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Watanabe T, Tanahashi M, Suzuki E, Yoshii N, Kohama T, Iguchi K, Endo T. Uniportal Video-Assisted Thoracoscopic Segmentectomy for Early-Stage Non-Small Cell Lung Cancer: Overview, Indications, and Techniques. Cancers (Basel) 2024; 16:2343. [PMID: 39001405 PMCID: PMC11240445 DOI: 10.3390/cancers16132343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
Twenty years have passed since uniportal video-assisted thoracoscopic surgery (VATS) was first reported. Several reports have already proven the minimal invasiveness of uniportal VATS. In addition, two large clinical trials recently demonstrated the benefits of segmentectomy for small peripheral early-stage non-small cell lung cancer. Uniportal VATS segmentectomy is considered the most beneficial minimally invasive surgery for patients with early-stage lung cancer. However, a high level of skill and experience are required to achieve this goal. Only a few reports have discussed specific techniques, particularly for complex segmentectomies. In this Special Issue, we reviewed previous reports on uniportal VATS segmentectomy regarding the indications, instrument selection, marking of the tumor location, methods of intersegmental plane identification, and lymph node dissection, including our own techniques with video content.
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Affiliation(s)
- Takuya Watanabe
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Chuo-ku, Hamamatsu 433-8558, Japan; (M.T.); (E.S.); (N.Y.); (T.K.); (K.I.); (T.E.)
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Zhang C, Jiang D, Luo C, Yuan D, Shang G. Perioperative Effect of Single-Port Thoracoscopic Segmentectomy and Three-Port Thoracoscopic Segmentectomy in the Treatment of Early Non-Small-Cell Lung Cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2023; 2023:7550317. [PMID: 36873790 PMCID: PMC9981298 DOI: 10.1155/2023/7550317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 02/25/2023]
Abstract
Background Clinically, there were few reports on single-hole thoracoscopic segmental resection in non-small-cell lung cancer (NSCLC), and no report on the comparison of single-hole and three-hole thoracoscopic segmental resection. Hence, the purpose of the study was to explore the perioperative role of single-port thoracoscopic segmentectomy and three-port thoracoscopic segmentectomy for early-stage NSCLC. Methods The clinical data of 80 patients with early-stage NSCLC who were treated in our hospital from January 2021 to June 2022 were selected as the retrospective research subjects and divided into a comparison/research group with 40 cases in each group according to different surgical methods. Among them, the comparison group was received three-port thoracoscopic segmentectomy, and the research group was received single-port thoracoscopic segmentectomy. The surgical indicators, immune and tumor marker levels, as well as prognostic complications between two groups were compared. Results There was no remarkable diversity between the two groups in terms of operation time and the number of lymph nodes dissected during the operation (P > 0.05). The surgical blood loss in research group was lower than comparison group (P < 0.05). After treatment, the levels of CYFRA21-1, CA125, as well as VGEF in the research group were markedly lower than comparison group (P < 0.05). The differences in CD4+, CD3+, and CD4+/CD8+ after treatment were prominent, and the research group was higher than comparison group (P < 0.05). There was no statistical difference in postoperative complications between the two groups (P > 0.05). Conclusions Single-hole thoracoscopic lobectomy has obvious advantages in the treatment of NSCLC, which can reduce intraoperative bleeding, enhance the recovery of patients' immune function, and promote postoperative recovery.
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Affiliation(s)
- Cong Zhang
- Department of Thoracic Surgery, Chengdu Seventh People's Hospital, Chengdu, 610200 Sichuan, China
| | - Dexiong Jiang
- Department of Thoracic Surgery, Chengdu Seventh People's Hospital, Chengdu, 610200 Sichuan, China
| | - Cuilian Luo
- Department of Oncology, Chengdu Seventh People's Hospital, Chengdu, 610200 Sichuan, China
| | - Dongdong Yuan
- Department of Thoracic Surgery, Chengdu Seventh People's Hospital, Chengdu, 610200 Sichuan, China
| | - Guansheng Shang
- Department of Thoracic Surgery, Chengdu Seventh People's Hospital, Chengdu, 610200 Sichuan, China
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Nachira D, Congedo MT, Tabacco D, Sassorossi C, Calabrese G, Ismail M, Vita ML, Petracca-Ciavarella L, Margaritora S, Meacci E. Surgical Effectiveness of Uniportal-VATS Lobectomy Compared to Open Surgery in Early-Stage Lung Cancer. Front Surg 2022; 9:840070. [PMID: 35310438 PMCID: PMC8931028 DOI: 10.3389/fsurg.2022.840070] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/31/2022] [Indexed: 12/25/2022] Open
Abstract
BackgroundAlthough the feasibility and safety of Uniportal-Video-Assisted thoracic surgery (U-VATS) has been proven, its surgical effectiveness is still debated. The aim of this study is to assess the equivalence of the U-VATS approach compared with an open technique in terms of surgical (nodal-upstaging, complications, and post-operative results) and short-term survival outcomes.MethodsThe clinical data of patients undergoing lobectomy for NSCLC at our center, from January 2014 to December 2019, were analyzed retrospectively. All patients undergoing open or U-VATS lobectomy with lymphadenectomy for early-stage lung cancer (cT1-T3N0, stages IA-IIB) were included in the study. Only 230 patients satisfied the inclusion criteria. Group bias was reduced through 1:1 propensity score matching, which resulted in 46 patients in each group (open surgery and U-VATS).ResultsThe intra- and post-operative mortality were null in both groups. There was no difference in the post-operative complications (p: 1.00) between U-VATS and open lobectomy. There was also no recorded difference in the pathological nodal up-staging [11 (23.9%) after thoracotomy vs. 8 (17.4%) after U-VATS, p: 0.440). The chest tube duration was longer in the open group (p: 0.025), with a higher post-operative pain (p: 0.001). Additionally, the 3-year overall survival (OS) was 78% after U-VATS lobectomy vs. 74% after open lobectomy (p: 0.204), while 3-year disease-specific survival (DSS) was 97 vs. 89% (p: 0.371), respectively. The 3-year disease-free survival (DFS) was 62% in the U-VATS group and 66% in the thoracotomy group, respectively (p: 0.917).ConclusionsUniportal-VATS lobectomy for the treatment of early-stage lung cancer seems to be a safe and effective technique with similar surgical and short-term survival outcomes as open surgery, but with lower post-operative pain and shorter in-hospital stay.
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Affiliation(s)
- Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Dania Nachira
| | - Maria Teresa Congedo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diomira Tabacco
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carolina Sassorossi
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Calabrese
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann Potsdam, Academic Hospital of the Charité-Universitätsmedizin Humboldt University Berlin, Potsdam, Germany
| | - Maria Letizia Vita
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Leonardo Petracca-Ciavarella
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Meacci
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli,” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
- Elisa Meacci
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Abdel Jalil R, Abou Chaar MK, Al-Qudah O, Al-Edwan A, Almajali O, Ababneh H, U'wais A, Al-Ghazawi M, Al-Najjar H, Abu-Shanab A. Early surgical and oncological outcomes during adoption of a single port VATS lung resection in a tertiary cancer center: a retrospective analysis. J Cardiothorac Surg 2022; 17:26. [PMID: 35236401 PMCID: PMC8890027 DOI: 10.1186/s13019-022-01777-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Background Video-assisted thoracoscopic surgery (VATS) is a safe and effective surgical approach for pulmonary resection. VATS can be accomplished with only a single incision, resulting in less postoperative pain and paresthesia, better cosmetic results, and greater patient satisfaction. Single-port VATS (spVATS) has become increasingly common for lung resection. We assess the early surgical and oncological outcomes after adopting this new technique at our tertiary cancer center as the first institution to do so in the country. Method Medical records for 257 patients in a tertiary cancer center, with a diagnosis of non-small cell lung cancer, pulmonary metastasis, or other chest-confined pathology, were accessed to obtain perioperative outcomes, pathologic results, post-operative follow-up data, and early surgical and oncological outcomes. All patients underwent spVATS for limited or major lung resection. Simple descriptive analysis was utilized. Results spVATS was either performed with curative intent (79.8%, N = 205), or as a diagnostic procedure (20.2%, N = 52). Resection types were subcategorized for curative intent group as limited (73.6%, N = 151), lobectomy (16.6%, N = 34), and complex (9.7%, N = 20). Resection with a negative margin (R0) rate was 100% for the primary lung cancer (PLC) patients and 97% for the pulmonary metastasectomy (PM) group. The complication rate was 5%. Three-year disease-free survival was 87% and 68.5% for PLC and PM group, respectively. The 3-year overall-survival was 91.3% for the PLC and 82.8% for PM. Operation duration showed a downtrend over the study period in each curative subcategory with a borderline difference in the limited resection (P value = 0.05).
Conclusion All the spVATS procedures were successfully performed without perioperative severe complications or mortality, regardless of complexity. R0 resection was excellent. Middle- and long-term efficacies of spVATS for lung cancer require further follow-up. With proper training, appropriate indication and meticulous application, adopting spVATS is safe and feasible technique that does not compromise surgical and oncological outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01777-y.
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Affiliation(s)
- Riad Abdel Jalil
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan.
| | | | - Obada Al-Qudah
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Ahed Al-Edwan
- Department of Anesthesia, King Hussein Cancer Center, Amman, Jordan
| | - Omar Almajali
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Hazim Ababneh
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Ahmad U'wais
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Munir Al-Ghazawi
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Hani Al-Najjar
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ahmad Abu-Shanab
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
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[Feasibility Investigation of Fluorescence Method in Uniport Thoracoscopic Anatomical Segmentectomy for Identifying the Intersegmental Boundary Line]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:756-763. [PMID: 34802206 PMCID: PMC8607284 DOI: 10.3779/j.issn.1009-3419.2021.102.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Segmentectomy has gradually become one of the standard surgical methods for small pulmonary nodules with early lung cancer on imaging. This study aimed to investigate the perioperative outcomes of patients who underwent uniport video-assisted thoracoscopic surgery (VATS) segmentectomy for identifying the intersegmental boundary line (IBL) by the near-infrared fluorescence imaging with intravenous indocyanine green (ICG) method or the modified inflation-deflation (MID) method and assess the feasibility and effectiveness of the ICG fluorescence (ICGF)-based method. METHODS We retrospectively analyzed the perioperative data in total 198 consecutive patients who underwent uniport VATS segmentectomy between February 2018 and August 2020. With the guidance of preoperative intelligent/interactive qualitative and quantitative analysis-three dimensional (IQQA-3D), the targeted segment structures could be precisely identified and dissected, and then the IBL was confirmed by ICGF-based method or MID method. Clinical effectiveness and postoperative complications of the two methods were evaluated. RESULTS An IBL was visible in 98% of patients by the ICGF-based group, even with the low-doses of ICG. The ICGF-based group was significantly associated with the shorter IBL clear presentation time [(23.59±4.47) s vs (1,026.80±318.34) s] (P<0.01) and operative time [(89.3±31.6) min vs (112.9±33.3) min] (P<0.01), compared to the MID group. The incidence of postoperative prolonged air leaks was higher in the MID group than in the ICGF-based group (8.0% vs 26.5%, P=0.025). There were no significant differences in bleeding volume, chest tube duration, postoperative hospital stays, surgical margin width and other postoperative complications (P>0.05). CONCLUSIONS The ICGF-based method could highly accurately identify the IBL and make anatomical segmentectomy easier and faster, and therefore has the potential to be a feasible and effective technique to facilitate the quality of uniport VATS segmentectomy.
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Sun Y, Zhang Q, Wang Z, Shao F, Yang R. Feasibility investigation of near-infrared fluorescence imaging with intravenous indocyanine green method in uniport video-assisted thoracoscopic anatomical segmentectomy for identifying the intersegmental boundary line. Thorac Cancer 2021; 12:1407-1414. [PMID: 33728793 PMCID: PMC8088968 DOI: 10.1111/1759-7714.13923] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To investigate the perioperative outcomes of patients who underwent uniport video-assisted thoracoscopic (VATS) segmentectomy for identifying the intersegmental boundary line (IBL) by the near-infrared fluorescence imaging with the intravenous indocyanine green (ICG) method or the modified inflation-deflation (MID) method and assess the feasibility and effectiveness of the ICG fluorescence (ICGF)-based method. METHODS We retrospectively analyzed the perioperative data in total 198 consecutive patients who underwent uniport VATS segmentectomy between February 2018 and August 2020. With the guidance of a preoperative imaging interpretation and analysis system (IQQA-3D), the targeted segment structures could be precisely identified and dissected, and then the IBL was confirmed by the ICGF-based method or the MID method. The clinical effectiveness and postoperative complications of the two methods were evaluated. RESULTS An IBL was visible in 98% of patients in the ICGF-based group, even with low doses of ICG. The ICGF-based group was significantly associated with a shorter IBL clear presentation time (23.6 ± 4.4 vs. 23.6 ± 4.4 s) (p < 0.01) and operative time (89.3 ± 31.6 vs. 112.9 ± 33.3 min) (p < 0.01) compared to the MID group. The incidence of postoperative prolonged air leaks was higher in the MID group than in the ICGF-based group (8/100, 8% vs. 26/98, 26.5%, p = 0.025). There were no significant differences in bleeding volume, chest tube duration, postoperative hospital stays, surgical margin width, and other postoperative complications. CONCLUSION The ICGF-based method could highly accurately identify the IBL and make anatomical segmentectomy easier and faster, and therefore has the potential to be a feasible and effective technique to facilitate the quality of uniport VATS segmentectomy.
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Affiliation(s)
- Yungang Sun
- Department of Thoracic SurgeryNanjing Chest HospitalNanjingChina
- Department of Thoracic SurgeryAffiliated Nanjing Brain Hospital, Nanjing Medical UniversityNanjingChina
- Department of Thoracic SurgeryPulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical UniversityNanjingChina
| | - Qiang Zhang
- Department of Thoracic SurgeryNanjing Chest HospitalNanjingChina
- Department of Thoracic SurgeryAffiliated Nanjing Brain Hospital, Nanjing Medical UniversityNanjingChina
- Department of Thoracic SurgeryPulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical UniversityNanjingChina
| | - Zhao Wang
- Department of Thoracic SurgeryNanjing Chest HospitalNanjingChina
- Department of Thoracic SurgeryAffiliated Nanjing Brain Hospital, Nanjing Medical UniversityNanjingChina
- Department of Thoracic SurgeryPulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical UniversityNanjingChina
| | - Feng Shao
- Department of Thoracic SurgeryNanjing Chest HospitalNanjingChina
- Department of Thoracic SurgeryAffiliated Nanjing Brain Hospital, Nanjing Medical UniversityNanjingChina
- Department of Thoracic SurgeryPulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical UniversityNanjingChina
| | - Rusong Yang
- Department of Thoracic SurgeryNanjing Chest HospitalNanjingChina
- Department of Thoracic SurgeryAffiliated Nanjing Brain Hospital, Nanjing Medical UniversityNanjingChina
- Department of Thoracic SurgeryPulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical UniversityNanjingChina
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Han D, Cao Y, Wu H, Wang H, Jiang L, Zhao D, Yao F, Li S, Zhang C, Zheng B, Fan J, Liao Y, Qiu B, Tan F, Chen C, Zhu Y, Gao S, Li H. Uniportal video-assisted thoracic surgery for the treatment of lung cancer: a consensus report from Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS) and Chinese Association of Thoracic Surgeons (CATS). Transl Lung Cancer Res 2020; 9:971-987. [PMID: 32953478 PMCID: PMC7481589 DOI: 10.21037/tlcr-20-576] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Uniportal video-assisted thoracoscopic surgery (UniVATS) has been widely adopted in China, where several ultra-high volume thoracic surgical and training centers are located. The objective of this consensus from Chinese experts was to summarize the current application and give reference for the future development of UniVATS in the treatment of lung cancer. A panel of 41 experts from 21 Chinese hospitals was invited to join this project. The Delphi method was used in this consensus consisting of two rounds of voting. The questionnaire was based on the current clinical evidence. Forty (97.6%) experts completed the 2 rounds of questionnaires. The experts’ experience was relatively similar. We defined the UniVATS as monitor-dependent surgery, no use of rib-spreading and single incision less than 4 cm. Tumor with stage of T1–T3 and N0–N2 is considered amenable to UniVATS. Other consensus was reached on several points outlining the safety and feasibility, surgical skills, learning curve, short-term and long-term outcomes for lung cancer, and current application of subxiphoid and nonintubated UniVATS approach. This consensus statement represents a collective agreement among Chinese experts to suggest that UniVATS is an effective alternative to multi-portal approach, although high-level evidence is expected in the future. Some agreements can be referred in the training of young surgeons.
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Affiliation(s)
- Dingpei Han
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqin Cao
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han Wu
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haifeng Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shuben Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chong Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Junqiang Fan
- Department of Thoracic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yongde Liao
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Qiu
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengwei Tan
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shugeng Gao
- Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yan Y, Huang Q, Han H, Zhang Y, Chen H. Uniportal versus multiportal video-assisted thoracoscopic anatomical resection for NSCLC: a meta-analysis. J Cardiothorac Surg 2020; 15:238. [PMID: 32907605 PMCID: PMC7488012 DOI: 10.1186/s13019-020-01280-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); however, whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown. Methods We performed a systematic review of two databases (Pubmed and Web of Science) to search comparative studies of U-VATS and M-VATS anatomical pulmonary resection for NSCLC. Operative time, blood loss, number of resected lymph nodes, drainage duration, length of postoperative stay, pain in postoperative day 1(POD1) and conversion rates were retrieved to estimate the comparison of outcomes. A subgroup analysis stratified by study type (propensity-matched analysis and randomized-controlled trial versus non-propensity matched analysis) was performed. Result A total of 20 studies with 4142 patients were included in this meta-analysis. U-VATS was performed on 1869 patients, whereas the other 2173 patients underwent M-VATS. This meta-analysis showed that there was no significant difference in operative time (U-VATS: 146.48 ± 55.07 min versus M-VATS: 171.70 ± 79.40 min, P = 0.81), blood loss (74.49 ± 109.03 mL versus 95.48 ± 133.67 mL, P = 0.18), resected lymph nodes (17.28 ± 9.46 versus 18.31 ± 10.17, P = 0.62), conversion rate (6.18% versus 4.34%, P = 0.14), drainage duration (3.90 ± 2.94 days versus 4.44 ± 3.12 days, p = 0.09), length of postoperative stay (6.16 ± 4.40 days versus 6.45 ± 4.80 days, P = 0.22), and pain in POD1 (3.94 ± 1.68 versus 3.59 ± 2.76, p = 0.07). Subgroup analysis showed the value of PSM and RCT group consistency with overall value. Conclusion This up-to-date meta-analysis shows that the perioperative outcomes of U-VATS and M-VATS anatomical pulmonary resection are equivalent. In addition, the differences in long-term outcomes of these two approaches are still unclear. Thoracic surgeons should pay more emphasize on providing high-quality and personalized surgical care for patients, to improve the survival ultimately.
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Affiliation(s)
- Yueren Yan
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China.,State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200433, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qingyuan Huang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China.,State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200433, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Han Han
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China.,State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200433, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.,Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China.,State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200433, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China. .,Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China. .,State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200433, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Hu CG, Zheng K, Liu GH, Li ZL, Zhao YL, Lian JH, Guo SP. Effectiveness and postoperative pain level of single-port versus two-port thoracoscopic lobectomy for lung cancer: a retrospective cohort study. Gen Thorac Cardiovasc Surg 2020; 69:318-325. [PMID: 32897502 PMCID: PMC7868319 DOI: 10.1007/s11748-020-01479-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/29/2020] [Indexed: 12/24/2022]
Abstract
Objectives Single-port thoracoscopic lobectomy is a new therapeutic technique for patients with lung cancer; however, insufficient data are available regarding its clinical outcomes. We therefore compared the clinical outcomes of single-port and two-port thoracoscopic lobectomies for lung cancer. Methods We retrospectively analyzed and compared the data of 204 and 368 patients with lung cancer who underwent single-port or two-port thoracoscopic lobectomy, respectively, between October 2014 and October 2017 at our institution. Patients in both groups underwent 1:1 propensity score matching, and 400 patients (200 patients in each group) were included. Perioperative clinical indicators were analyzed, including operation time, lymph node dissection stations and numbers, incidence of postoperative complications, and pain scores at 24 h, 72 h, and 1 week after surgery. Results No perioperative deaths occurred in either group. The operation time, intraoperative blood loss, chest drainage duration, duration of postoperative hospital stay, lymph node dissection station and number, rate of conversion to open surgery, number of ruptured intraoperative pulmonary vessel, and incidence of postoperative complications were not significantly different between the groups (all P > 0.05). However, analysis of the 24-h (P = 0.005), 72-h (P = 0.011), and 1-week (P = 0.034) visual analog scale score after surgery revealed that the postoperative pain levels were significantly lower in the single-port than in the two-port group. Conclusions Single-port and two-port thoracoscopic lobectomies had similar perioperative outcomes, although the postoperative pain was lower after single-port than two-port thoracoscopic lobectomy. Hence, we concluded that single-port thoracoscopic lobectomy is an effective, minimally invasive, and promising surgical procedure.
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Affiliation(s)
- Cheng-Guang Hu
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China.
| | - Kang Zheng
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
| | - Guan-Hua Liu
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
| | - Zhi-Long Li
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
| | - Yan-Li Zhao
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
| | - Jian-Hong Lian
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
| | - Shi-Ping Guo
- Department of Thoracic Surgery, ShanXi Cancer Hospital, the Affiliated Cancer Hospital of Shanxi Medical University, No. 3 Kaixuan Street, Xinghualing District, Taiyuan, 030013, China
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10
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Affiliation(s)
- Amaya Ojanguren
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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11
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Yoon DW, Choi YS, Sung K, Kim H. Comparison of oncological outcomes of single-port versus multi-port video-assisted thoracoscopic surgery for non-small-cell lung cancer: a propensity-matched analysis. PRECISION AND FUTURE MEDICINE 2020. [DOI: 10.23838/pfm.2020.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Choi JS, Lee J, Moon YK, Moon SW, Park JK, Moon MH. Nodal Outcomes of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Clinical Stage I Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:104-113. [PMID: 32551290 PMCID: PMC7287225 DOI: 10.5090/kjtcs.2020.53.3.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 10/30/2019] [Indexed: 12/19/2022]
Abstract
Background Accurate intraoperative assessment of mediastinal lymph nodes is a critical aspect of lung cancer surgery. The efficacy and potential for upstaging implicit in these dissections must therefore be revisited in the current era of uniportal video-assisted thoracoscopic surgery (VATS). Methods A retrospective study was conducted in which 544 patients with stage I (T1abc–T2a, N0, M0) primary lung cancer were analyzed. To assess risk factors for nodal upstaging and to limit any imbalance imposed by surgical choices, we constructed an inverse probability of treatment-weighted (IPTW) logistic regression model (in addition to non-weighted logistic models). We also evaluated risk factors for early locoregional recurrence using IPTW logistic regression analysis. Results In the comparison of uniportal and multiportal VATS, the resected lymph node count (14.03±8.02 vs. 14.41±7.41, respectively; p=0.48) and rate of nodal upstaging (6.5% vs. 8.7%, respectively; p=0.51) appeared similar. Predictors of nodal upstaging included tumor size (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.12–2.70), carcinoembryonic antigen level (OR, 1.11; 95% CI, 1.04–1.18), and histologically confirmed pleural invasion (OR, 3.97; 95% CI, 1.89–8.34). The risk factors for locoregional recurrence within 1 year were found to be number of resected N2 nodes, age, and nodal upstaging. Conclusion Uniportal and multiportal VATS appear similar with regard to accuracy and thoroughness, showing no significant difference in the extent of nodal dissection.
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Affiliation(s)
- Jung Suk Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jiyun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyu Moon
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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13
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Bin Yameen TA, Gupta V, Behzadi A. Uniportal versus multiportal video-assisted thoracoscopic surgery in the treatment of lung cancer: a Canadian single-centre retrospective study. Can J Surg 2020; 62:468-474. [PMID: 31782644 DOI: 10.1503/cjs.001418] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Observational studies comparing uniportal and multiportal video-assisted thoracoscopic surgery (VATS) in the treatment of lung cancer have produced conflicting results. We present a Canadian study comparing clinical outcomes of uniportal and multiportal VATS in the treatment of lung cancer. Methods A retrospective study evaluating patients who underwent multiportal (2012–2014) or uniportal (2014–2016) VATS lobectomies, segmentectomies and wedge resections for lung cancer. Clinical outcomes measured included patient demographics, tumour factors, operative factors, length of hospital stay, postoperative complications, analgesic use, pain scores and mortality. Descriptive statistics were used to compare the 2 groups. Results Of 185 patients, 65 underwent uniportal and 63 underwent multiportal VATS resection. Patients were similar in terms of their baseline demographics, comorbidies and cancer characteristics. Median operative time was 184 and 185 minutes in the uniportal and multiportal groups, respectively. There were 5 conversions to thoracotomy in the uniportal group and 1 in the multiportal group. Similar lymph node retrieval (median 7 v. 5 nodes) and positive margin rates (6.2% v. 4.8%) were seen in the 2 groups. Median length of stay was 2 days (interquartile range [IQR] 1–3) and 3 days (IQR 2–4) in the uniportal and multiportal groups, respectively. Rates of postoperative complications were similar in the 2 groups (16.9% v. 19.0%, p = 0.76). Patient-controlled analgesia use and pain scores did not differ between the groups. Conclusion Adoption of uniportal VATS appears to be feasible and safe, without compromising oncologic principles or increasing intraoperative resource utilization. Larger, prospective studies can help confirm these findings.
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Affiliation(s)
- Tarek A. Bin Yameen
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Bin Yameen, Gupta, Behzadi); the Division of Thoracic Surgery, Department of Surgery, Trillium Health Partners, University of Toronto, Toronto, Ont. (Gupta, Behzadi); and the Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Gupta)
| | - Vaibhav Gupta
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Bin Yameen, Gupta, Behzadi); the Division of Thoracic Surgery, Department of Surgery, Trillium Health Partners, University of Toronto, Toronto, Ont. (Gupta, Behzadi); and the Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Gupta)
| | - Abdollah Behzadi
- From the Faculty of Medicine, University of Toronto, Toronto, Ont. (Bin Yameen, Gupta, Behzadi); the Division of Thoracic Surgery, Department of Surgery, Trillium Health Partners, University of Toronto, Toronto, Ont. (Gupta, Behzadi); and the Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ont. (Gupta)
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14
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Tosi D, Nosotti M, Bonitta G, Mazzucco A, Righi I, Mendogni P, Rosso L, Palleschi A, Rocco G, Crisci R. Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database. Interact Cardiovasc Thorac Surg 2020; 29:714-721. [PMID: 31363760 DOI: 10.1093/icvts/ivz153] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/06/2019] [Accepted: 05/19/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay. METHODS This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy. RESULTS Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62-3.21; P < 0.001] and OR 2.58 (95% CI 1.74-3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001). CONCLUSIONS Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.
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Affiliation(s)
- Davide Tosi
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Bonitta
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Mazzucco
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Righi
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Palleschi
- Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo, Italy
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15
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Al-Ameri M, Sachs E, Sartipy U, Jackson V. Uniportal versus multiportal video-assisted thoracic surgery for lung cancer. J Thorac Dis 2019; 11:5152-5161. [PMID: 32030232 DOI: 10.21037/jtd.2019.12.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Video-assisted thoracic surgery (VATS) lobectomy is the recommended surgical approach for patients with stage I lung cancer. Whether a multiportal or a uniportal approach is preferable remains unclear. The aim of this study was to evaluate the safety of implementing uniportal VATS lobectomy into the treatment program of lung cancer patients. Methods We used the national quality register for general thoracic surgery in Sweden and included all patients who underwent VATS lobectomy for lung cancer at the Karolinska University Hospital between 2016-2018. Early postoperative complications were compared in patients undergoing uniportal (n=122) and multiportal (n=211) VATS lobectomy for lung cancer. Inverse probability of treatment weighting and standardized mean differences were used to limit differences in baseline characteristics and to assess balance after weighting. Results The proportion of uniportal VATS lobectomies increased during the study period and the conversion rates declined significantly. Baseline characteristics were similar in the two groups with the exception of a higher percentage of patients without any comorbidity in the uniportal group (59.8% vs. 44.5%, P=0.010). After inverse probability of treatment weighting the groups were well balanced. Postoperative complications were rare regardless of surgical approach, 94% in both groups had no complications. The 30-day mortality and overall survival at 1 year was 0% and 97% in the uniportal group, and 0.5% and 98% in the multiportal group (P=0.71). Patients undergoing uniportal VATS lobectomy were discharged directly to home to a higher extent than multiportal VATS patients (76.2% vs. 62.1%, P=0.008). Conclusions We found that uniportal VATS lobectomy was feasible and safe, and might entail advantages in terms of a faster recovery after surgery as compared to multiportal VATS lobectomy in patients with lung cancer.
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Affiliation(s)
- Mamdoh Al-Ameri
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Erik Sachs
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Jackson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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16
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Zhang H, Xiang R, He J, Zhu J. Uniportal video-assisted thoracoscopic surgery: Sichuan Cancer Hospital experience. J Thorac Dis 2019; 11:273-275. [PMID: 30863604 PMCID: PMC6384340 DOI: 10.21037/jtd.2018.12.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/13/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Huachuan Zhang
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Affiliate to the School of Medicine, The University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Run Xiang
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Affiliate to the School of Medicine, The University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Jintao He
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Affiliate to the School of Medicine, The University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Jiang Zhu
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Affiliate to the School of Medicine, The University of Electronic Science and Technology of China, Chengdu 610041, China
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17
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Liu X, Chen X, Shen Y, Wang H, Feng M, Tan L, D'Amico TA. Learning curve for uniportal video-assisted thoracoscopic surgery lobectomy-results from 120 consecutive patients. J Thorac Dis 2018; 10:5100-5107. [PMID: 30233885 DOI: 10.21037/jtd.2018.08.87] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Uniportal video-assisted thoracoscopic surgery (VATS) is considered a technically demanding procedure. The learning curve, which directly influences the adoption of uniportal VATS, has not been described. In this study, we aimed to describe the learning curve for uniportal VATS lobectomy from our single center's experience. Methods Uniportal VATS lobectomy was started in October 2013 in Zhongshan Hospital, Fudan University. Since then, a total of 120 consecutive patients who underwent uniportal VATS lobectomy were retrospectively enrolled. Surgical videos were reviewed to determine the operation time, to which cumulative sum (CUMSUM) method was applied to evaluate the learning phases of the procedure. Accordingly, patients' clinical features in different phases were collected and compared to determine the learning curve for uniportal VATS lobectomy. Results Among the 120 consecutive patients reviewed from October 2013 to September 2014, the CUMSUM curve showed its inflection at patient number 44: the first 30 patients were in the ascending phase, the second 30 patients were in the plateau phase, and the remaining patients were in the descending phase. Comparable CUMSUM results were recorded both from upper and not-upper lobectomy. Intra-operatively, more repeated stapler attempts (73% versus 13% and 5%, P<0.001) and higher conversion rate (17% versus 7% and 2%, P=0.028) were recorded in ascending phase vs. the plateau phase and descending phase, respectively. Post-operatively, the morbidity, mortality and the length of hospital stay were similar before and after the learning curve cases. Conclusions In a center with conventional VATS experience, the learning period of uniportal VATS lobectomy was characterized by repeated stapler attempts, and the volume requirements would be approximately 30 cases to reach the performance plateau. Upper lobectomy seemed not more difficult to learn than lower or middle lobectomy in uniportal VATS.
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Affiliation(s)
- Xiaochuan Liu
- Department of Thoracic Surgery, Guangan People's Hospital, Guangan 638000, China
| | - Xiaosang Chen
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Thomas A D'Amico
- Department of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
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18
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Uniportal versus multiport video-assisted thoracoscopic surgery for anatomical lung resections: a glance at a dilemma. Wideochir Inne Tech Maloinwazyjne 2018; 13:215-220. [PMID: 30002754 PMCID: PMC6041572 DOI: 10.5114/wiitm.2018.75897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/04/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction As the number of operations performed by videothoracoscopy is increasing, there is also a tendency to decrease the number of port incisions. Apart from the reduced number of surgical incisions, there are a few reports and systematic reviews that demonstrate some potential advantages of the uniportal video-assisted thoracoscopic surgery, but the impact of the reduced incisions in the clinical setting still remains uncertain. Aim To compare uniportal video-assisted thoracoscopic surgery to multiport video-assisted thoracoscopic surgery for anatomical lung resections in patients with malignant and benign lung diseases. Material and methods From August 2010 to April 2016, a total of 102 patients with malignant and benign lung diseases underwent videothoracoscopic lobar and sublobar lung resections in our department. Comorbidities, tumor stage, tumor localization, mortality, operative time, pain visual analogue scale, length of hospital stay, perioperative blood loss, duration and amount of postoperative drainage and air leak, number of harvested lymph nodes and complication rates were analyzed. Results No significant difference was found in the duration of chest tube drainage, pain visual analogue scale score, length of hospital stay, perioperative blood loss, amount of postoperative drainage, number of harvested lymph nodes or complication rate. There was no surgical mortality in either of the two groups. However, operative time was shorter (189 min vs. 256 min, p < 0.005) in the multiport group than in the uniportal group. Conclusions Compared with the uniportal approach, the multiport approach is associated with a significantly shorter operative time in our study.
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Abstract
Thoracic surgery has evolved throughout the decades. The difficulty of accessing the intrathoracic organs through the bony rib-cage has been a challenge for thoracic surgeons. In the past, large incisions stretching across the chest, such as posterolateral thoracotomies with rib spreading was the standard approach to access the lungs. These methods cause large amounts of trauma to the patient, with high rates of mortality and morbidity. However, with the advances in technology and the improvements in surgical technique, thoracic surgery has progressed to minimise trauma to the patient while still maintaining oncological and surgical principles. State-of-the-art technology, combined with wide variety of old and new surgical techniques give the thoracic surgeon a formidable armamentarium. Although there has been a focus on reducing the number and size of surgical wounds, considerations other than surgical approach can reduce the trauma suffered by the patient. Preservation of pulmonary function via organ preservation and anaesthetic techniques to further minimise the systemic inflammation such as non-intubated anaesthesia have also been shown to improve patient outcomes. This article aims to review the recent advances in minimally invasive thoracic surgery.
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Affiliation(s)
- Max K H Wong
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
| | - Alva K Y Sit
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
| | - Timmy W K Au
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
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20
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Rami-Porta R, Call S, Dooms C, Obiols C, Sánchez M, Travis WD, Vollmer I. Lung cancer staging: a concise update. Eur Respir J 2018; 51:13993003.00190-2018. [PMID: 29700105 DOI: 10.1183/13993003.00190-2018] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022]
Abstract
Diagnosis and clinical staging of lung cancer are fundamental to planning therapy. The techniques for clinical staging, i.e anatomic and metabolic imaging, endoscopies and minimally invasive surgical procedures, should be performed sequentially and with an increasing degree of invasiveness. Intraoperative staging, assessing the magnitude of the primary tumour, the involved structures, and the loco-regional lymphatic spread by means of systematic nodal dissection, is essential in order to achieve a complete resection. In resected tumours, pathological staging, with the systematic study of the resected specimens, is the strongest prognostic indicator and is essential to make further decisions on therapy. In the present decade, the guidelines on lung cancer staging of the American College of Chest Physicians and the European Society of Thoracic Surgeons are based on the best available evidence and are widely followed. Recent advances in the classification of the adenocarcinoma of the lung, with the definition of adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma, and the publication of the eighth edition of the tumour, node and metastasis classification of lung cancer, have to be integrated into the staging process. The present review complements the latest guidelines on lung cancer staging by providing an update of all these issues.
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Affiliation(s)
- Ramón Rami-Porta
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.,Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Barcelona, Spain
| | - Sergi Call
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.,Dept of Morphological Sciences, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christophe Dooms
- Dept of Respiratory Diseases, University Hospitals, KU Leuven, Leuven, Belgium
| | - Carme Obiols
- Dept of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - William D Travis
- Dept of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ivan Vollmer
- Centre of Imaging Diagnosis, Radiology Dept, Hospital Clínic, University of Barcelona, Barcelona, Spain
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21
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Ricciardi S, Zirafa CC, Davini F, Melfi F. Robotic-assisted thoracic surgery versus uniportal video-assisted thoracic surgery: is it a draw? J Thorac Dis 2018; 10:1361-1363. [PMID: 29707285 DOI: 10.21037/jtd.2018.03.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sara Ricciardi
- Unit of Thoracic Surgery, Robotic Multispeciality Center for Surgery, University Hospital of Pisa, Pisa, Italy
| | - Carmelina Cristina Zirafa
- Unit of minimally invasive and robotic thoracic surgery, Robotic Multispeciality Center for Surgery, University Hospital of Pisa, Pisa, Italy
| | - Federico Davini
- Unit of minimally invasive and robotic thoracic surgery, Robotic Multispeciality Center for Surgery, University Hospital of Pisa, Pisa, Italy
| | - Franca Melfi
- Unit of minimally invasive and robotic thoracic surgery, Robotic Multispeciality Center for Surgery, University Hospital of Pisa, Pisa, Italy
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22
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Liu CC, Wang BY, Shih CS, Pennarun N, Lim LC, Gao SY, Cheng CT. Comparison of survival between lung cancer patients receiving single or multiple-incision thoracoscopic surgery. J Thorac Dis 2018; 10:930-940. [PMID: 29607166 DOI: 10.21037/jtd.2018.01.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The effect of single-incision thoracoscopic surgery for lung cancer on long-term survival is unknown and no studies have investigated whether there are differences in survival between single and multiple incision approaches. We aimed to compare long-term overall survival and disease-free survival of patients who underwent single-incision thoracoscopic surgery with those who received multiple-incision thoracoscopic surgery for lung cancer. Methods We retrospectively analyzed 532 patients with lung cancer who underwent either single-incision (n=150) or multiple-incision thoracoscopic resection (n=382) during the period January 2000 to December 2014. Patients were matched on propensity score at a 1:2 ratio to estimate the effect of treatment on long-term and disease-free survival. Overall survival and disease-free survival were assessed using the Kaplan-Meier method, the log-rank test and Cox proportional-hazards regression. Results Propensity matching resulted in 138 patients in the single-incision group and 276 patients in the multiple-incision group. The matched patients in the single-incision group had a significantly better 5-year overall survival than those in the multiple-incision group (P=0.027). Disease-free survival was similar between the two groups before and after matching. The number of chest wall incisions did not influence overall survival or disease-free survival. Conclusions The long-term outcomes of single-incision thoracoscopic surgery are comparable to those of multiple-incision thoracoscopic surgery for lung cancer.
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Affiliation(s)
- Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei
| | - Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital and Chung Shan Medical University, Taichung.,School of Medicine, Kaohsiung Medical University, Kaohsiung.,Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung
| | - Chih-Shiun Shih
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei
| | - Nicolas Pennarun
- Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei
| | - Lay-Chin Lim
- Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei
| | - Shi-Ying Gao
- Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei
| | - Chih-Tao Cheng
- Department of Medical Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei.,Department of Psychology and Social Work, National Defense University, Taipei
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23
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Yang X, Li M, Yang X, Zhao M, Huang Y, Dai X, Jiang T, Feng M, Zhan C, Wang Q. Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis 2018; 10:2186-2195. [PMID: 29850122 DOI: 10.21037/jtd.2018.03.74] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Uniport video-assisted thoracoscopic surgery (VATS) has emerged as a less invasive approach for the treatment of non-small cell lung cancer (NSCLC). However, whether uniport VATS has more potential advantages over multiport VATS remains controversial. This meta-analysis aimed to compare the perioperative efficacy of uniport and multiport VATS for T1-3N0M0 NSCLC. Methods An electronic and manual search of literature published before 1st October 2017 was conducted using PubMed, Embase, Web of Science, and the Wiley Online library. The effective values of dichotomous variables or continuous variables were estimated by odds ratios (OR) or by standardized mean differences (SMD) with 95% confidence intervals (CIs) respectively. Results Eleven relevant observational studies were included for meta-analysis. Results demonstrated that patients in the uniport group had a significant reduction in the duration of postoperative drainage (uniport: 4.39±2.48 vs. multiport: 4.99±3.24 days; P=0.003), bleeding volume (97.7±60.0 vs. 116.7±99.7 mL; P=0.006), length of hospital stay (6.3±2.4 vs. 7.0±3.6 days; P<0.001), VAS of postoperative pain (2.53±0.73 vs. 4.22±0.71, P=0.02) and in the overall rate of complications (14.5% vs. 17.5%; P=0.008). There were no significant differences between the two treatment groups with regards to mortality, operative time, the number of dissected lymph nodes or the conversion rate. Conclusions Uniport VATS might have represent a preferable option for the treatment of T1-3N0M0 NSCLC, due to its superior perioperative efficacy.
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Affiliation(s)
- Xinyu Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Eight-year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Eight-year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiaodong Yang
- Department of Thoracic Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Mengnan Zhao
- Department of Thoracic Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yiwei Huang
- Department of Thoracic Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiyu Dai
- Department of Thoracic Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Eight-year Program Clinical Medicine, Grade of 2014, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Tian Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032, China
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24
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Mineo TC, Ambrogi V. A glance at the history of uniportal video-assisted thoracic surgery. J Vis Surg 2017; 3:157. [PMID: 29302433 DOI: 10.21037/jovs.2017.10.11] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/03/2017] [Indexed: 01/26/2023]
Abstract
In the history of thoracic surgery, the advent of video-assisted thoracic surgery (VATS) had on effect equivalent to that provoked by a true revolution. VATS successfully allowed minor, major and complex procedures for various lung and mediastinal pathologies with small incision instead of the traditional accesses. These small incisions abolished ugly scars, generated less acute and chronic pain, reduced hospital stay and costs, allowed faster return to normal day life activities. Conventional VATS was initially performed through 3-4 ports and rapidly evolved to uniportal or single portal access [uniportal video-assisted thoracic surgery (uniVATS)]. First uniportal procedures were published in 2000. In 2010, uniportal technique for lobectomy was described. Focused experimental courses, live surgery events, the internet media favored the rapid diffusion of this technique over the world. Major and complex uniVATS lung resections involving segmentectomy, pneumonectomy, bronchoplasty and vascular reconstruction, redo VATS, en bloc chest wall resections have been accomplished with satisfactory outcomes. Interestingly, different uniportal approaches and techniques are emerging from a number of VATS centers particularly experienced in the mini-invasive thoracic surgery. As confidence grew, in 2014, the first uniVATS left upper lobectomy via the subxiphoid approach was reported. This novel technique is quite challenging but appropriate patient selection as well as availability of dedicated instruments allowed to perform procedures safely. The diffusion of uniVATS paralleled with the development of nonintubated awake anesthesia technique. In 2007 the first nonintubated lobectomy was described. In 2014 the first single port VATS lobectomy in a nonintubated patient with lung cancer of the right middle lobe was accomplished. The nonintubated uniVATS represents an intriguing technique, so that very experienced thoracoscopic surgeons may enroll to surgery elderly and high risk patients. Decreased postoperative pain and hospitalization, faster access to the radio-chemotherapy and diminished inflammatory response are important benefits of the modern approach to the thoracic pathologies. The history of uniVATS documented a constant and irresistible progress. This technique may further provide unthinkable surprises in next future.
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Affiliation(s)
- Tommaso Claudio Mineo
- Department of Surgery and Experimental Medicine, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy
| | - Vincenzo Ambrogi
- Department of Surgery and Experimental Medicine, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy.,Thoracic Surgery, Official Group of Awake Thoracic Surgery Research, Policlinico Tor Vergata University, Rome, Italy
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25
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Ji C, Xiang Y, Pagliarulo V, Lee J, Sihoe ADL, Kim H, Zhang X, Wang Z, Zhao W, Feng J, Fang W. A multi-center retrospective study of single-port versus multi-port video-assisted thoracoscopic lobectomy and anatomic segmentectomy. J Thorac Dis 2017; 9:3711-3718. [PMID: 29268378 DOI: 10.21037/jtd.2017.09.39] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To assess the feasibility and perioperative outcomes of single-port (SP) and multi-port (MP) approaches for video-assisted thoracoscopic surgery (VATS) lobectomy and anatomical segmentectomy. Methods Retrospective data from 458 patients who received VATS lobectomy or anatomical segmentectomy at Shanghai Chest Hospital, Korea University Guro Hospital, Affiliated Hospital of National Taiwan University, University of Hong Kong Queen Mary Hospital and Shenzhen Hospital were collected. Patients were divided into SP group and MP group according to the surgical approach. Perioperative factors such as operation time, blood loss during surgery, conversion rate, the number and stations of lymph nodes harvested, postoperative chest tube drainage time, postoperative hospitalization time, perioperative morbidity and mortality, and pain scores during the first 3 days after surgery were compared between the two groups. Results There were no differences in the number (P=0.278) and stations (P=0.564) of lymph nodes harvested, postoperative morbidity (P=0.414) or mortality(P=0.246), and pain score on the third day (P=0.630) after surgery between the two groups. The SP group had a longer operation time (P=0.042) and greater intraoperative blood loss (P<0.001), but the conversion rate was even higher in the MP group (P=0.018). Patients in the SP group had shorter chest tube removal time (P=0.012) and postoperative hospitalization time (P=0.005). Pain scores were lower on the first (P=0.014) and second (P=0.006) day after surgery in the SP group. Conclusions SP VATS lobectomy and anatomical segmentectomy is technologically more demanding than MP VATS. It can be safe and feasible in the hands of experienced surgeons, with comparable preoperative outcomes to MP VATS, but less pain in the early postoperative period.
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Affiliation(s)
- Chunyu Ji
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yangwei Xiang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Vincenzo Pagliarulo
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Department of Thoracic Surgery, Nottingham University Hospital, Nottingham, UK
| | - Jangming Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Alan D L Sihoe
- Department of Surgery, the University of Hong Kong, Hong Kong, China
| | - HyunKoo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Xuefei Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Zhexin Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Weigang Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jian Feng
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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26
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Ke H, Liu Y, Zhou X, Xue Q. Anterior fissureless uniport vs. posterior intra-fissure triple-port thoracoscopic right upper lobectomy: a propensity-matched study. J Thorac Dis 2017; 9:3866-3874. [PMID: 29268396 DOI: 10.21037/jtd.2017.09.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background This study aimed to assess the efficiency of anterior fissureless uniport (AFU) thoracoscopic lobectomy for early stage right upper non-small cell lung cancer (NSCLC). Methods Between June 2014 and Dec 2016, 162 consecutive NSCLC patients who underwent thoracoscopic right upper lobectomy (RUL) by AFU approach (AFU group, n=65) or posterior intra-fissure triple-port dissection (PIFT group, n=97) were enrolled. A propensity-matched analysis was used to compare perioperative outcomes, safety and efficiency between the two groups. Results Propensity matching produced 40 pairs in this retrospective study. During the operation, lobectomy took less time in the AFU group compared with the PIFT group, while no statistical differences in mediastinal lymphadenectomy time, intraoperative blood loss, and total of lymph nodes harvested were found between the two groups. Postoperatively, length of hospital stay (LOS) and time of postoperative air leak were significantly reduced in AFU group than in PIFT group. However, the overall complication rate and volume of pleural effusion drainage within 48 h were similar. Compared with the PIFT group, visual analogue scale (VAS) of 3 postoperative days in AFU group was slighter. Conclusions In RUL, AFU thoracoscopic approach is safe, efficient and easily maneuverable, which would reduce the duration of lobectomy, LOS and time of postoperative air leak. Postoperative pain is also mild.
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Affiliation(s)
- Honggang Ke
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Yifei Liu
- Department of pathology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Xiaoyu Zhou
- Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Qun Xue
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong 226001, China
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27
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Halezeroğlu S. Advantages and disadvantages of single incision VATS in major anatomical resection for lung cancer. J Vis Surg 2017; 3:115. [PMID: 29078675 DOI: 10.21037/jovs.2017.07.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 11/06/2022]
Abstract
Safety and feasibility of lung resections by single incision thoracoscopy have been confirmed in large number of studies. As proponents claim its lesser invasive nature caused by lacking of additional intercostal port(s), opponents question the outcome measures of the approach especially in oncological manner. Since there is no major discussion regarding the superiority of video-assisted thoracoscopic surgery (VATS) on lung resections over the open technique in the surgical management of lung cancer today, advantage and disadvantage of single incision VATS lung resections was reviewed with the comparison of standard, multi-port VATS approach in this article. Overall, results of comparative studies confirm that single incision and multiportal thoracoscopy are similar, or single incision thoracoscopy has more advantages in the lung resection for lung cancer. Currently, the main disadvantage of single incision approach is the lacking of long-term oncological results.
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Affiliation(s)
- Semih Halezeroğlu
- Thoracic Surgery Department, Acıbadem University School of Medicine, Acıbadem Maslak Hospital, Istanbul, Turkey
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28
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Jiménez MF, Gómez Hernández MT. A greater quality of clinical evidence is needed. J Thorac Dis 2017; 9:E274-E276. [PMID: 28449518 DOI: 10.21037/jtd.2017.03.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marcelo F Jiménez
- Service of Thoracic Surgery. Salamanca University Hospital. Salamanca, Spain
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29
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Passera E, Rocco G. From full thoracotomy to uniportal video-assisted thoracic surgery: lessons learned. J Vis Surg 2017; 3:36. [PMID: 29078599 PMCID: PMC5637876 DOI: 10.21037/jovs.2017.01.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/10/2016] [Indexed: 11/06/2022]
Abstract
Over the last two decades, conventional video-assisted thoracic surgery (VATS) has established itself as the preferred approach for almost all thoracic surgical procedures. The procedure provides a safe and easy approach with undisputed patient benefit at a cost acceptable to the healthcare system all over the world, in large hospitals as well as underprivileged rural areas. VATS has effectively addressed the patients' right to less scarring, trauma (both of access and intrathoracic manipulation), medication, pain, hospitalization, and early return home and work. These improvements have been further stressed by the introduction of uniportal VATS (uniVATS). Single port surgery is a very exciting new modality in the field of minimal access surgery which aims at further reducing scars of standard vats and towards an hypothetical prospective of scarless surgery.
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Affiliation(s)
- Eliseo Passera
- Department of Thoracic Surgery, Humanitas Gavazzeni Institute, Bergamo, Italy
| | - Gaetano Rocco
- Department of Thoracic Surgery and Oncology, Division of Thoracic Surgery, Istituto Nazionale Tumori, IRCCS, Pascale Foundation, Naples, Italy
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30
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Pastina M, Menna C, Andreetti C, Ibrahim M. The era of uniportal video-assisted thoracoscopic surgery. J Thorac Dis 2017; 9:462-465. [PMID: 28449445 DOI: 10.21037/jtd.2017.02.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Monica Pastina
- Division of Thoracic Surgery, Policlinico "A. Gemelli" Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Cecilia Menna
- Division of Thoracic Surgery, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Claudio Andreetti
- Division of Thoracic Surgery, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sant'Andrea Hospital, University of Rome "Sapienza", Rome, Italy
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31
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Özyurtkan MO, Kaba E, Toker A. Technological innovation in video-assisted thoracic surgery. J Vis Surg 2017; 3:20. [PMID: 29078583 DOI: 10.21037/jovs.2017.01.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 11/06/2022]
Abstract
The popularity of video-assisted thoracic surgery (VATS) which increased worldwide due to the recent innovations in thoracic surgical technics, equipment, electronic devices that carry light and vision and high definition monitors. Uniportal VATS (UVATS) is disseminated widely, creating a drive to develop new techniques and instruments, including new graspers and special staplers with more angulation capacities. During the history of VATS, the classical 10 mm 0° or 30° rigid rod lens system, has been replaced by new thoracoscopes providing a variable angle technology and allowing 0° and 120° range of vision. Besides, the tip of these novel thoracoscopes can be positioned away from the operating side minimize fencing with other thoracoscopic instruments. The curved-tip stapler technology, and better designed endostaplers helped better dissection, precision of control, more secure staple lines. UVATS also contributed to the development of embryonic natural orifice transluminal endoscopic surgery. Three-dimensional VATS systems facilitated faster and more accurate grasping, suturing, and dissection of the tissues by restoring natural 3D vision and the perception of depth. Another innovation in VATS is the energy-based coagulative and tissue fusion technology which may be an alternative to endostaplers.
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Affiliation(s)
- Mehmet Oğuzhan Özyurtkan
- Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Erkan Kaba
- Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Alper Toker
- Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey
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32
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Tu CC, Hsu PK. The long-waited high level evidence in thoracic surgery. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:383. [PMID: 27826585 DOI: 10.21037/atm.2016.08.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Cheng-Che Tu
- Division of Thoracic Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan;; School of Medicine, National Yang-Ming University, Taipei, Taiwan
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33
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Chang JM, Kam KH, Yen YT, Huang WL, Chen W, Tseng YL, Wu MH, Lai WW, Gonzalez-Rivas D. From biportal to uniportal video-assisted thoracoscopic anatomical lung resection: A single-institute experience. Medicine (Baltimore) 2016; 95:e5097. [PMID: 27749589 PMCID: PMC5059092 DOI: 10.1097/md.0000000000005097] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Our study sought to review our experience from biportal to uniportal video-assisted thoracoscopic surgery (VATS) major lung resection. Lessons we learned from the evolution regarding technical aspects were also discussed.We retrospectively reviewed patients who underwent VATS lobectomy or segmentectomies in Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan, during January 2012 and December 2014. Patient clinical profiles, surgical indications and procedures, postoperative course, and oncological parameters were analyzed and compared between the biportal and uniportal groups.A total of 121 patients were enrolled in this study with median follow-up of 19.5 ± 11.6 months for all patients and 22.5 ± 11.5 months for primary lung cancer patients. Operation time (146.1 ± 31.9-158.7 ± 40.5 minutes; P = 0.077), chest drainage time (3.8 ± 3.3-4.4 ± 2.4 days; P = 0.309), conversion to thoracotomy rate (2.2%-2.6%; P = 0.889), and complication rate (15.6%-19.7%; P = 0.564) were equal between the groups, whereas blood loss (96.7 ± 193.2-263.6 ± 367; P = 0.006) was lower in the uniportal group. For lung cancer cases, there were no statistical differences in the histology, cancer staging, mediastinal lymph node dissection stations, numbers of dissected N1, N2, and overall lymph nodes between uniportal and biportal groups.Our preliminary data showed that uniportal VATS anatomical lung resection is as feasible, equally safe, and of comparative oncological clearance efficacy to biportal VATS.
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Affiliation(s)
- Jia-Ming Chang
- Division of Thoracic Surgery, Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
- Graduate Institute of Medical Sciences, College of Health Science, Chang Jung Christian University, Tainan, Taiwan
| | - Kam-Hong Kam
- Division of Thoracic Surgery, Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yi-Ting Yen
- Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei Chen
- Division of Pulmonary and Critical Care Medicine, Chia-Yi Christian Hospital, and Department of Respiratory Therapy, China Medical University
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ming-Ho Wu
- Division of Thoracic Surgery, Department of Surgery, Tainan Municipal Hospital, Tainan, Taiwan
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
- Correspondence: Wu-Wei Lai, Associate Professor, No.138, Sheng Li Road, Tainan, Taiwan 704, ROC (e-mail: )
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Coruna University Hospital and Minimally Invasive Thoracic Surgery Unit, Coruna, Spain
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34
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Dai F, Meng S, Mei L, Guan C, Ma Z. Single-port video-assisted thoracic surgery in the treatment of non-small cell lung cancer: a propensity-matched comparative analysis. J Thorac Dis 2016; 8:2872-2878. [PMID: 27867563 DOI: 10.21037/jtd.2016.10.27] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS)-assisted lobectomy is widely used to treat non-small cell lung carcinoma (NSCLC). There are no reports concerning the comparison between single-port VATS and two-port VATS in treating NSCLC. This study aimed to compare the perioperative and short-term follow-up results between these two methods for treating NSCLC. METHODS A retrospective surgical evaluation of patients undergoing either single-port VATS or two-port VATS for NSCLC between January 2013 and June 2015 was conducted. The propensity score (PS) matching method was used to reduce selection bias by creating two groups. After generating the PSs, 1:1 ratio and nearest-neighbor score matching was completed. The primary outcome measures were surgical time, blood loss, drainage time, length of hospital stay, postoperative pain score and patient satisfaction score. The data were analyzed statistically with P<0.05 defined as statistically significant. RESULTS Of the 143 patients who met the inclusion criteria, 66 (46.2%) were operated on using two-port VATS and 77 (53.8%) using single-port VATS. After 1-to-1 PS matching, 63 pairs were selected. Both groups were well balanced for age, gender, body mass index, pulmonary function, preoperative comorbidity, tumor size and tumor type. The single-port VATS group had less blood loss, less postoperative pain, and a higher satisfaction score than those in the two-port VATS group, with statistical significance. Postoperative complications occurred in 2 (2/63, 3.2%) patients in the single-port VATS group and 6 (6/63, 9.5%) patients in the two-port VATS group, not a significant difference. No deaths occurred during the follow-up period. CONCLUSIONS A single-port VATS-assisted lobectomy is suggested to be safe and feasible for treating NSCLC. Compared with two-port VATS, single-port VATS has many advantages, including reduced blood loss, less postoperative pain and a higher satisfaction score.
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Affiliation(s)
- Fuqiang Dai
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
| | - Shenglan Meng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
| | - Longyong Mei
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
| | - Chen Guan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
| | - Zheng Ma
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, the Third Military Medical University, Chongqing 400042, China
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35
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Martin-Ucar AE, Socci L. Why perform uniportal video-assisted thoracic surgery?-multiple considerations. J Vis Surg 2016; 2:108. [PMID: 29399495 DOI: 10.21037/jovs.2016.06.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/31/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Antonio E Martin-Ucar
- Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Laura Socci
- Department of CardioThoracic Surgery, Sheffield Teaching Hospitals, Sheffield, UK
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Harris CG, James RS, Tian DH, Yan TD, Doyle MP, Gonzalez-Rivas D, Cao C. Systematic review and meta-analysis of uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer. Ann Cardiothorac Surg 2016; 5:76-84. [PMID: 27134832 DOI: 10.21037/acs.2016.03.17] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Uniportal video-assisted thoracoscopic surgery (VATS) has emerged as a less invasive alternative to the conventional multiportal approach in the treatment of lung cancer. The benefits of this uniportal technique have not yet been characterized in patients undergoing VATS lobectomy. This meta-analysis aimed to compare the clinical outcomes of uniportal and multiportal VATS lobectomy for patients with lung cancer. METHODS A systematic review was conducted using seven electronic databases. Endpoints for analysis included perioperative mortality and morbidity, operative time, length of hospital stay, perioperative blood loss, duration of postoperative drainage and rates of conversion to open thoracotomy. RESULTS Eight relevant observational studies were identified and included for meta-analysis. Results demonstrated a statistically significant reduction in the overall rate of complications, length of hospital stay and duration of postoperative drainage for patients who underwent uniportal VATS lobectomy. There were no significant differences between the two treatment groups in regard to mortality, operative time, perioperative blood loss and rate of conversion to open thoracotomy. CONCLUSIONS The present meta-analysis demonstrated favourable outcomes for uniportal VATS lobectomy in the treatment of lung cancer compared to the conventional multiportal approach. However, long-term follow-up data is still needed to further characterize the benefits of the uniportal approach.
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Affiliation(s)
- Christopher G Harris
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The Sydney Children's Hospital, Sydney, Australia ; 3 Royal North Shore Hospital, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia ; 5 University of Sydney, Sydney, Australia ; 6 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia ; 7 Department of Thoracic Surgery (Coruña University Hospital) and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Rebecca S James
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The Sydney Children's Hospital, Sydney, Australia ; 3 Royal North Shore Hospital, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia ; 5 University of Sydney, Sydney, Australia ; 6 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia ; 7 Department of Thoracic Surgery (Coruña University Hospital) and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - David H Tian
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The Sydney Children's Hospital, Sydney, Australia ; 3 Royal North Shore Hospital, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia ; 5 University of Sydney, Sydney, Australia ; 6 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia ; 7 Department of Thoracic Surgery (Coruña University Hospital) and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Tristan D Yan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The Sydney Children's Hospital, Sydney, Australia ; 3 Royal North Shore Hospital, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia ; 5 University of Sydney, Sydney, Australia ; 6 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia ; 7 Department of Thoracic Surgery (Coruña University Hospital) and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Mathew P Doyle
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The Sydney Children's Hospital, Sydney, Australia ; 3 Royal North Shore Hospital, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia ; 5 University of Sydney, Sydney, Australia ; 6 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia ; 7 Department of Thoracic Surgery (Coruña University Hospital) and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Diego Gonzalez-Rivas
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The Sydney Children's Hospital, Sydney, Australia ; 3 Royal North Shore Hospital, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia ; 5 University of Sydney, Sydney, Australia ; 6 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia ; 7 Department of Thoracic Surgery (Coruña University Hospital) and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
| | - Christopher Cao
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 The Sydney Children's Hospital, Sydney, Australia ; 3 Royal North Shore Hospital, Sydney, Australia ; 4 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia ; 5 University of Sydney, Sydney, Australia ; 6 Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia ; 7 Department of Thoracic Surgery (Coruña University Hospital) and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain
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Abstract
Single port video-assisted thoracic surgery (VATS) is the most recent evolution in minimally invasive thoracic surgery. With increasing global popularity, the single port VATS approach has been adopted by experienced thoracic surgeons in many Asian countries. From initial experience of single port VATS lobectomy to the more complex sleeve resection procedures now forming part of daily practice in some Asia institutes, the region has been the proving ground for single port VATS approaches' feasibility and safety. In addition, certain technical refinements in single port VATS lung resection and lymph node dissection have also sprung from Asia. Novel equipment designed to facilitate single port VATS allowing further reduce access trauma are being realized by the partnership between surgeons and the industries. Advanced thoracoscopes and staplers that are narrower and more maneuverable are particularly important in the smaller habitus of patients from Asia. These and similar new generation equipment are being applied to single port VATS in novel ways. As dedicated thoracic surgeons in the region continue to striving for excellence, innovative ideas in single incision access including subxiphoid and embryonic natural-orifice transluminal endoscopic surgery (e-NOTES) have been explored. Adjunct techniques and technology used in association with single port VATS such as non-intubated surgery, hybrid operating room image guidance and electromagnetic navigational bronchoscopy are all in rapid development in Asia.
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Affiliation(s)
- Peter S Y Yu
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Freddie Capili
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Abstract
In the era of video-assisted thoracoscopic surgery (VATS), uniportal and single incision thoracoscopic surgeries are gaining popularity. The spectrum of uniportal VATS indications is now almost equal to that of conventional VATS. For example, successful uniportal sleeve lobectomy, rib segmental resection, and management of intraoperative bleeding have all been reported. According to published data in the English-language literature, more than 9,545 uniportal VATS have been performed to date, including 1,293 lobectomies, 1,024 procedures for pneumothorax, and 6,845 sympathectomies. Of the 192 articles discussing this topic, 35 were conducted in Spain, and there were an increasing number of publications from China, Korea, and other Asian countries. There were 41 technical and review articles, all of which provided an excellent foundation of surgical concept and skill learning. The benefits of uniportal VATS include better surgical geometry and cosmetics. Regarding postoperative outcomes, thirteen out of the 15 articles reviewed showed that uniportal VATS has similar or superior outcomes to conventional VATS. Most studies demonstrated that uniportal VATS produced less postoperative pain and paresthesia. In conclusion, uniportal VATS can produce excellent operative outcome, which is becoming a mature surgical approach in thoracic disease, supported by fast-accumulating and abundant experience.
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Affiliation(s)
- Cheng-Che Tu
- 1 Division of Thoracic Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan ; 2 Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan ; 3 School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Kuei Hsu
- 1 Division of Thoracic Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan ; 2 Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan ; 3 School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Abstract
The uniportal video assisted thoracic surgery (VATS) approach to lung lobectomy has generated phenomenal interest in recent years. It promises to offer patients less morbidity and faster recovery, even when compared to conventional multiportal VATS. However, critics of the uniportal VATS approach may raise concerns about whether this most minimally invasive surgical approach for lung surgery may compromise safety and treatment efficacy. This debate has great potential importance not only in determining how patients are operated on, but in understanding how 'success' is gauged in major pulmonary surgery. This article explores both sides of this debate, drawing on the experience of how clinical research in multiportal VATS evolved over the years. Systematic generation of clinical evidence with progressively increasing sophistication is required to fairly evaluate the uniportal VATS approach. A review of the current literature suggests that there remain many large gaps in the evidence surrounding uniportal VATS. Hence, at the present time, the reasons voiced by critics as to why uniportal VATS should not be performed should not be lightly dismissed. Instead, it behoves surgeons on both sides of the debate to continue to generate good clinical evidence to resolve it.
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Affiliation(s)
- Alan D L Sihoe
- 1 Department of Surgery, The University of Hong Kong, Hong Kong, China ; 2 Department of Thoracic Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China ; 3 Department of Thoracic Surgery, Tongji University, Shanghai Pulmonary Hospital, Shanghai 200030, China
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Fang W. Less number of ports means less invasiveness-a Siren's song? J Vis Surg 2016; 2:66. [PMID: 29078494 DOI: 10.21037/jovs.2016.03.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, China
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Bertolaccini L, Terzi A, Viti A. Why should we prefer the single port access thoracic surgery? J Vis Surg 2016; 2:43. [PMID: 29078471 DOI: 10.21037/jovs.2016.02.11] [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: 12/18/2015] [Accepted: 02/04/2016] [Indexed: 11/06/2022]
Abstract
One of the greatest advances in Thoracic Surgery in our generation has been the advent of video assisted thoracic surgery (VATS). The more recent advance in VATS is the increasing use of Uniportal surgery. The development of single-port VATS has come a long way, from the beginning, when it was employed for performing simple procedures, to the last years with complex major lung resections. Nowadays, Uniportal VATS is not a Manichean law because there are several steps between open thoracotomy and Uniportal VATS. In thoracic surgery, a skilled surgeon alone cannot sustain new approaches or techniques; it is natural that minimally invasive thoracic surgery continues to evolve, since VATS is a never-ending story and Uniportal VATS is not the end of this history.
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Affiliation(s)
- Luca Bertolaccini
- Thoracic Surgery Unit, Sacro Cuore Don Calabria Research Hospital - Cancer Care Center, Negrar Verona, Italy
| | - Alberto Terzi
- Thoracic Surgery Unit, Sacro Cuore Don Calabria Research Hospital - Cancer Care Center, Negrar Verona, Italy
| | - Andrea Viti
- Thoracic Surgery Unit, Sacro Cuore Don Calabria Research Hospital - Cancer Care Center, Negrar Verona, Italy
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Shih CS, Liu CC, Liu ZY, Pennarun N, Cheng CT. Comparing the postoperative outcomes of video-assisted thoracoscopic surgery (VATS) segmentectomy using a multi-port technique versus a single-port technique for primary lung cancer. J Thorac Dis 2016; 8:S287-94. [PMID: 27014476 PMCID: PMC4783730 DOI: 10.3978/j.issn.2072-1439.2016.01.78] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 12/29/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Single-port video-assisted thoracoscopic surgery (VATS) has attracted much attention recently; however, it is still very challenging to perform especially on more technically demanding sublobar anatomic resection procedures such as segmentectomy. Therefore we conducted a retrospective study on the perioperative results of single-port segmentectomy using a propensity-matched method for comparison with multi-port segmentectomy in patients with primary lung cancer. METHODS For procedures of anatomic segmentectomy performed between May 2006 and March 2014, we retrieved data on patients' demographic information, medical history, cancer information, and postoperative outcomes from our surgical database of thoracoscopic lung cancer surgery. Outcome variables included the number of lymph nodes retrieved during the surgery, the amount of blood loss, the duration of hospitalization, the length of the wound, the operation duration in minutes, and incidence and types of complication. The t-test and Chi-squared test were used to compare demographic and clinical variables between single- and multi-port approaches. RESULTS A total of 98 consecutive patients who underwent VATS segmentectomy for lung cancer treatment were identified in our database: 52 (53.1%) underwent a single-port segmentectomy and 46 (46.9%) had a multi-port segmentectomy. After propensity score matching, the differences in patients' age, pulmonary function tests, tumor size, and operating surgeons were no longer significant between the two sample groups. The length of the wound was the only surgical outcome for which single-port segmentectomy had a significantly better outcome than multi-port segmentectomy (P value <0.001). CONCLUSIONS This study showed that single-port VATS segmentectomy yielded comparable surgical outcomes to multi-port segmentectomy despite technique difficulties and smaller wound in our setting.
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