A 3-cm Single-port Video-assisted Thoracoscopic Lobectomy for Lung Cancer

Modified 2-cm super single port vs. the traditional 3-cm single port for video-assisted thoracoscopic surgery lobectomy

PURPOSES

We introduce a novel 2-cm single port designed to minimize intercostal muscle and nerve damage in video-assisted thoracoscopic surgery (VATS) lobectomy, and compared it with the 3-cm traditional single port.

METHODS

We analyzed, retrospectively, the clinical data, safety, convenience, incision complications, and postoperative pain and numbness in 81 patients who underwent either modified (n = 42) or traditional (n = 39) single-port VATS lobectomy.

RESULTS

The preoperative variables were comparable between both single-port VATS lobectomy groups after matching. There were no serious complications and there was no mortality in either group. There were no remarkable differences between the groups in intraoperative blood loss, chest tube duration, lymph node dissection, or postoperative complications. The modified single-port group had a longer operation time (p < 0.05), but the static and dynamic postoperative VAS scores and incisional numbness were better in the modified single-port group (p < 0.05). The modified single-port group also had an obvious advantage in incision seepage, healing, and appearance.

CONCLUSIONS

Our 2-cm modified single port for lobectomy is safe and effective, and results in less postoperative pain and incisional numbness than the 3-cm traditional single port.

Uniportal Thoracoscopic Approach For Pulmonary Hydatid Cyst: Preliminary Results

PURPOSE

Pulmonary hydatid cyst is a preventable parasitary disease with high prevalence in low-medium income countries. Thoracoscopic approach is seen in the literature as small-case groups and multiple-port incisions are observed in these studies. Unlike other thoracoscopic approaches for the surgical treatment, we describe the single-port technique for the first time in our study. We attempt to compare the clinical outcomes and preliminary results of patients with pulmonary hydatid cyst treated with either minimally invasive or thoracotomy.

METHODS

The medical records of 66 patients undergoing surgery for pulmonary hydatid cyst disease between January 2013 and July 2017 were reviewed. The number of patients who underwent thoracotomy was 48, whereas 18 were managed by single-port video-assisted thoracoscopic surgery. Variables statistically compared between the 2 groups were age, diameter of the cystic, operation time, volume and duration of the drainage, postoperative complications, length of stay, duration of narcotic analgesic usage, and pain score.

RESULTS

Thoracoscopic approach was superior to conventional thoracotomy in terms of operation time, drainage volume, time to drain removal, hospital stay, narcotic analgesic treatment duration, and postoperative pain scores. All thoracoscopic procedures were concluded successfully, and conversion to open surgery was not required. No postoperative mortality was seen in either group. During the follow-up period, no recurrence was encountered in either group.

CONCLUSIONS

Uniportal thoracoscopic approach is a safe option for the treatment of hydatid cyst disease. It can be used as an alternative to thoracotomy, depending on the size and location of the lesion.

Uniportal video-assisted thoracic surgery, and the uni-surgeon: new words for the contemporary world

Uniportal video-assisted thoracic surgery (U-VATS) is gaining popularity, and is currently performed by a team formed by one surgeon, one camera holder and one nurse. As expected, the new word "uni-surgeon" is becoming more and more common. In this article, using the example of thoracic surgery, I try briefly to analyze the pro and cons of the uniportal-single incision VATS and uni-surgeon in the modern world, and how uniportal surgery may bring a novel dimension to the future of surgery.

Uniportal video assisted thoracic surgery: summary of experience, mini-review and perspectives

The uniportal-video assisted thoracic surgery (VATS) technique comprises operations which can be performed with skin incisions ranging from 2 to 8 cm and the manifest result of the introduction of the uniportal lobectomy had made possible to increase rapidly the number of published papers on this subject. Many of the large ensuing literature report incomplete historical information on uniportal VATS, and doubts exist about the indication of uniportal VATS for some thoracic oncologic pathologies. Known limitations have been overcome. On the other hand, the modern thoracic surgical team includes one surgeon, one assistant and a scrub nurse, and it is clear that the new generation of thoracic surgeons need to use the "less" used hand. The new technology which permitted the introduction of the uniportal VATS could influence the future need of thoracic surgeons worldwide.