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)

Clinical Analysis of Different Anesthesia and Analgesia Methods for Patients Undergoing Uniportal Video-assisted Lung Surgery

PURPOSE

The purpose of this study was to compare 3 intraoperative modalities to determine the best and most convenient one for pain control for uniportal lung surgery. This study compared general anesthesia with serratus plane block, general anesthesia with epidural, and general anesthesia alone to examine postoperative pain scores in patients.

METHODS

Eighty patients were enrolled and statistically analyzed. Three interventions were studied: general anesthesia with serratus plane block (group S), general anesthesia with thoracic epidural (group E), and general anesthesia only (group G). Outcome measures compared among the 3 groups included demographic characteristics; surgical types; anesthesia and operative time; postoperative pain scores; vital signs; morphine consumption at 0, 2, and 6 hours and day 1 and day 2 after surgery; incidence of opioid-related adverse events and chronic pain; hospital length of stay (LOS); and overall expenses. The numerical rating scale was used to assess the degree of pain on the first and second postoperative days. Postoperative morphine consumption, incidence of opioid-related side effects, hospital LOS, and overall hospital expenses were documented, as well as incidence of chronic postoperative pain.

FINDINGS

There was no difference in the incidence of opioid-related adverse events and chronic pain, hospital LOS, and overall expenses among the 3 groups. After investigating factors that may influence hospital LOS and overall expenses, the multivariable analysis indicated that only longer operative time was associated with longer hospital stay and more hospital expenses.

IMPLICATIONS

This prospective study found that general anesthesia alone offers an easy and efficient approach resulting in similar postoperative pain scores and morphine consumption compared with nerve block and epidural. Longer operative time was associated with longer hospital stay and more hospital expenses.

CLINICALTRIALS

gov identifier: NCT03839160. (Clin Ther. 2024;XX:XXX-XXX) © 2024 Elsevier HS Journals, Inc.

Suction versus non-suction drainage strategy after uniportal thoracoscopic lung surgery: a prospective cohort study

Background

The postoperative outcomes of suction drainage versus non-suction drainage after uniportal video-assisted thoracoscopic surgery (UniVATS) come with little consensus. This study aimed to prospectively compare the postoperative outcomes of suction drainage versus non-suction drainage in patients who underwent UniVATS.

Methods

Between October 2022 and January 2023, patients undergoing UniVATS were prospectively enrolled. The choice of drainage strategy (suction or non-suction) was at the surgeon's discretion. The primary outcome was chest tube duration, with secondary outcomes including postoperative drainage volume, pain scores, postoperative complications, length of hospital stay, and hospitalization cost. Baseline characteristics and postoperative outcomes were compared. Univariable and multivariable analyses were used to identify risk factors for postoperative outcomes.

Results

A total of 206 patients were enrolled in this study, with 103 patients in each group. Baseline characteristics were well-balanced. The chest tube duration did not significantly differ between the two groups. However, suction drainage exhibited a significantly lower total drainage volume compared to non-suction drainage (280.00 vs. 400.00 mL, P=0.03). Suction drainage was associated with a significantly shorter postoperative hospital stay (3.00 vs. 4.00 days, P<0.001) and lower pain score on the second postoperative day (POD). Multivariable analyses also confirmed that suction drainage was significantly correlated with a lower total drainage volume and a shorter postoperative hospital stay.

Conclusions

These findings suggested that the suction drainage was superior to non-suction drainage in terms of postoperative drainage volume and length of hospital stay in patients undergoing UniVATS.

Effect of lung rehabilitation training combined with nutritional intervention on patients after thoracoscopic resection of lung cancer

Thoracoscopic lobectomy is the main type of surgical treatment for lung cancer. Postoperative patients have complications and decreased pulmonary function, which affects their discharge time and quality of life. Lung ventilator training has been shown to promote the postoperative recovery of patients; however, no specific treatment plan has been approved to enhance lung rehabilitation. Therefore, it is necessary to explore methods to promote the postoperative rehabilitation of patients with lung cancer. The patients with lung cancer who were admitted to Banan Hospital Affiliated to Chongqing Medical University (Chongqing, China) between January 2022 and January 2023, and who planned to undergo a thoracoscopic lobectomy, were randomly categorized into two groups. The experimental group began lung rehabilitation training 2 weeks before the operation and received individualized nutrition programs. The control group did not receive lung rehabilitation training and nutrition programs. The quality of life, lung function, 6-min walking distance (6MWD), nutritional status, postoperative complications, hospital expenses and hospital stay between the two groups were compared. Finally, 86 and 83 patients were included in the test and control groups, respectively. Regarding the postoperative indicators, the patients in the test group scored higher in all areas of quality of life, exhibited higher lung function and 6MWD, and had significantly higher serum total protein, albumin and hemoglobin levels, and body mass index, compared with the control group. Furthermore, the incidence of postoperative pulmonary complications, the duration of hospitalization and the hospitalization costs were lower in the experimental group. In conclusion, lung rehabilitation training combined with nutritional intervention can promote the postoperative rehabilitation of patients with lung cancer. The research has been duly registered in the Chinese Clinical Trial Register platform (registration no. ChiCTR2300078681; registered Dec 15, 2023).

Modified surgical incision suturing technique in uniportal video-assisted thoracoscopic pulmonary resection

Background

In recent years, single-hole thoracoscopic surgery technology is widely used in major medical centers and chest-specialized hospitals for the treatment of lung diseases. However, the single-hole minimally invasive surgery method focuses on one incision, and all surgical instruments need to pass through the same hole, resulting in repeated extrusion and tissue damage of the surgical incision. Therefore, we have improved the suture method of conventional surgical incision in order to reduce the probability of wound infection and dehiscence, promote early healing, and reduce the severity of postoperative wound scar, thereby enhancing the postoperative rapid recovery of patients. The purpose of this study is to explore the clinical efficacy of a modified surgical incision suture technique applied to uniportal thoracoscopic pulmonary resection.

Methods

This study retrospectively analyzed 151 patients who were admitted to the Department of Thoracic Surgery and underwent pulmonary resection from January 2019 to October 2021 in the North District of Suzhou Municipal Hospital. The patients were divided into two groups according to the different surgical incision suture methods: a modified group and a conventional group. The postoperative general clinical indexes, incision infection rate, secondary suture rate, postoperative incision pain score, and the severity of postoperative incision scar were compared and analyzed between the two groups.

Results

There were no statistically significant differences between the two groups in terms of chest tube duration or postoperative drainage and postoperative incision pain scores; the incision infection rate (1.3% vs. 6.7%, P<0.05), secondary suture rate (2.6% vs. 9.4%, P<0.05), and postoperative scar score (4.853 vs. 5.543, P=0.03) were better in the modified group than in the conventional group, and the differences between the two groups were statistically significant.

Conclusions

Our modified suture method reduces the chance of infection and splitting and the severity of postoperative incision scar formation, promoting early healing. It can be safely and effectively applied to the incision suture of uniportal thoracoscopic pulmonary resection, enhancing the rapid postoperative recovery of patients.

Innovative Techniques in Video-Assisted Thoracoscopic Surgery: Lu's Approach

Purpose

Lu's approach for video-assisted thoracoscopic surgery (LVATS), which derives from Uniportal Video-Assisted Thoracoscopic Surgery(UVATS), is a novel surgical approach for VATS and carries out micro-innovation for lung cancer resection. The objective of this study is to elucidate the safety, feasibility, and efficacy of this novel surgical approach.

Patients and Methods

The clinical data of patients with non-small cell lung cancer (NSCLC) who underwent a curative thoracoscopic lobectomy between Mar. 2021 and Mar. 2022, were retrospectively collected and analyzed. Patients were divided into the LVATS group and the UVATS group. Propensity score matching (PSM) was used to reduce selection bias and create two comparable groups. Perioperative variables were compared, and a p-value < 0.05 was deemed statistically significant.

Results

A total of 182 patients were identified, among whom 86 patients underwent LVATS and 96 UVATS. Propensity matching produced 62 pairs in this retrospective study. There were no deaths during perioperative period. Patients in the LVATS group experienced a shorter operation time (88 (75, 106) VS 122 (97, 144) min, P <0.001), less intraoperative blood loss (20 (20, 30) VS 25 (20, 50) mL, P = 0.021), shorten incision length (2.50 (2.50, 2.50) VS 3.00 (3.00, 3.50) cm, P <0.001), and more drainage volume (460 (310, 660) VS 345 (225, 600) mL, P = 0.041) than patients in the UVATS group. There was not significant difference in the lymph node stations dissected (5 (4, 5) VS 5 (4, 5), P = 0.436), drainage duration (3 (3, 4) VS 3 (3, 4) days, P =0.743), length of postoperative hospital stay (4 (4, 5) VS 4 (4, 6) days, P = 0.608), VAS on the POD1 (4 (4, 4) VS 4 (4, 4), P=0.058) and POD3 (3 (3, 4) VS 4 (3, 4), P=0.219), and incidence of postoperative complications (P=0.521) between the two groups.

Conclusion

Lu's approach for video-assisted thoracoscopic lobectomy is safe and feasible, potentially reducing surgery time, incision length, and intraoperative blood loss.

Comparison of erector spinae plane block and serratus anterior plane block for postoperative analgesia in uniportal thoracoscopic lobectomy: a randomized controlled trial

BACKGROUND

Postoperative pain remains a significant concern following uniportal thoracoscopic surgery. The analgesic efficacy of erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in terms of postoperative opioid consumption in uniportal thoracoscopic surgery still needs further studies.

METHODS

A randomized controlled trial was conducted, enrolling 150 patients who underwent uniportal thoracoscopic lobectomy. The patients were randomly allocated to three groups in a 1:1:1 ratio: the ESPB group (administered 20 ml of 0.5% ropivacaine), the SAPB group (administered 20 ml of 0.5% ropivacaine), and the standard care (control) group. The primary endpoint was the consumption of sufentanil during the first 24 h following surgery. Secondary endpoints assessed the area under the curve (AUC) of pain numerical rating scale (NRS) scores, occurrence of moderate to severe pain, time to initial sufentanil request, and postoperative adverse events.

RESULTS

No significant difference was observed in the consumption of sufentanil during the first 24 h following surgery between the ESPB and SAPB groups (adjusted difference, 1.53 [95% CI, -5.15 to 2.08]). However, in comparison to the control group, both intervention groups demonstrated a significant decrease in sufentanil consumption, with adjusted differences of -9.97 [95% CI, -13.10 to -6.84] for the ESPB group and -12.55 [95% CI, -15.63 to -9.47] for the SAPB group. There were no significant differences in AUC of NRS scores during rest and movement between the ESPB and SAPB groups, with adjusted differences of -7.10 [95% CI, 1.33 to -15.55] for the rest condition and 5.61 [95% CI, -13.23 to 2.01] for the movement condition. At 6 h postoperatively, there were fewer patients with moderate to severe pain in the ESPB group compared with those in the SAPB group (adjusted difference, -1.37% [95% CI, -2.29% to -0.45%]. The time to first sufentanil request significantly differed among the three groups (ESPB vs Control P < 0.01, SAPB vs Control P < 0.01, ESPB vs SAPB P = 0.015).

CONCLUSIONS

In patients undergoing uniportal thoracoscopic lobectomy, although the differences between the two groups are not statistically significant, both the ESPB and SAPB demonstrate effective reduction in postoperative opioid consumption and the need for rescue analgesics compared to the control group. Moreover, the ESPB group experienced a significantly lower incidence of moderate to severe pain at 6 h postoperatively compared to the SAPB group.

TRIAL REGISTRATION

The study was registered in the Chinese Clinical Trial Registry (registration No: ChiCTR1900021695, Date of registration: March 5th, 2019).

Effect of single-port video-assisted thoracoscopy on surgical site wound infection and healing in patients with lung cancer: A meta-analysis

We performed a meta-analysis to comprehensively assess the effect of single-port video-assisted thoracoscopy on surgical site wound infection and healing in patients with lung cancer. A computerised search for studies on single-port video-assisted thoracoscopy treatment of lung cancer was conducted from the time of database creation through February 2023 using the PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases. Two investigators independently screened the literature, extracted information, and evaluated the quality of studies according to inclusion and exclusion criteria. Either a fixed or random-effects model was used in calculating the relative risk (RR) with 95% confidence intervals (CIs). Meta-analysis was performed using RevMan 5.4 software. The results showed that, compared with multi-port video-assisted thoracoscopy, single-port video-assisted thoracoscopy significantly reduced surgical site wound infection (RR: 0.38, 95% CI: 0.19-0.77, P = .007) and significantly promoted wound healing (RR: 0.37, 95% CI: 0.22-0.64, P < .001). Compared with multi-port video-assisted thoracoscopy, single-port video-assisted thoracoscopy significantly reduced surgical site wound infections and also promoted wound healing. However, because of large variations in study sample sizes, some of the literature reported methods of inferior quality. Additional high-quality studies containing large sample sizes are needed to further validate these results.

Clinical applications of minimally invasive uniportal video-assisted thoracic surgery

BACKGROUND

In recent years, the field of minimally invasive thoracic surgery has experienced significant advancements driven by improvements in video-assisted thoracoscopic surgery (VATS) techniques and surgical instruments. These advances have given rise to uniportal VATS as a new area of exploration in minimally invasive thoracic surgery. This technique presents several potential advantages, including reduced access trauma, less postoperative pain, improved cosmesis, fewer complications, shorter hospital stays, and faster rehabilitation, ultimately leading to an improvement in patient quality of life.

PURPOSE

This article reviews the evolutionary history of minimally invasive thoracic surgery, highlights novel techniques, explores possible applications and obtained results, and discusses future prospects of uniportal VATS.

CONCLUSION

Experienced thoracic surgeons have demonstrated the capacity to perform uniportal VATS with a high level of safety and efficacy. Further studies are necessary to assess its long-term efficacy, address limitations, and enhance clinical decision-making for optimal treatment of thoracic conditions.

Uniportal video-assisted anatomical segmentectomy: an analysis of the learning curve

BACKGROUND

This study aimed to demonstrate the learning curve of anatomical segmentectomy performed by uniportal video-assisted thoracoscopic surgery (U-VATS).

METHOD

We conducted a retrospective study of U-VATS segmentectomies performed by the same surgeon between September 2019 and August 2022. The learning curve was demonstrated using risk-adjusted cumulative sum (RA-CUSUM) analysis in terms of perioperative complications, which reflected surgical quality and technique proficiency. The surgical outcomes were also compared between different phases.

RESULT

The complication-based learning curve of U-VATS segmentectomy could be divided into two phases based on RA-CUSUM analysis: phase I, the initial learning phase (cases 1-50) and phase II, the proficiency phase (cases 51-141). Significantly higher complication rates (24.0 vs. 8.8%, p=0.013), longer surgical times (119.8±31.9 vs. 106.2±23.8 min, p=0.005), and more blood loss (20 [IQR, 20-30] vs. 20 [IQR, 10-20] ml, p=0.003) were observed in phase I than in phase II.

CONCLUSION

The learning curve of U-VATS segmentectomy consists of two phases, and at least 50 cases were required to gain technique proficiency and achieve high-quality surgical outcomes.

Junior surgeons are quicker to master the single-port thoracoscopic lobectomy: comprehensive analysis of the learning curve and oncological outcomes

BACKGROUND

The learning curve of single-port thoracoscopic lobectomy (SPTL) in lung cancer has been widely studied. However, the efficiency of different experience levels of thoracic surgeons in mastering the learning curve is unknown. Hence, we discuss this issue in depth by using several perioperative parameters and oncological outcomes.

METHODS

A total of 120 consecutive cases of SPTL performed by a senior (STS group) and junior (JTS group) thoracic surgeons were retrospectively analyzed. Operation time, estimated blood loss, and duration of postoperative hospital stay were recorded for cumulative summation (CUSUM) learning curve analysis, while the 5-year survival rate was used for oncological evaluation.

RESULTS

The CUSUM learning curve of the STS group was y = 0.000106x³ - 0.019x² + 0.852x - 0.036, with a high R-value of 0.9517. When the number of cases exceeded 33, the slope changed from positive to negative. The CUSUM learning curve of the JTS group was y = 0.000266x³ - 0.04x² + 1.429 × -0.335, with a high R-value of 0.9644. When the number of cases exceeded 25, the slope changed from positive to negative. The learning curve was divided into two phases (phases 1 and 2). The slope of the JTS group in phase 1 was greater than that of the STS group in phase 1 (p < 0.001). Meanwhile, comparisons of various parameters between both groups in phase 2 showed no statistically significant difference (p > 0.05). In addition, the 5-year survival rate was not significantly different between the two groups (p = 0.72).

CONCLUSION

This is the first study to analyze the learning curve of thoracic surgeons with different experience levels in mastering SPTL. Moreover, it is also the first study to include multiple perioperative parameters and overall survival to study how quickly surgeons master the SPTL technique. The junior thoracic surgeon was found to have a shorter learning curve for SPTL.

Transition from multiportal video-assisted thoracic surgery to uniportal video-assisted thoracic surgery… and evolution to uniportal robotic-assisted thoracic surgery?

The greatest disruptive innovation in lung cancer surgery in modern times has been the switch from open thoracotomy to video-assisted thoracic surgery (VATS). More recently, the transition from multiportal VATS (MVATS) to uniportal VATS (UVATS) has represented another mini-advance in reducing surgical access trauma. In the search for the next breakthrough in lung cancer surgery, a number of promising candidates have emerged, including screening, sublobar resections, 3D technology, enhanced peri-operative care pathways, ablative therapy and multi-modality management. However, could the way forwards be simply a further minimization of surgical access trauma, and could this be achieved by uniportal robotic surgery? Emergence of a 'winning' candidate will depend on a systematic evaluation of the evidence for the benefits and costs of each.

[Consensus guideline on the interdisciplinary diagnosis of interstitial lung diseases]

The evaluation of a patient with interstitial lung disease (ILD) includes assessment of clinical, radiological, and often histopathological data. As there were no specific recommendations to guide the evaluation of patients under the suspicion of an ILD within the German practice landscape, this position statement from an interdisciplinary panel of ILD experts provides guidance related to the diagnostic modalities which should be used in the evaluation of ILD. This includes clinical assessment rheumatological evaluation, radiological examinations, histopathologic sampling and the need for a final discussion in a multidisciplinary team.

Learning curve of uniportal video-assisted thoracoscopic lobectomy: an analysis of the proficiency of 538 cases from a single centre

OBJECTIVES

Uniportal video-assisted thoracoscopic surgery (UniVATS) is widely used as a minimally invasive thoracic operation. The goal of our study was to analyse the effect of long-term experience with the UniVATS lobectomy on the learning curve.

METHODS

The learning curves were quantitatively evaluated by the unadjusted cumulative sum, and they were segmented using joinpoint linear regression analysis. The variables were compared between subgroups using trend analysis, and linear regression analysis was applied to correlate clinical characteristics at different stages of the learning curve with the duration of the operation.

RESULTS

The learning curve for the UniVATS lobectomy can be divided into 3 phases of proficiency at ∼200-300 procedures, with a fourth phase as the number of procedures increases. The 1st-52nd, 52nd-156th, 156th-244th and 244th-538th procedures comprised the preliminary learning stage, preliminary proficiency stage, proficiency stage and advanced proficiency stage, respectively. Surgical outcomes and their variability between stages improved with increasing case numbers, with the most significant addition of an auxiliary operating port and conversions. In multivariable analysis, as stages progressed, influences other than surgical experience increased the operative time, with male and extensive pleural adhesions in the preliminary proficiency stage; male and incomplete pulmonary fissures in the proficiency stage; and male, extensive pleural adhesions and incomplete pulmonary fissures in the advanced proficiency stage.

CONCLUSIONS

As the number of procedures increases, there may be 4 different proficiency stages in the UniVATS lobectomy learning curve. The surgeon enters the fourth stage at approximately the 244th procedure. Moreover, at stage 4, the perioperative indicators tend to stabilize, and influences other than surgical experience become more significant.

Electromagnetic Navigation Bronchoscopy Integrated Non-intubated Uniportal VATS in Localization and Resection of Pulmonary Nodules

Background

With the development of computed tomography, the detection rate of pulmonary nodules is increasing. Accurate localization, minimally invasive resection, and rapid recovery are the most concentrated issues in modern thoracic surgery. However, some traditional procedures, including CT-guided localization and general intubated anesthesia, might prolong the operation and postoperative recovery. The integrated operating room provides a practical approach to achieve precise pulmonary nodule localization with real-time images using electromagnetic navigation bronchoscopy (ENB). Meanwhile, the minimally invasive video-assisted thoracoscopic surgery (VATS) under non-intubated anesthesia is also applied in the same place, enhancing operative efficiency and recovery after surgery.

Method

The patients with pulmonary nodules resection who underwent nodules localization and uniportal VATS under non-intubated anesthesia in the integrated operating room between September 2018 and December 2021 were identified and collected. They all received ENB localization before uniportal VATS under non-intubated anesthesia, provided by the same group of anesthesiologists and surgeons. Perioperative data of patients were analyzed and evaluated to demonstrate the feasibility and efficiency of the procedure.

Result

A total of 243 patients with 251 pulmonary nodules underwent ICG staining localization by ENB. The mean calibration time and navigation time were 0.91 ± 0.43 min and 10.56 ± 7.24 min, respectively. Overall, successful navigation occurred in 248 (98.80%) nodules. All patients received thoracoscopic surgery after localization, including wedge resection (231, 92.03%), segmentectomy (13, 5.18%), and lobectomy (7, 2.79%). All nodules were completely resected without serious complications. The mean postoperative hospital was 1.80 ± 0.83 days.

Conclusion

ENB localization and nodules resection under non-intubated uniportal VATS in the integrated operating room provides a feasible and efficient approach to the pulmonary nodules patients, favoring the treatment precision and enhanced recovery.

Efficacy of multi-groove silicone drains in single-port video-assisted thoracoscopic lung cancer surgery and their effect on C-reactive protein: a single-center experience

Background

The purpose of this study was to systematically evaluate the effectiveness and safety of a multi-groove silicone drain in single-port video-assisted thoracoscopic lung cancer surgery and its effect on postoperative serum C-reactive protein (CRP) levels.

Methods

We retrospectively analyzed 122 surgical cases who underwent standard lobectomy and lymph node dissection for primary lung cancer between May 2020 and December 2020. A total of 62 patients received 19-F multi-groove silicone drains (experimental group) and 60 patients received 24-F conventional chest drains (control group). According to the different thoracic drainage approaches, the clinical efficacy in the perioperative period, postoperative complications, and postoperative serum CRP levels were compared between the 2 groups.

Results

In this study, thoracic drainage volume, the average visual analog scale (VAS) pain scores in incisions, the rate of primary healing at the site of incisions, and the pulmonary infection rate in the multi-groove silicone drain group were significantly lower than those in the conventional chest drain group (P<0.05), but there was no significant difference in the average hospital stay time, arrhythmia rates, and chest tube removal time between the 2 groups. At postoperative day 1, the levels of serum CRP in the 2 groups were further increased (P>0.05), and the comparison between the 2 groups showed that the levels of serum CRP in the multi-groove silicone drain group at 72 h after the operation were significantly lower than those in the conventional drain group (P<0.05).

Conclusions

Our results showed that a multi-groove silicone drain is feasible and relatively safe in single-port video-assisted thoracoscopic lung cancer surgery for most patients. However we should take cautious in those patients with higher susceptibility of postoperative active bleeding. In patients undergoing lung cancer surgery in the clinical treatment process, the use of a multi-groove silicone drain can improve the quality of life of patients. Due to a small number of included studies and unclear bias, the above results should be verified by high-quality, large-sample randomized controlled studies.

Keywords

Video-assisted thoracoscopic lung cancer surgery; multi-groove silicone drains; conventional chest drains

Thoracic surgery in the non-intubated spontaneously breathing patient

BACKGROUND

The interest in non-intubated video-assisted thoracic surgery (NIVATS) has risen over the last decade and numerous terms have been used to describe this technique. They all have in common, that the surgical procedure is performed in a spontaneously breathing patient under locoregional anaesthesia in combination with intravenous sedation but have also been performed on awake patients without sedation. Evidence has been generated favouring NIVATS compared to one-lung-ventilation under general anaesthesia.

MAIN BODY

We want to give an overview of how NIVATS is performed, and which different techniques are possible. We discuss advantages such as shorter length of hospital stay or (relative) contraindications like airway difficulties. Technical aspects, for instance intraoperative handling of the vagus nerve, are considered from a thoracic surgeon's point of view. Furthermore, special attention is paid to the cohort of patients with interstitial lung diseases, who seem to benefit from NIVATS due to the avoidance of positive pressure ventilation. Whenever a new technique is introduced, it must prove noninferiority to the state of the art. Under this aspect current literature on NIVATS for lung cancer surgery has been reviewed.

CONCLUSION

NIVATS technique may safely be applied to minor, moderate, and major thoracic procedures and is appropriate for a selected group of patients, especially in interstitial lung disease. However, prospective studies are urgently needed.

Early Patient-Reported Outcomes After Uniportal Versus Multiportal Thoracoscopic Lobectomy

BACKGROUND

Uniportal video-assisted thoracoscopic surgery (U-VATS) can achieve comparable traditional clinical outcomes as those of multiportal video-assisted thoracoscopic surgery (M-VATS). This study aimed to compare patient-reported outcomes between U-VATS and M-VATS for lung cancer lobectomy in the early postoperative period.

METHODS

This comparative analysis used data from a longitudinal prospective study (CN-PRO-Lung 1). Symptom severity, functional status, and quality of life were compared between groups using generalized estimation equation models. Symptom severity and functional status were reported as proportion of patients with clinically meaningful severe scores on 0-10-point scales assessed using the MD Anderson Symptom Inventory-Lung Cancer module.

RESULTS

Of the 174 patients included, 102 (58.6%) underwent U-VATS lobectomy and 72 (41.4%) underwent M-VATS lobectomy. After adjusting for confounders, patients in the U-VATS group reported less severe pain (p = 0.02), fatigue (p = 0.001), constipation (p = 0.01), coughing (p = 0.003), shortness of breath (p < 0.001), and disturbed sleep (p = 0.007) during the 6-day postoperative hospitalization than those in the M-VATS group. Moreover, fewer patients reported severe impairment to walking (p = 0.033) or their capacity to enjoy life (p = 0.027) in the U-VATS group. Meanwhile, there were no significant between-group differences in the quality of life scores, operative time, chest tube duration, length of hospital stay, or early complication rate (≥ grade II) (all p ˃ 0.05).

CONCLUSIONS

U-VATS might produce fewer severe symptoms and better functional status than M-VATS for lung cancer lobectomy in the early postoperative period.

A novel technique to optimize uniportal thoracoscopic right middle lobectomy

The study aimed to describe a novel port design and simple surgical strategy for uniportal thoracoscopic right middle lobectomy (RML). In this approach, a 3-4 cm incision was created at sixth intercostal space posterior to the scapular line. The surgery was performed by serial division of the anterior oblique fissure, vein, bronchus, artery, and horizontal fissure. Based on our preliminary experience, this approach could provide an appropriate direction and angle for dissection and stapling, solving the challenge of conventional uniportal RML lobectomy.

Effect and feasibility of uniportal thoracoscopic surgery in the treatment of early-stage lung cancer in a primary hospital

BACKGROUND

Thoracoscopic radical lobectomy is a routine procedure for radical surgery of lung cancer. Meanwhile, thoracoscopic surgery has been gradually transformed from assisted small incision and multiport thoracoscopic radical surgery to uniportal thoracoscopic surgery for treatment of early-stage lung cancers. However, there are still controversies regarding the efficacy and feasibility of 2 surgical methods. The purpose of this study is to investigate the effect and feasibility of uniportal thoracoscopic surgery for treatment of early-stage lung cancer in a primary hospital.

METHODS

Clinical data of 142 patients with early-stage lung cancer were retrospectively chosen in the period from September 2019 to March 2021 in our hospital and divided into 2 groups: a control group (66 patients) with 3-port thoracoscopic radical surgery and an experimental group (76 patients) with uniportal thoracoscopic radical surgery. The baseline clinical data, perioperative clinical data, and lymph node dissection of 2 groups were compared.

RESULTS

There was no significant difference in baseline general clinical data between 2 groups (P>0.05), and no significant difference in the incidence of postoperative complications, conversion rate, or operation time between 2 groups (P>0.05). The intraoperative blood loss volume, postoperative chest drainage volume, postoperative hospitalization time, and postoperative catheter time of experimental group were significantly lower than those of control group (P<0.05). There was no significant difference in the total number of lymph node dissection stations and lymph node dissections, the number of N2 lymph node dissection stations, or N2 lymph node dissections between 2 groups (P>0.05). There was also no significant difference in the number of left and right lymph node dissection stations between 2 groups (P>0.05).

CONCLUSIONS

Compared with 3-port thoracoscopic radical surgery, uniportal thoracoscopic radical surgery in the treatment of patients with early-stage lung cancer provides the same effect of lymph node dissection and has advantages in reducing surgical trauma and accelerating postoperative rehabilitation, popularizing for use in primary hospitals.