Uniportal versus multiport video-assisted thoracoscopic surgery for anatomical lung resections: a glance at a dilemma

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).

Safety and effectiveness of uniportal video-assisted thoracoscopic surgery compared to triportal surgery: a single institution experience

Introduction

Uniportal video-assisted thoracoscopic surgery (VATS) has increasingly been used in thoracic surgery during the last decade.

Aim

To assess the safety and effectiveness of uniportal VATS compared to triportal VATS.

Material and methods

Data of a total of 318 patients between 2009 and 2019 who underwent uniportal and triportal VATS were reviewed. Bivariate statistical analysis using Pearson's χ² test was performed.

Results

Our data showed statistical differences only in complications and hospital stay between the 2 groups.

Conclusions

Uniportal VATS has a safe post-operative outcome and is comparable to triportal VATS.

Analysis of lung volume reduction surgery results with video-assisted thoracoscopic surgery in emphysematous lung patients

AIM

In our study, we aimed to evaluate the results of patients who underwent lung volume reduction surgery with video-assisted thoracoscopic surgery due to diffuse or upper lobe limited emphysema.

MATERIAL AND METHODS

Patients who underwent lung volume reduction surgery (LVRS) for emphysema in our clinic between March 2015 and January 2020 were included in the study. The files of the patients were evaluated retrospectively. Age, gender, smoking history, hospitalization time, drain removal time, complications, and postoperative pulmonary function test values were evaluated in the patient records.

RESULTS

Twenty-four of the patients were male and 2 were female. The average age was determined as 49.6. Twenty-six patients underwent 31 surgical procedures, 5 of which were bilateral. Twenty-seven of them were performed by videothoracoscopic LVRS. Preoperative mean forced expiratory volume in 1 s (FEV1) value was 32.7%, total lung capacity 132%, residual volume 280%. The average length of hospital stay was found to be 7.75 days (4-19), and the time to remove the thorax drain was 9.5 (4-23) days. FEV1: 1.78 (48.5%) was found in the pulmonary function tests of the patients at the 6th month postoperative controls. According to preoperative FEV1, 48.3% improvement was detected.

CONCLUSIONS

Volume reduction surgery is a treatment method that positively affects the natural course of emphysema in addition to quitting smoking and oxygen therapy. Patients with predominantly emphysema in the upper lobes, low exercise capacity, and appropriate FEV1 values benefited most from this treatment.