger was used to extract the specimen.

RESULTS

Fifty-five wedge-resected specimens were extracted successfully by glove-finger technique. There was no conversion to two-port nor three-port VATS. After intraoperative frozen section analysis for all specimens, 24 were revealed to have primary lung cancer and subsequently underwent completion lobectomy or segmentectomy; the other 31 showed 10 pulmonary metastases, 9 pulmonary benign lesions, and 12 pulmonary infectious lesions. All specimens were resected with free margins and the mean diameter of the lesions was 1.64 ± 0.59 cm (range: 0.2-2.6 cm) by pathological examination. No intraoperative complication related to the technique was observed.

CONCLUSIONS

This is the first study to reveal the efficacy and benefits of the glove-finger extraction technique in uniportal VATS. In our preliminary experience, this method can decrease costs without compromising the quality and safety of patient care.