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Zheng X, Wang W, Li X, He P, Wu X. Efficacy of uniportal versus multiportal video-assisted thoracoscopic lobectomy for non-small cell lung cancer: A retrospective analysis. Pak J Med Sci 2024; 40:1135-1139. [PMID: 38952522 PMCID: PMC11190387 DOI: 10.12669/pjms.40.6.9313] [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: 12/12/2023] [Revised: 12/22/2023] [Accepted: 02/25/2024] [Indexed: 07/03/2024] Open
Abstract
Objective To compare the uniportal and multiportal video-assisted thoracoscopic surgery (VATS) in patients with non-small-cell lung cancer (NSCLC). Methods Medical records of 128 patients with NSCLC who underwent surgical treatment in the First School of Clinical Medicine, Southern Medical University from August 2020 to February 2022 were retrospectively analyzed. There were 60 patients who underwent uniportal VATS (UVATS group) and 68 patients underwent multiportal VATS (MVATS group). The relevant indexes, complications, postoperative pain levels and quality of life, recurrence, metastases and survival between the two groups were compared. Results UVATS was associated with longer operation time and higher intraoperative blood loss compared to MVATS (P<0.05). The postoperative drainage volume, and the visual analogue scale (VAS) scores at 24 and 72 hours were lower in the UVATS group compared to the MVATS group, while the chest tube retention time and hospitalization time were shorter than those in the MVATS group (P<0.05). The quality of life at six months after surgery in the UVATS group was significantly higher than that in the MVATS group (P<0.05). Conclusions UVATS and MVATS have similar outcomes in patients with NSCLC. Although UVATS surgery takes longer and is associated with more interoperative bleeding, it can reduce postoperative pain, shorten postoperative recovery time, and help further improve the quality of life of patients after surgery.
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Affiliation(s)
- Xing Zheng
- Xing Zheng, Department of Thoracic Surgery, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Wenmin Wang
- Wenmin Wang Department of Breast Surgery, Nanfang Hospital Baiyun Branch, Guangzhou, Guangdong province 510405, China
| | - Xiang Li
- Xiang Li Department of Emergency, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Pengyixiang He
- Pengyixiang He, Department of Thoracic Surgery, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Xu Wu
- Xu Wu, Department of Thoracic Surgery, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province 510515, China
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Kösek V, Al Masri E, Nikolova K, Ellger B, Wais S, Redwan B. Comparative clinical experience of subcostal VATS versus conventional uniportal lateral VATS approach. J Minim Access Surg 2024; 20:326-333. [PMID: 39047681 PMCID: PMC11354960 DOI: 10.4103/jmas.jmas_26_24] [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: 02/11/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION The present study reports the first clinical experience with subcostal uniportal VATS (suVATS) compared with the conventional lateral uniportal VATS (luVATS) approach. PATIENTS AND METHODS All patients who underwent suVATS between January 2019 and April 2020 were included. Patients who had undergone luVATS for similar indications were included as the control group. The data were prospectively and retrospectively analysed. RESULTS The suVATS group included 38 patients with a mean age of 61 (30-83) years. The luVATS group included 33 patients (mean age, 69 years; range: 46-89 years). An intercostal block was performed intraoperatively in the luVATS group. Local infiltration under anaesthesia was performed around the incision in the suVATS group. The duration of the surgery was significantly longer in the suVATS group. However, the chest tube treatment and hospital stay duration were significantly shorter in the suVATS group. The routinely recorded Visual Analogue Scale scores on the first post-operative day and the day of discharge were significantly lower in the suVATS group. CONCLUSION Subcostal uniportal VATS enables a shorter drainage treatment duration and hospital stay and significantly reduces post-operative pain. Thus, a faster patient recovery can be achieved.
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Affiliation(s)
- Volkan Kösek
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
- Faculty of Medicine, University of Witten/Herdecke, Witten, Germany
| | - Eyad Al Masri
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
| | - Katina Nikolova
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
| | - Björn Ellger
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Knappschaftskrankenhaus Dortmund, Klinikum Westfalen, Dortmund, Germany
| | - Shadi Wais
- Department of General Visceral, Thoracic and Endocrine Surgery, Augusta Hospital, Düsseldorf, Germany
| | - Bassam Redwan
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen, Lünen, Germany
- Faculty of Medicine, University of Witten/Herdecke, Witten, Germany
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Bertolaccini L, Batirel H, Brunelli A, Gonzalez-Rivas D, Ismail M, Ucar AM, Ng CSH, Scarci M, Sihoe ADL, Ugalde PA, Abu Akar F, Bedetti B, Nadal SB, Brandolini J, Crucitti P, Enyedi A, Fernando HC, Furak J, Gallego-Poveda J, Galvez-Munos C, Hanke I, Hernandez-Arenas LA, Janik M, Juhos P, Libretti L, Lucciarini P, Macrì P, Margaritora S, Mahoozi HR, Nachira D, Pardolesi A, Pischik V, Sagan D, Schreurs H, Sekhniaidze D, Socci L, Tosi D, Turna A, Vannucci F, Zielinski M, Rocco G. Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2019; 56:224-229. [DOI: 10.1093/ejcts/ezz133] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/07/2019] [Accepted: 03/20/2019] [Indexed: 01/05/2023] Open
Abstract
Abstract
OBJECTIVES
Our goal was to report the results of the first consensus paper among international experts in uniportal video-assisted thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi process, the objective of which was to define and standardize the main procedural steps, optimize its indications and perioperative management and identify elements to assist in future training.
METHODS
The 40 members of the working group were convened and organized on a voluntary basis by the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). An e-consensus finding exercise using the Delphi method was applied to require 75% agreement for reaching consensus on each question. Repeated iterations of anonymous voting continued for 3 rounds.
RESULTS
Overall, 31 international experts from 18 countries completed all 3 rounds of questionnaires. Although a technical quorum was not achieved, most of the responders agreed that the maximum size of a UniVATS incision should be ≤4 cm. Agreement was reached on many points outlining the currently accepted definition of a UniVATS lobectomy, its indications and contraindications, perioperative clinical management and recommendations for training and future research directions.
CONCLUSIONS
The UVIG Consensus Report stated that UniVATS offers a valid alternative to standard VATS techniques. Only longer follow-up and randomized controlled studies will predict whether UniVATS represents a valid alternative approach to multiport VATS for major lung resections or whether it should be performed only in selected cases and by selected centres. The next step for the ESTS UVIG is the establishment of a UniVATS section inside the ESTS databases.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | - Hasan Batirel
- Department of Thoracic Surgery, Marmara University Hospital, Istanbul, Turkey
| | | | - Diego Gonzalez-Rivas
- Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain
| | - Mahmoud Ismail
- Department of Thoracic Surgery, Klinikum Ernst von Bergmann, Potsdam, Germany
| | | | - Calvin S H Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Marco Scarci
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Alan D L Sihoe
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Department of Thoracic Surgery, Tongji University Shanghai Pulmonary Hospital, Shanghai, China
| | - Paula A Ugalde
- Department of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (Hôpital Laval), Quebec, Canada
| | - Firas Abu Akar
- Department of Cardiothoracic Surgery, Makassed Charitable Society Hospital, East Jerusalem, Israel
- Department of Cardiothoracic Surgery, Shaare Zedek Medical Center (SZMC), Jerusalem, Israel
| | | | | | - Jury Brandolini
- Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy
| | | | - Attila Enyedi
- Division of Thoracic Surgery, University of Debrecen, Debrecen, Hungary
| | - Hiran C Fernando
- Department of Surgery, Fairfax Medical Campus, Falls Church, VA, USA
| | - Jozsef Furak
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Carlos Galvez-Munos
- Department of Thoracic Surgery, General University Hospital, Alicante, Spain
| | - Ivo Hanke
- Department of Thoracic Surgery, University Hospital Hradec Kralove, Hradec, Kralov, Czech Republic
| | - Luis A Hernandez-Arenas
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Miroslav Janik
- Department of Thoracic Surgery, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Juhos
- Department of Thoracic Surgery, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia
| | - Lidia Libretti
- Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy
| | - Paolo Lucciarini
- Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Paolo Macrì
- Thoracic Surgery Unit, Istituto Clinico Humanitas CCO – Catania, Catania, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli”, Rome, Italy
| | - Hamid Reza Mahoozi
- Department of Thoracic Surgery, Evangelisches Krankenhaus Herne, Herne, Germany
| | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario “A. Gemelli”, Rome, Italy
| | | | - Vadim Pischik
- Faculty of Medicine, St-Petersburg State University, Saint-Petersburg, Russia
| | - Dariusz Sagan
- Department of Thoracic Surgery, Medical University of Lublin, Lublin, Poland
| | | | | | - Laura Socci
- Thoracic Surgery Units, Sheffield Teaching Hospital, Sheffield, UK
| | - Davide Tosi
- Department of Thoracic Surgery, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Akif Turna
- Division of Thoracic and Transplant Surgery, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fernando Vannucci
- Department of Thoracic Surgery, Hospital Federal do Andaraí, Rio de Janeiro, Brazil
| | - Marcin Zielinski
- Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
| | - Gaetano Rocco
- Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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