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Gurz S, Sengul A, Buyukkarabacak Y, Pirzirenli MG, Temel NG, Sullu Y, Tanrivermis Sayit A, Gundogdu H, Basoglu A. Effect of preoperative three-dimensional modeling on uniportal video-assisted thoracoscopic bronchial sleeve resection and early postoperative outcomes. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:212-221. [PMID: 38933318 PMCID: PMC11197408 DOI: 10.5606/tgkdc.dergisi.2024.26059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 06/28/2024]
Abstract
Background The aim of this study was to evaluate the effects of preoperative three-dimensional (3D) modeling on the performance of uniportal video-assisted thoracoscopic bronchial sleeve resection and early postoperative outcomes. Methods A total of 10 patients (5 males, 5 females; mean age: 53.8±16.9 years; range, 18 to 75 years) who underwent uniportal video-assisted thoracoscopic bronchial sleeve resection with preoperative 3D modeling between April 2021 and November 2023 were retrospectively analyzed. Preoperative 3D modeling was prepared using computed tomography with an open-source 3D software program. Demographic, clinical, intraoperative, and postoperative data of the patients were recorded. Anatomical landmarks identified by preoperative 3D modeling were compared with intraoperative findings. Results The anatomical landmarks created with the 3D model were in 100% agreement with the intraoperative findings. The procedures performed were three left lower lobes, three right upper lobes, one middle lobe, one right lower lobe, and one parenchyma-sparing intermediate bronchial sleeve resection. Bronchial sleeve resection was completed using uniportal video-assisted thoracoscopic technique in 90% of patients, with only one patient requiring conversion to open thoracotomy. The mean resection time was 264.2±40.5 min, and the mean anastomosis time was 86.0±20.3 min. Anastomosis times decreased with increasing experience (p=0.008). Postoperative atelectasis was observed in two patients, and there was no mortality. The mean follow-up duration was 12.2±11.8 months. Conclusion Preoperative 3D modeling significantly contributed to the successful implementation of uniportal video-assisted thoracoscopic bronchial sleeve resection surgery. In the future, with advancements in simulation programs, patient-specific 3D modeling is expected to benefit the identification of anatomical landmarks for bronchial sleeve resections.
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Affiliation(s)
- Selcuk Gurz
- Department of Thoracic Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
| | - Aysen Sengul
- Department of Thoracic Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
| | - Yasemin Buyukkarabacak
- Department of Thoracic Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
| | | | - Necmiye Gul Temel
- Department of Thoracic Surgery, Samsun Education and Research Hospital, Dr. Kamil Furtun Chest Diseases and Thoracic Surgery Hospital Additional Service Building, Samsun, Türkiye
| | - Yurdanur Sullu
- Department of Pathology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
| | | | - Hasan Gundogdu
- Department of Radiology, Samsun University Faculty of Medicine, Samsun, Türkiye
| | - Ahmet Basoglu
- Department of Thoracic Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
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Re Cecconi E, Mangiameli G, De Simone M, Cioffi U, Marulli G, Testori A. Vats lobectomy for lung cancer. What has been the evolution over the time? Front Oncol 2024; 13:1268362. [PMID: 38260828 PMCID: PMC10800971 DOI: 10.3389/fonc.2023.1268362] [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: 07/27/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Video assisted thoracic surgery (VATS) lobectomy is the treatment of choice for early-stage lung cancer. It is safe and effective compared to open surgery, as demonstrated by a large body of scientific evidence over the last few decades. VATS lobectomy's evolution was driven by the need to decrease post-operative pain by reducing the extent of surgical accesses, maintaining the same oncological efficacy of open lobectomy with less invasiveness. VATS lobectomy just turned 30 years old, evolving and changing significantly from its origins. The aim of this mini review is to retrace the history, starting from a multiport approach to a single port approach. At the end of this mini review, we will discuss the advanced and the future challenges of the technique that has revolutionized thoracic surgery.
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Affiliation(s)
- Emanuela Re Cecconi
- Division of Thoracic Surgery, Department of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
| | - Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Giuseppe Marulli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
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Parshin VD, Porkhanov VA, Polyakov IS, Kovalenko AL, Zhikharev VA, Parshin AV, Rusakov MA, Parshin VV. [Improving surgical technique for tracheal resection with anastomosis]. Khirurgiia (Mosk) 2024:6-20. [PMID: 38258683 DOI: 10.17116/hirurgia20240116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To present modern aspects of improving surgical techniques in tracheal resection developed in recent years. MATERIAL AND METHODS The authors have the most extensive experience in tracheal surgery (>2.000 patients over the past 50 years). Diagnostic capabilities, perioperative management and surgical techniques have changed over such a long period. This concerns the proposed classification of cicatricial tracheal stenosis, features of endoscopic and X-ray diagnostics, indications for various surgeries, choice of surgical approach, technique of tracheal tube mobilization and anastomosis after tracheal excision. Preventive measures for severe postoperative complications are described. CONCLUSION Such an extensive experience allowed the authors to develop an algorithm for the treatment of patients with tracheal stenosis. This significantly reduced the incidence of postoperative complications and mortality. Replication of such equipment is associated with technical support of hospitals and professional level of specialists consisting of endoscopist, anesthesiologist, intensive care specialist and thoracic surgeon.
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Affiliation(s)
- V D Parshin
- National Medical Research Center for Phthisiopulmonology and Infectious Diseases, Moscow, Russia
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - V A Porkhanov
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - I S Polyakov
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A L Kovalenko
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - V A Zhikharev
- Research Center - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Rusakov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Current perspective on uniportal and multiportal video-assisted thoracic surgery during lobectomy for lung cancer. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2022; 19:146-151. [PMID: 36268481 PMCID: PMC9574583 DOI: 10.5114/kitp.2022.119763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/02/2022] [Indexed: 11/23/2022]
Abstract
Non-small cell lung cancer (NSCLC) is the most typical type of lung cancer, and it is the leading cancer-related mortality globally. Lobectomy for early-stage NSCLC has been characterized in the previous decade using a wide range of methodologies. The development of video-assisted thoracoscopic surgery (VATS) allowed surgeons first to reduce the thoracotomy size, which is generally anterior, limiting it to trocar incisions or a single portal approach. This review aimed to describe current perspectives on operative outcomes, lymph node removal, oncologic outcomes, and advantages for surgeons performing uniportal VATS (uVATS) and multiportal (mVATS) lobectomy. The advantages of uVATS include comfortable operating for surgeons with a direct view and safety, and for patients more favourable operative outcomes. Also, the uVATS approach has previously been demonstrated to be effective and safe, with positive outcomes not just with respect to cosmetics but also in terms of a speedy recovery. Oncological uVATS clearance is comparable to multiportal VATS with respect to early mid-term survivability as well as nodal staging, as per retrospective comparison studies. However, the interpretation of outcomes must be made cautiously due to selection bias as well as lack of long-term follow-up; the choice of which VATS approach to utilize for patients' treatment following pulmonary resection is largely based on the preferences of the surgeon. As a result, it is difficult to say if one VATS method is better than another.
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Seong YW, Jeon JH, Jang HJ, Cho S, Jheon S, Kim K. Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy. J Cardiothorac Surg 2021; 16:302. [PMID: 34656152 PMCID: PMC8520266 DOI: 10.1186/s13019-021-01685-7] [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: 04/30/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background Video-assisted thoracic surgery sleeve resection with bronchial anastomosis or bronchoplasty is a technically demanding procedure. Three-dimensional endoscopic surgery has been reported to be helpful in decreasing operation time and improving spatial perception with less surgical errors, but there have been rare reports about relatively difficult thoracoscopic procedures utilizing 3D thoracoscope. We performed this study to evaluate early clinical outcomes of thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope.
Methods Data from a total of 36 patients who underwent thoracoscopic sleeve lobectomy or bronchoplasty at our institution from December 2015 to October 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 10 mm, 30° three-dimensional thoracoscope. Twenty-three patients (81%) were male, and mean age was 65.9 ± 9.4 years. Fourteen patients (38.9%) underwent sleeve resection with bronchial anastomosis, 22 (61.1%) underwent wedge or simple bronchoplasty, and one patient received concomitant PA procedure. Bronchial anastomosis sites were not covered with viable tissue flaps.
Results There was no (0%) suture needle injury from spatial misperception during bronchoplasty or sleeve anastomosis. There was no (0%) operative mortality. The pathologic report revealed squamous cell carcinoma (63.9%), adenocarcinoma (19.4%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (2.8%). One (2.8%) late mortality was due to systemic recurrence of sarcomatoid carcinoma. There was no (0.0%) anastomotic failure. The mean number of dissected lymph nodes were 27.4 ± 13.2, and mean operation time was 216.8 ± 60.0 min. Median postoperative 24-h drain amount was 315 mL. Median chest tube days and hospital days were 4 and 6, respectively. Two patients (5.6%) had complications greater than Clavien-Dindo grade II—one case of ARDS, and the other case of a delayed bronchopleural fistula. Conclusions Thoracoscopic sleeve resection and bronchoplasty utilizing HD 3D thoracoscope is a safe and effective procedure with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed.
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Affiliation(s)
- Yong Won Seong
- Department of Thoracic and Cardiovascular Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo-Jun Jang
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, Seoul, Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Deng J, Jiang L, Li S, Zhang L, Zhong Y, Xie D, Chen C. The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary center. JTCVS Tech 2021; 9:143-152. [PMID: 34647085 PMCID: PMC8501212 DOI: 10.1016/j.xjtc.2021.07.006] [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: 01/12/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives To evaluate the time course and caseload required to achieve proficiency by plotting the learning curve of video-assisted thoracoscopic sleeve lobectomy. Methods We reviewed 127 cases of video-assisted thoracoscopic sleeve lobectomy by a single surgeon at Shanghai Pulmonary Hospital to evaluate its learning curve using the cumulative sum (CUSUM) analysis. The changes of perioperative outcomes were assessed. Results The inflection points of the CUSUM curve were around case 30 and 90, according to which 3 phases were identified: Phase I, Phase II, and Phase III. Significant downtrends were observed regarding operative time (Phase I, 194 [173-233 minutes] vs Phase II, 172 [142-215 minutes] vs Phase III, 138 [117-164 minutes], P < .05, all), blood loss (Phase I, 200 [100-238 mL] vs Phase II, 100 [50-200 mL] vs Phase III, 50 [50-100 mL]; P < .05, all), drainage duration (Phase I [5.53 ± 1.11 days] vs Phase II [4.52 ± 1.38 days]; P < .05), and length of postoperative stays (Phase I [6.60 ± 1.13 days] vs Phase II [5.68 ± 1.47 days], P < .05). The rate of severe complications significantly decreased from Phase I to Phase II (P = .03). Conclusions Thirty cases should be accumulated to lay the technical foundation, and 90 cases were required to achieve proficiency. The focus should now shift to providing sufficient training opportunities for centers wanting to implement this technique.
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Affiliation(s)
- Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shenghui Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yifan Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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Zhao J, Zeng Q, Li J, Tan F, Xue Q, Mu J, Gao Y, Wang D, Gao S. Uniportal versus multiportal thoracoscopic sleeve lobectomy for the surgical treatment of centrally located lung cancer: a single institution experience. J Thorac Dis 2020; 12:7145-7155. [PMID: 33447403 PMCID: PMC7797837 DOI: 10.21037/jtd-20-2695] [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] [Indexed: 11/25/2022]
Abstract
Background Uniportal thoracoscopic sleeve lobectomy is rarely reported owing to its high degree of difficulty. We conducted a comparative study on the safety and efficacy of uniportal versus multiportal thoracoscopic sleeve lobectomy for the treatment of centrally located lung cancer. Methods From January 2016 to December 2018, 30 thoracoscopic sleeve lobectomies (12 by the uniportal approach and 20 by the multiportal approach) for centrally located lung cancer at our institution were retrospectively analyzed. Results The uniportal approach resulted in a significantly shorter chest drainage duration (5.3±1.9 vs. 7.1±2.8 days, P=0.028) and a smaller chest drainage volume (796.7±582.9 vs. 1,667.8±1,154.9 mL, P=0.004) than the multiportal approach. The two groups showed no significant differences in the dissection of lymph nodes, operation time, estimated blood loss, conversion rate, length of postoperative hospital stay and the proportion of patients with postoperative complications. The short-term overall survival (OS) and disease-free survival (DFS) between uniportal and multiportal groups were similar (3-year OS, 100.0% vs. 82.5%, P=0.222; 3-year DFS, 75.8% vs. 84.4%, P=0.641). For the eight cases of the uniportal approach conducted by the same surgeon, the cumulative sum (CUSUM) curve showed its inflection at patient number 4 and divided the series into phase I (learning phase) and phase II (experienced phase). A significant reduction in estimated blood loss (42.5±8.7 vs. 177.5±121.2 mL, P=0.037), chest drainage volume (280.0±155.8 vs. 972.5±464.5 mL, P=0.043) and chest drainage duration (3.8±1.0 vs. 6.8±2.2 days, P=0.027) was also noted in the phase II patients compared with the phase I patients. Conclusions Uniportal thoracoscopic sleeve lobectomy is technically feasible and safe for the treatment of centrally located lung cancer and may achieve superior surgical outcomes compared with the multiportal approach.
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Affiliation(s)
- Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingpeng Zeng
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiagen Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengwei Tan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juwei Mu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yushun Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dali Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Gonzalez-Rivas D, Soultanis KM, Garcia A, Yang K, Qing Y, Yie L, Zhao G, Chen A, Huang Y, Li G, Jiang G. Uniportal video-assisted thoracoscopic lung sparing tracheo-bronchial and carinal sleeve resections. J Thorac Dis 2020; 12:6198-6209. [PMID: 33209458 PMCID: PMC7656374 DOI: 10.21037/jtd.2020.04.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pathology arising from the intrathoracic portion of the trachea (distal trachea), the carina and the main bronchi is usually neoplastic and is mainly treated with surgery. Resection of the intrathoracic portion of the trachea, the carina and the main bronchi for neoplastic lesions does not necessitate lung resection and is traditionally being conducted via open surgery. Video-assisted thoracic surgery (VATS) is witnessing an exponential growth and is the treatment of choice for early-stage non-small cell lung cancer (NSCLC). The experience accumulated over the past two decades along with the introduction of reliable and ergonomic technology, has led to the expansion of its indications. In this article we provide a detailed description of lung sparing distal tracheal, carinal and main bronchi resection for primary neoplasms of the airway, without involvement of the lung, with the uniportal video-assisted technique. The chest is entered through the fourth intercostal space, mid-axillary line. Dissection of the paratracheal space anteriorly, the tracheoesophageal groove posteriorly and the subcarinal space and division of the azygos arch are essential to mobilize the distal trachea and carina. Lateral dissection should be avoided beyond the points of division of the airway, as it may hinder the blood supply to the anastomosis. Any tension to the anastomosis should be relieved by release maneuvers. Ventilation is achieved through an endobronchial catheter, inserted into the left main bronchus through which a high-frequency jet ventilation catheter can be also inserted through it. The rationale of applying a minimally invasive technique for the conduction of tracheal and carinal resections, is to exploit its advantages, namely less pain, earlier mobilization and lower morbidity. Uniportal video-assisted resections of the distal trachea, carina and the main bronchi, are safe when conducted by experienced surgical and anesthetic teams.
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Affiliation(s)
- Diego Gonzalez-Rivas
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China.,Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain.,Thoracic Surgery Department, Yunnan Cancer Hospital, the 3rd Affiliated Hospital of Kunming Medical University, Kunming, China
| | | | - Alejandro Garcia
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Kaiyun Yang
- Thoracic Surgery Department, Yunnan Cancer Hospital, the 3rd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yue Qing
- Thoracic Surgery Department, Yunnan Cancer Hospital, the 3rd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Linhua Yie
- Thoracic Surgery Department, Yunnan Cancer Hospital, the 3rd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guangqiang Zhao
- Thoracic Surgery Department, Yunnan Cancer Hospital, the 3rd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Anning Chen
- Thoracic Surgery Department, Yunnan Cancer Hospital, the 3rd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yunchao Huang
- Thoracic Surgery Department, Yunnan Cancer Hospital, the 3rd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guangjian Li
- Thoracic Surgery Department, Yunnan Cancer Hospital, the 3rd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Gening Jiang
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
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Abstract
Robotic technology is positioned to transform the approach to tracheobronchial surgery. With its magnified 3D view, intuitive controls, wristed-instruments, high-fidelity simulation platforms, and the steady implementation of new technical improvement, the robot is well-suited to manage the careful dissection and delicate handling of the airway in tracheobronchial surgery. This innovative technology has the potential to promote the widespread adoption of minimally invasive techniques for this complex thoracic surgery.
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Affiliation(s)
- Brian D Cohen
- General Surgery Residency Program, MedStar Georgetown/Washington Hospital Center, Washington DC, USA
| | - M Blair Marshall
- Division of Thoracic Surgery, Brigham and Women's Hospital, Faculty, Harvard Medical School, Boston, MA, USA
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10
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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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11
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Abstract
Tracheobronchial tumors with involvement of the carina represent a challenging problem in the pulmonary surgery. Carinal resection is referred to removal and reconstruction of the airway itself, whereas concomitant removal of the lung parenchyma (usually a whole lung) is termed as carinal pneumonectomy. Thorough preoperative workup of these patients is mandatory. Meticulous surgical technique and aggressive postoperative management is required for the best outcomes in these difficult cases. In the paper authors review surgical technique, evaluation and management of this challenging patient population.
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Affiliation(s)
- Roman V Petrov
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Charles T Bakhos
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Abbas E Abbas
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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12
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Huang L, Wu P, Zhao L, Chai Y. Reduced complexity of uniportal video-assisted thoracoscopic left upper sleeve lobectomy. J Thorac Dis 2018; 10:3791-3796. [PMID: 30069378 DOI: 10.21037/jtd.2018.05.97] [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)
- Lijian Huang
- Department of Thoracic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Pin Wu
- Department of Thoracic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Lufeng Zhao
- Department of Thoracic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Ying Chai
- Department of Thoracic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
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13
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Zhang G, Yu Z, Wang L, Shen G, Chai Y. Uniportal video-assisted thoracoscopic S 8 segmentectomy and S 1a subsegmentectomy for synchronous multiple primary lung cancers. J Thorac Dis 2018; 10:4475-4480. [PMID: 30174897 PMCID: PMC6106009 DOI: 10.21037/jtd.2018.06.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/01/2018] [Indexed: 11/06/2022]
Abstract
With the increasing incidence of synchronous multiple primary lung cancers (SMPLC), difficulties in diagnosis and decision making for treating patients with SMPLC can result in clinical dilemmas for clinicians. To simplify the diagnostic and treatment course, the less-invasive technique of video-assisted thoracic surgery (VATS) segmentectomy and subsegmentectomy can be selected preferentially. However, segmentectomy and subsegmentectomy are technically more sophisticated compared to lobectomy, and they involve the identification of the nodule locations, confirmation of the targeted structures and ensuring the surgical margin. Here, we describe the performance of uniportal VATS segmentectomy and subsegmentectomy technique in a patient with SMPLC in the right upper lobe with the assistance of three-dimensional (3D) navigation. We detected the intersegmental planes using infrared thoracoscopy with an intravenous injection of indocyanine green (ICG). The patient was discharged with no complication. We think that uniportal VATS segmentectomy is a feasible alternative and technically safe for treating patients with SMPLC.
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Affiliation(s)
- Guofei Zhang
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Zipu Yu
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Lian Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Gang Shen
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Ying Chai
- Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, China
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14
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Guido-Guerrero W, Bolaños-Cubillo A, González-Rivas D. Single-port video-assisted thoracic surgery (VATS)-advanced procedures & update. J Thorac Dis 2018; 10:S1652-S1661. [PMID: 30034831 DOI: 10.21037/jtd.2018.05.43] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The uniportal approach for major pulmonary resections began in 2010, with the first case being reported by D González-Rivas and colleagues in La Coruña, Spain. Since then, in different countries, thoracic surgeons had been performing hundreds of cases, with more advanced and complex procedures. Nowadays, there are reports of uniportal tracheal resection and reconstruction, carinal resection, bronchoplastic procedures, lobectomies with en bloc chest wall excision, and vascular reconstruction with optimal outcomes. The development of technologies and the potential benefits of a direct view, anatomic instrumentation, better cosmesis, and, potentially, less postoperative pain have led uniportal video-assisted thoracic surgery to grow exponentially worldwide.
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Affiliation(s)
- William Guido-Guerrero
- Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica
| | - Albert Bolaños-Cubillo
- Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica
| | - Diego González-Rivas
- Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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15
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Royo-Crespo I, Vieira A, Ugalde PA. Extended uniportal video-assisted thoracic surgery for lung cancer: is it feasible? J Vis Surg 2018; 4:57. [PMID: 29682467 DOI: 10.21037/jovs.2018.03.09] [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] [Received: 07/27/2017] [Accepted: 01/24/2018] [Indexed: 11/06/2022]
Abstract
Since the first description of uniportal video-assisted thoracic surgery (U-VATS) (or single-port) lobectomy, several centers in Asia and Europe rapidly adopted this technique as a standard approach for treatment of early stage non-small cell lung cancer (NSCLC). Despite the controversies regarding feasibility and completeness of resection, thoracic surgeons in high volume centers keep pushing the limits to perform very complex procedures also known as "extended resections" through minimally invasive surgery. Published series and case reports confirm the viability of U-VATS in highly complex surgical cases such as pneumonectomy, chest wall resection and bronchoplasty, which require experience and technical ability to be performed through a 3-6 cm single incision. In this article, the authors would like to present several clinical indications of locally advanced NSCLC and the technical aspects to accomplish an extended resection through U-VATS.
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Affiliation(s)
- Iñigo Royo-Crespo
- Department of Thoracic Surgery, Miguel Servet University Hospital, Lozano Blesa University Clinic Hospital, and IIS Aragón, Zaragoza, Spain
| | - Arthur Vieira
- Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada
| | - Paula A Ugalde
- Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Canada
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16
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Tian K, Yang R, Han B. Left upper lobectomy and pulmonary angioplasty by uniportal video-assisted thoracic surgery. J Thorac Dis 2017; 9:3269-3271. [PMID: 29221305 DOI: 10.21037/jtd.2017.07.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diego Gonzalez-Rivas and his colleagues performed the first case for pulmonary major resection by the uniportal approach in 2010. In the following years, more and more expert surgeons developed the uniportal approach and even applied it to very complex cases. Many centers have showed that uniportal video-assisted thoracic surgery (VATS) lobectomy is a safe and feasible technique. The patient presented here is a complex case: The lingular segmental artery was invaded seriously by the tumor and it was difficult to divide it freely, and the pulmonary artery plasty was needed. Although this condition made the procedure some technically challenging, the case was performed successfully without any operative complications.
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Affiliation(s)
- Kaihua Tian
- Thoracic Department, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Ronghua Yang
- Thoracic Department, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Bin Han
- Thoracic Department, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
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17
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Kocher GJ, Dorn P. Minimally invasive resection and reconstruction of the intrathoracic trachea and carina. J Thorac Dis 2017; 9:4319-4322. [PMID: 29268499 DOI: 10.21037/jtd.2017.10.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Gregor J Kocher
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Dorn
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
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18
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Han DP, Xiang J, Jin RS, Hu YX, Li HC. Uniportal video-assisted thoracic surgery for complicated pulmonary resections. J Vis Surg 2017; 2:150. [PMID: 29078537 DOI: 10.21037/jovs.2016.08.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/22/2016] [Indexed: 11/06/2022]
Abstract
In the past 20 years, video-assisted thoracic surgery has made a great progress, from 4-ports to 2-ports, and eventually to this revolutionary approach-uniportal video-assisted thoracic surgery (VATS). It can share the same instruments, the same surgical principles, the same strategies of trouble-shooting and the same postoperative short-term outcomes with conventional VATS via the improvement of instruments and surgical skills. And it has already been safe to adopt uniportal VATS in complicated pulmonary resections. In this study, we shared five video clips about uniportal VATS for complicated pulmonary resections: sleeve resection, segmentectomy, pneumonectomy and angioplasty. We hope these video clips can be instrumental for young surgeons.
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Affiliation(s)
- Ding-Pei Han
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jie Xiang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Run-Sen Jin
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Yan-Xia Hu
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - He-Cheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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19
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Galvez C, Navarro-Martinez J, Bolufer S, Lirio F, Sesma J, Corcoles JM. Nonintubated uniportal VATS pulmonary anatomical resections. J Vis Surg 2017; 3:120. [PMID: 29078680 DOI: 10.21037/jovs.2017.08.10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 11/06/2022]
Abstract
Nonintubated procedures have widely developed during the last years, thus nowadays major anatomical resections are performed in spontaneously breathing patients in some centers. In an attempt for combining less invasive surgical approaches with less aggressive anesthesia, nonintubated uniportal video-assisted thoracic surgery (VATS) lobectomies and segmentectomies have been proved feasible and safe, but there are no comparative trials and the evidence is still poor. A program in nonintubated uniportal major surgery should be started in highly experienced units, overcoming first a learning period performing minor procedures and a training program for the management of potential crisis situations when operating on these patients. A multidisciplinary approach including all the professionals in the operating room (OR), emergency protocols and a comprehensive knowledge of the special physiology of nonintubated surgery are mandatory. Some concerns about regional analgesia, vagal block for cough reflex control and oxygenation techniques, combined with some specific surgical tips can make safer these procedures. Specialists must remember an essential global concept: all the efforts are aimed at decreasing the invasiveness of the whole procedure in order to benefit patients' intraoperative status and postoperative recovery.
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Affiliation(s)
- Carlos Galvez
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Jose Navarro-Martinez
- Department of Anesthesiology and Surgical Critical Care, University General Hospital, Alicante, Spain
| | - Sergio Bolufer
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Francisco Lirio
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Julio Sesma
- Department of Thoracic Surgery, University General Hospital, Alicante, Spain
| | - Juan Manuel Corcoles
- Department of Thoracic Surgery, University Hospital of Vinalopo, Alicante, Spain
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20
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Wang A, Chen X, Huang D, Wang S. Deeper wedge resection and parenchymal-sparing bronchoplasty of the secondary carina: an alternative surgical technique for removal of tumor located at the orifice of upper lobar bronchus. J Cardiothorac Surg 2017; 12:51. [PMID: 28610612 PMCID: PMC5470209 DOI: 10.1186/s13019-017-0610-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sleeve resection and reconstruction of the bronchial corner between the upper lobar bronchus and the intermediate bronchus is technique demanding. CASE PRESENTATION A 33-year-old Chinese man suffered from recurrence of low-grade malignant mucoepidermoid carcinoma located at the orifice of upper lobar bronchus with invasion to the main bronchus nearly 1 year after he had undergone an incomplete bronchoscopic resection. With detailed preoperative and intraoperative evaluation by computed tomography and bronchoscopy, a deeper wedge resection and bronchoplasty of the secondary carina was performed. The freedom from tumor cells at the cut-edges was guaranteed by frozen examination. The postoperative course was uneventful and the patient was free from recurrence for 18 months after the surgery. CONCLUSIONS With an R0 resection, the procedure described in the present case report was feasible and relatively easy, thus an alternative to sleeve lobectomy or sleeve bronchial resection for small-size low-grade malignancy located at the orifice of upper lobar bronchus.
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Affiliation(s)
- An Wang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaofeng Chen
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Dayu Huang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shaohua Wang
- Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China.
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22
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Ismail M, Swierzy M, Nachira D, Rückert JC, Gonzalez-Rivas D. Uniportal video-assisted thoracic surgery for major lung resections: pitfalls, tips and tricks. J Thorac Dis 2017; 9:885-897. [PMID: 28523133 DOI: 10.21037/jtd.2017.02.04] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nearly six years since inception, uniportal video-assisted thoracic surgery (VATS) has become a growing part of major lung resections and has revolutionized the way thoracic surgeons treat pulmonary lesions. This technique is being touted for various benefits. It ensures direct visualization together with a better exposure of the lung and allows the chance of a digital palpation of the lesion through a small incision. Postoperative pain is reduced due to the involvement of only one intercostal space without rib spreading and muscle disruption. The comfort and aesthetics factors are improved significantly since the oncological principles and radicality of open surgery are restored. As the surgeons gain more experience in uniportal-VATS lobectomy, more complex cases can be managed by this technique. The objectives of this work are to set the basic steps for performing major lung resections (lobectomy, bilobectomy and pneumonectomy) by utilizing uniportal-VATS and to analyze some common pitfalls that thoracic surgeons face when practicing this technique and provide practical tips and tricks on how to avoid.
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Affiliation(s)
- Mahmoud Ismail
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Swierzy
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dania Nachira
- Department of General Thoracic Surgery, "A.Gemelli" University Hospital - Catholic University of Sacred Heart, Rome, Italy
| | - Jens C Rückert
- Competence Center of Thoracic Surgery, Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.,Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
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23
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Roque Cañas SR, Oviedo Argueta AJ, Wu CF, Gonzalez-Rivas D. Technological aids in uniportal video-assisted thoracoscopic surgery. J Vis Surg 2017; 3:29. [PMID: 29078592 DOI: 10.21037/jovs.2017.01.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/11/2016] [Indexed: 11/06/2022]
Abstract
With the evolution of uniportal video-assisted thoracoscopic surgery (VATS), the technological aids have come to help skill surgeons to improve the results in thoracic surgery and feasible to perform a complex surgery. The technological aids are divided into three important groups, which make surgical steps easy to perform, besides reducing surgical time and surgical accidents in the hands of experienced surgeons. The groups are: (I) conventional thoracoscopic instruments; (II) sealing devices using in uniportal VATS; (III) high definition cameras, robotic arms prototype and the future robotic aids for uniportal VATS surgery. Uniportal VATS is an example of the continuing search for methods that aim to provide the patient a surgical cure of the disease with the lowest morbidity. That is the reason companies are creating more and new technologies, but the surgeon have to choose properly and to know how, when and where is the moment to use each new aids to avoid mistakes. The future of the thoracic surgery is based on evolution of surgical procedures and innovations to try to reduce even more the surgical and anesthetic trauma. This article summarizes the technological aids to improve and help a thoracoscopics surgeons perform a uniportal VATS feasible and safe.
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Affiliation(s)
- Sonia Raquelline Roque Cañas
- Department of General Surgery, Salvadoran Social Security Institute, San Salvador, El Salvador.,Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, Coruña, Spain
| | - Alonso José Oviedo Argueta
- Department of General Surgery, Salvadoran Social Security Institute, San Salvador, El Salvador.,Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, Coruña, Spain
| | - Ching Feng Wu
- Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, Coruña, Spain
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, Coruña, Spain.,Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Hospital San Rafael, Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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24
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Liu Z, Yang R, Shao F, Pan Y. Modified procedure of uniportal video-assisted thoracoscopic lobectomy with muscle sparing incision. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:367. [PMID: 27826570 DOI: 10.21037/atm.2016.09.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To describe modified procedure for uniportal video-assisted thoracoscopic surgery (UVATS) lobectomy with a small, total muscle-sparing incision. METHODS Forty-eight UVATS leucotomy were attempted and successfully completed. A single incision of approximately 3 cm was made in an intercostal space along the anterior axillary line. Muscle-sparing technique was applied with this single-incision approach using muscle sparing technique. RESULTS Incision size was kept to a minimum, with a median of 3 cm. Mediastinal lymph node dissection was performed in all patients with malignancy. Overall median operative time was 1.3 hours. Median hospitalization was 13.5 days (range, 6-21 days). Morbidity rate was low at 3%. There were no other postoperative complications, mortality, or re-admissions. CONCLUSIONS Modified procedure of lobectomy with UVATS might be easy to operate with less surgical time and morbidity rate, muscle sparing technique might reduce post-operation pain.
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Affiliation(s)
- Zhengcheng Liu
- Department of Thoracic Surgery, Nanjing Chest Hospital Affiliated to Southeast University, Nanjing 210029, China
| | - Rusong Yang
- Department of Thoracic Surgery, Nanjing Chest Hospital Affiliated to Southeast University, Nanjing 210029, China
| | - Feng Shao
- Department of Thoracic Surgery, Nanjing Chest Hospital Affiliated to Southeast University, Nanjing 210029, China
| | - Yanqing Pan
- Department of Thoracic Surgery, Nanjing Chest Hospital Affiliated to Southeast University, Nanjing 210029, China
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Han DP, Xiang J, Li HC, Hang JB. Uniportal video-assisted thoracic surgery right upper lobectomy with systemic lymphadenectomy. J Thorac Dis 2016; 8:2272-4. [PMID: 27621890 DOI: 10.21037/jtd.2016.05.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This video demonstrated a performance of uniportal video-assisted thoracoscopic surgery (VATS) right upper lobectomy with systemic lymphadenectomy. The patient had a malignant mass in his right upper lobe. The operator took a posterior to anterior approach to dissection the right upper lobe, the adjacent structures were clearly demonstrated after the entire dissection of mediastinal lymph nodes. Postoperative pathological report suggested the stage of the tumor was T1bN0M0 (stage IA).
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Affiliation(s)
- Ding-Pei Han
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jie Xiang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - He-Cheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jun-Biao Hang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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26
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Feng M, Lin M, Shen Y, Wang H. Uniportal video-assisted thoracic surgery for left upper lobe: single-direction lobectomy with systematic lymphadenectomy. J Thorac Dis 2016; 8:2281-3. [PMID: 27621892 DOI: 10.21037/jtd.2016.06.64] [Citation(s) in RCA: 4] [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
A 62-year-old female was admitted to our hospital after computed tomography (CT) revealed a 2.5 cm × 2.1 cm mass in the left upper lobe. PET/CT scan diagnosed as malignant lesion with no signs of metastasis. Under general anesthesia, the patient was placed in right lateral decubitus position. A 4cm incision was made in the 4th intercostal space with plastic protector. The camera was placed in the upper part of the incision and the instruments were inserted below the camera. Left upper lobectomy along with systematic lymphadenectomy was performed. Total surgical time was 135 min and estimated blood loss was 70 mL. The chest tube was removed on the 2nd postoperative day and the patient was discharged on the 3rd postoperative day with no complication. This uniportal VATS single-direction lobectomy for the left upper lobe is feasible and amplifies the concept of thoracotomy-like minimally invasive surgery.
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Affiliation(s)
- Mingxiang Feng
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Yaxin 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
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27
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Yang Y, Guerrero WG, Algitmi I, Gonzalez-Rivas D. Complex uniportal video-assisted thoracoscopic sleeve lobectomy during live surgery broadcasting. J Thorac Dis 2016; 8:1345-8. [PMID: 27293857 DOI: 10.21037/jtd.2016.04.58] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The uniportal approach for major pulmonary resections began in 2010 with the first case being performed by González-Rivas and colleagues in La Coruña. Since then a number of teams around the world had being performing hundreds of cases, applying it to more advance and complex cases recently. The technique has been reported to be feasible and reliable with similar results to that obtained in early stage lung cancer lobectomies. The case presented in this article is an example of an extreme condition: very obese patient, strong adhesions, fused lower lobe to the diaphragm and enlarged inflammatory adenopathies that made the procedure very technically challenging. In addition, the surgery was performed during a live surgery event and it was broadcasted to an auditorium. However, the case was successfully completed through a uniportal VATS approach with no complications.
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Affiliation(s)
- Yang Yang
- 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 2 Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica ; 3 Department of Cardiothoracic Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia ; 4 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - William Guido Guerrero
- 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 2 Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica ; 3 Department of Cardiothoracic Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia ; 4 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Iskander Algitmi
- 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 2 Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica ; 3 Department of Cardiothoracic Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia ; 4 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| | - Diego Gonzalez-Rivas
- 1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China ; 2 Department of Thoracic Surgery, Rafael Angel Calderón Guardia Hospital, San José, Costa Rica ; 3 Department of Cardiothoracic Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia ; 4 Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
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