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Laven IEWG, Verkoulen KCHA, Franssen AJPM, Hulsewé KWE, Vissers YLJ, Štupnik T, Gonzalez-Rivas D, de Loos ER. Evolution of uniportal video-assisted thoracoscopic surgery: optimization and advancements. J Thorac Dis 2024; 16:4839-4843. [PMID: 39268107 PMCID: PMC11388257 DOI: 10.21037/jtd-24-647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/09/2024] [Indexed: 09/15/2024]
Affiliation(s)
- Iris E W G Laven
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Koen C H A Verkoulen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Aimée J P M Franssen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Karel W E Hulsewé
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Yvonne L J Vissers
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Tomaž Štupnik
- Department of Thoracic Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Erik R de Loos
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
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Lobdell KW, Perrault LP, Drgastin RH, Brunelli A, Cerfolio RJ, Engelman DT. Drainology: Leveraging research in chest-drain management to enhance recovery after cardiothoracic surgery. JTCVS Tech 2024; 25:226-240. [PMID: 38899104 PMCID: PMC11184673 DOI: 10.1016/j.xjtc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Kevin W. Lobdell
- Sanger Heart & Vascular Institute, Wake Forest University School of Medicine, Advocate Health, Charlotte, NC
| | - Louis P. Perrault
- Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
| | | | - Alessandro Brunelli
- Department of Thoracic Surgery, Leeds Teaching Hospitals, Leeds, United Kingdom
| | | | - Daniel T. Engelman
- Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical, School-Baystate, Springfield, Mass
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Xu Y, Luo J, Ge Q, Cong Z, Jiang Z, Diao Y, Huang H, Wei W, Shen Y. Safety and feasibility of a novel chest tube placement in uniportal video-assisted thoracoscopic surgery for non-small cell lung cancer. Thorac Cancer 2023; 14:2648-2656. [PMID: 37491972 PMCID: PMC10493483 DOI: 10.1111/1759-7714.15049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND The type and placement of chest tube for patients undergoing uniportal video-assisted thoracoscopic lobectomy remains controversial. The aim of this study was to assess the efficacy and safety of a novel technique in which a pigtail catheter was used alone as the chest tube and placed near the incision for chest drainage after uniportal video-assisted thoracoscopic lobectomy and extended lymphadenectomy. METHODS A total of 217 patients undergoing uniportal video-assisted thoracoscopic lobectomy were retrospectively reviewed and divided into two groups. In group A, a 12-Fr pigtail catheter with several side ports was placed next to the uniportal wound. In group B, a conventional 20-Fr chest tube was placed through the uniportal wound itself. Postoperative complications related to chest tube placement and patients' subjective satisfaction were compared between the two groups. Postoperative pain management effect and other clinical outcomes such as duration of chest drainage and postoperative stay were also compared. RESULTS There were 112 patients in group A and 105 patients in group B. A significantly lower incidence of wound complications was found in group A postoperatively (p = 0.034). The pain score on coughing in group A was significantly lower than that in group B on postoperative day two (POD2) (p = 0.021). There was no significant difference of other clinical outcomes such as duration of chest drainage and postoperative stay as well as major complications between the two groups. CONCLUSION Placing a 12-Fr pigtail catheter alone next to the uniportal wound for chest drainage might be effective and safe after uniportal video-assisted thoracoscopic lobectomy and extended lymphadenectomy.
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Affiliation(s)
- Yang Xu
- Department of Cardiothoracic Surgery, Jingling Hospital, Jingling School of Clinical MedicineNanjing Medical UniversityNanjingChina
| | - Jing Luo
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
| | - Qi‐Yue Ge
- Department of Cardiothoracic Surgery, Jingling Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Zhuang‐Zhuang Cong
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
| | - Zhi‐Sheng Jiang
- Department of Cardiothoracic Surgery, Jingling HospitalBengbu Medical CollegeNanjingChina
| | - Yi‐Fei Diao
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
- Department of Cardiothoracic Surgery, Jingling Hospital, School of MedicineSoutheast UniversityNanjingChina
| | - Hai‐Rong Huang
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
| | - Wei Wei
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
- Department of Cardiothoracic Surgery, Jingling HospitalBengbu Medical CollegeNanjingChina
| | - Yi Shen
- Department of Cardiothoracic Surgery, Jingling Hospital, Jingling School of Clinical MedicineNanjing Medical UniversityNanjingChina
- Department of Cardiothoracic Surgery, Jingling HospitalMedical School of Nanjing UniversityNanjingChina
- Department of Cardiothoracic Surgery, Jingling Hospital, School of MedicineSoutheast UniversityNanjingChina
- Department of Cardiothoracic Surgery, Jingling HospitalBengbu Medical CollegeNanjingChina
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Shi W, Hu Y, Wang C, Chang G, Zheng H, Yang Z, Yang Y, Zhao X, Li X. Experience of a modified chest tube suture-fixation technique in uniportal thoracoscopic pulmonary resection. BMC Surg 2023; 23:73. [PMID: 36991429 DOI: 10.1186/s12893-023-01952-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/28/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE This study aimed to explore the feasibility and advantages of a modified chest tube suture-fixation technique in uniportal video-assisted thoracic surgery for pulmonary resection. METHODS A retrospective analysis was conducted on 116 patients who underwent uniportal video-assisted thoracic surgery (U-VATS) for lung diseases in Zhengzhou People's Hospital between October 2019 and October 2021. Patients were stratified into two groups based on the applied suture-fixation methods, i.e., 72 patients in the active group and 44 patients in the control group. The two groups were subsequently compared in the terms of gender, age, operation method, indwelling time of chest tube, postoperative pain score, chest tube removal time, wound healing grade, length of hospital stay, incision healing grade, and patient satisfaction. RESULTS There was no significant difference between the two groups in terms of gender, age, operation method, indwelling time of chest tube, postoperative pain score, and length of hospital stay (P = 0.167, 0.185, 0.085, 0.051, 0.927, and 0.362, respectively). However, the chest tube removal time, incision healing grade, and incision scar satisfaction in the active group were significantly better compared with those of the control group (P = < 0.001, 0.033, and < 0.001, respectively). CONCLUSION In summary, the new suture-fixation approach can minimize the number of stitches, and time necessary for chest tube removal process, and avoid the pain experienced when removing the drainage tube. This method is more feasible, has better incision conditions, and provides a convenient tube removal, making it more suitable to patients.
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Affiliation(s)
- Wensong Shi
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Yuzhui Hu
- Department of Geratology, Ninth People's Hospital of Zhengzhou, Zhengzhou, 450053, China
| | - Cuimei Wang
- Department of Plastic Surgery, The fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Guotao Chang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Huiyu Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Zhiqiang Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Yulun Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China
| | - Xiaogang Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital Affiliated to Tongji University, Shanghai, 200433, China
| | - Xiangnan Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, The fifth Clinical Medical College of Henan of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, 450052, China.
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Bertolaccini L, Spaggiari L. If a Single Swallow Does Not Make a Summer, Ten Patients Do Not Make an Alternative. Ann Thorac Surg 2021; 113:1755. [PMID: 33839136 DOI: 10.1016/j.athoracsur.2021.03.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/21/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435 - 20141 Milan (IT).
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Off-Label Use of T-Tube as Chest Drainage for Uniportal Surgery. Ann Thorac Surg 2021; 112:e197-e199. [PMID: 33684347 DOI: 10.1016/j.athoracsur.2021.01.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 11/23/2022]
Abstract
Uniportal video-assisted thoracic surgery implies the positioning of a single chest drain at the mid thorax level. Therefore, this tube cannot reach simultaneously the basal and apical regions of the pleural cavity. We propose the off-label use of a T-tube usually utilized in biliary duct surgery. Despite mid thorax insertion, this tube allows effective air and fluid drainage of the entire pleural space. We tested it in 10 patients undergoing uniportal surgery and report satisfactory results. No postoperative chest tube displacement, pleural effusion infection, or subatelectasies occurred. We conclude that the T-tube represents a good alternative in patients at high risk of postoperative effusion undergoing the uniportal approach.
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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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