Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax using a single-incision laparoscopic surgery port: a feasible and safe procedure. Surg Endosc. 2011;25:2044-2047. [PMID: 21136111 DOI: 10.1007/s00464-010-1470-7]

Evaluating postoperative recovery in uniportal versus needlescopic video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: a comparable study

Objectives

Primary spontaneous pneumothorax (PSP) is a common disease in young and thin male. Operation has been regarded as definitive treatment for it. However, the operative methods for those patients are under dispute. This study aims to directly compare the outcomes of uniportal VATS vs. needlescopic VATS in the treatment of PSP, focusing on postoperative pain and safety outcomes.

Methods

From July 2013 to December 2017, the patients who underwent video-assisted thoracic surgery for pneumothorax in National Taiwan University Hospital were retrospectively collected. The preoperative condition, surgical results, and postoperative outcomes was analyzed.

Results

There were 60 patients undergoing needlescopic VATS and 91 undergoing uniportal VATS during the study period. There was no significant difference between the patients who underwent needlescopic VATS and those who underwent uniportal VATS in their demographic and clinical characteristics. The post-operative pain score was significantly lower in the uniportal VATS group compared to the needlescopic VATS group at day 1 (2.65 ± 1.59 vs. 1.74 ± 1.35, p = 0.001).

Conclusion

Uniportal VATS offers an effective, safe alternative for PSP treatment, with benefits including reduced post-operative pain. Our findings support the use of uniportal VATS, supplemented by a wound protector, as a viable option for PSP patients.

Sub-axillary cosmetic incision versus single-incision thoracoscopic surgery for primary spontaneous pneumothorax

BACKGROUND

In recent years, single-incision thoracoscopic surgery (SITS) has been increasingly applied as an optimal treatment option for primary spontaneous pneumothorax (PSP). However, most SITS techniques are used in the fourth to sixth intercostal space between the anterior axillary and mid axillary lines. To find out more concealed incisions, this study performed PSP surgery via the sub-axillary cosmetic incision (SACI) technique.

METHODS

A total of 128 PSP patients were subjected to video-assisted thoracoscopic surgery (VATS) between January 2017 and January 2019 at our institution. These patients were evaluated and assigned into SACI (n = 21) and SITS (n = 57) groups. Propensity score matching (PSM) was performed based on patients' backgrounds, and the enrolled cohort was divided into 21 pairs. The incision satisfaction was assessed at 2 weeks and 6 months post-surgery.

RESULTS

The 21 pairs with matching baseline characteristics in the two groups did not exhibit significant differences in their backgrounds and surgical results. However, compared with the SITS group, the operation time was longer in the SACI group (p = 0.013). There were no post-operative complications in both groups. At 2 weeks and 6 months, incision satisfaction scores in the SACI group were significantly lower than those in the SITS group (p = 0.022 and p = 0.039, respectively). There were no recurrences of ipsilateral pneumothorax in both groups.

CONCLUSIONS

SACI is a safe and feasible surgical method for PSP treatment. In addition, incision concealment can be used for patients with incision needs.

Outcomes of Single-Incision Thoracoscopic Surgery Using the Spinal Needle Anchoring Technique for Primary Spontaneous Pneumothorax

Background

Although classical multi-port video-assisted thoracic surgery has been widely performed, single-incision thoracoscopic surgery (SITS) is a popular surgical technique for the treatment of primary spontaneous pneumothorax (PSP). However, the inconvenient alignment of instruments and the limited field of view occasionally make surgeons convert from SITS to multi-port surgery or extend the incision. This study aimed to present an easy and safe SITS technique for PSP using a spinal needle.

Methods

In total, 139 patients underwent SITS between May 2011 and December 2017. We used a spinal needle to hook the bulla or bleb, and wedge resection was performed through a small incision. Patients' medical records were reviewed retrospectively, and a telephone survey was conducted to investigate the recurrence rate.

Results

The mean age of the 139 patients was 23.62±9.60 years. The mean operative time was 36.69±14.64 minutes, and multi-port conversion was not performed. The mean postoperative hospital stay was 3.00±0.78 days, and the mean indwelling chest tube duration was 1.97±0.77 days. No complications were observed. In the mean follow-up period of 86.75±23.20 months, recurrence of pneumothorax was found in 3 patients.

Conclusion

We suggest that SITS for PSP with the aid of a spinal needle to replace a grasper is a safe and easy technique that only requires a small incision.

An air-locking port and high-flow nasal cannula in non-intubated uniportal video-assisted thoracic surgery for pneumothorax with pulmonary dysfunction: a case report

Background

Non-intubated video-assisted thoracic surgery is a therapeutic option for intractable secondary spontaneous pneumothorax in patients who are poor candidates for surgery with endotracheal intubation under general anesthesia. However, intraoperative respiratory management in this surgery is often challenging because of hypoxia caused by surgical pneumothorax.

Case presentation

A 75-year-old man with idiopathic pulmonary fibrosis who had been on home oxygen therapy underwent non-intubated uniportal video-assisted thoracic surgery for intractable spontaneous pneumothorax. During the operation, oxygen was administered using a high-flow nasal cannula at a high flow rate. An air-locking port for single-incision surgery was used to minimize the inflow of air into the pleural cavity. The intrapleural air was continuously suctioned through the chest tube. The air-leak point was easily identified and closed using ligation. Oxygenation was satisfactory throughout the operation.

Conclusions

Non-intubated uniportal video-assisted thoracic surgery for secondary spontaneous pneumothorax with an air-locking port, continuous pleural suction, and high-flow nasal cannula may achieve satisfactory intraoperative oxygenation in patients with respiratory dysfunction. The intrapleural space can be feasible for surgical manipulation without surgical pneumothorax in non-intubated video-assisted thoracic surgery even when supplied with oxygen at a high flow rate using a high-flow nasal cannula.

Uniportal thoracoscopic surgical management using a suture traction for primary pneumothorax

BACKGROUND

We devised a new strategy using suture traction to facilitate the management of primary spontaneous pneumothorax during uniportal thoracoscopy. To test its validity, we compared the outcomes of our modified technique with those of conventional three-port thoracoscopy.

METHODS

This retrospective study included all 43 consecutive patients with primary spontaneous pneumothorax undergoing thoracoscopy between January 2017 and December 2019. They were divided within two groups: uniportal thoracoscopy using suture traction (n = 21) and conventional 3-port thoracoscopy (n = 22). Postoperative pain, paresthesia, patient satisfaction, and surgical outcomes were compared to test the validity of our technique.

RESULTS

There were no significant differences in operative time (47 ± 4.8 vs. 43 ± 7.9 min), number of staples used (2.5 ± 0.9 vs. 2.3 ± 0.6), postoperative drainage (235 ± 15 vs. 240 ± 19 mL), chest tube drainage time (3.2 ± 0.8 vs. 3.4 ± 1.8 days), and hospital stay (4.2 ± 1.2 vs. 4.3 ± 0.9 days). However, uniportal thoracoscopy was associated with less pain at 24 (p = 0.01), 48 (p = 0.02), and 72 h (p = 0.03) postoperatively, less paresthesia at 24 (p = 0.03), 48 (p = 0.02), and 72 h (p = 0.02) postoperatively, and greater patient satisfaction at 24 (p = 0.04), 48 (p = 0.02), and 72 h (p = 0.02) postoperatively.

CONCLUSIONS

Our technique may facilitate the use of uniportal thoracoscopy for treatment of primary spontaneous pneumothorax, reducing neurological sequelae and improving patient satisfaction compared to the traditional three-port thoracoscopy.

Low-cost of uniportal thoracoscopic surgery for primary spontaneous pneumothorax

Objective

Single-incision thoracoscopic surgery is a favorable treatment choice for primary spontaneous pneumothorax, and manual ligation of the bleb during thoracoscopic surgery appears to offer better economic results. In this study we undertook ligation of the bleb by hand under uniportal thoracoscopic surgery for primary spontaneous pneumothorax.

Methods

Between June 2015 and December 2016, a series of 26 patients with primary spontaneous pneumothorax underwent hand ligation of blebs using the technology of uniportal thoracoscopy, followed by pleural abrasion as necessary.

Results

No case was converted to two- or three-port video-assisted thoracoscopic surgery during the operation. No patients experienced prolonged (>5 days) air leakage. No other complication was recorded. No recurrence of pneumothorax was encountered during 29–47 months follow-up. Compared with the group treated by bullectomy using stapler, we found a significant reduction in medical costs in the group with bleb ligation.

Conclusions

Ligation of the bleb by hand under uniportal thoracoscopic surgery for primary spontaneous pneumothorax is a safe and offers better economic results, which is applicable for low income family.

Single incision VATS decortication for 3rd stage empyema

The use of U-VATS should be preferred to conventional three-port VATS if skills are mastered as it causes less and single intercostal trauma. Moreover, it minimizes infection spread to the chest wall. We advocate the use of U-VATS as a routine approach in patient with empyema stage III for positive outcome.

Uniportal bilateral video-assisted sequential thoracoscopic extended thymectomy

Standard video-assisted thoracoscopic surgery has been reported as a minimally invasive approach alternative to sternotomy for management of myasthenia gravis (MG) associated with thymoma or thymic hyperplasia. Uniportal video-thoracoscopy is an evolution of standard multi-portal video-thoracoscopy for management of several thoracic diseases but its role for resecting mediastinal tumor remains under-evaluated. Herein, we describe our experience with bilateral uniportal thoracoscopic sequential extended thymectomy with case and video illustrations.

Barbed suture material technique for wound closure and concomitant tube placement in uniportal VATS for pneumothorax

BACKGROUND

Uniportal video-assisted thoracoscopic surgery (VATS) is an alternative modality for treatment of primary spontaneous pneumothorax (PSP) with its less invasiveness and acceptable surgical outcomes. However, a few reports have been introduced for wound management to achieve better cosmetic wound healing and for placement of the chest tube in uniportal VATS. Thus, we aimed to evaluate the feasibility of our novel method for wound closure and concomitant tube placement using continuous barbed suture material in uniportal VATS for PSP.

METHODS

Between July 2012 and December 2015, consecutive 31 patients (22 males) underwent uniportal VATS to treat PSP. Bilateral approaches were performed in four patients, thus total 35 cases were enrolled. We divided them into two groups with one group of 17 (48.5%) cases (group A), using barbed absorbable wound closure device for knotless continuous wound closure and subsequent chest tube anchoring, and the other group of 18 (51.4%) cases (group B), using conventional suture anchoring after skin closure using absorbable suture device. Postoperative surgical outcomes were compared to assess the feasibility of this technique.

RESULTS

Demographic data demonstrate no significant difference in both groups. There was no significant difference in length of hospital stay (3.7±1.2 vs. 4.1±1.2 days, P=0.267) and in median chest tube indwelling time (2.4±0.9 vs. 3.1±1.2 days, P=0.066), respectively. Operation time in group A was shorter than in group B but there was no significant difference (41.7±11.8 vs. 45.6±16.0 minutes, P=0.415). There was neither conversion to two or three port VATS in all cases. In group A, all chest tubes were removed with concomitant sealing the tube removal site by pulling the thread. Residual knots do not exist that stitch out procedure is not required. There was no wound complication in both groups during the median follow-up period of 18 months.

CONCLUSIONS

Knotless, barbed suture material technique for continuous wound closure with concomitant chest tube placement achieved equivocal outcomes in comparison to the conventional suture anchoring method. We suggest this simple technique for wound closure and easy tube removal with cosmetic wound healing in uniportal VATS for PSP.

Three Hundred Fifty-One Patients With Pneumothorax Undergoing Uniportal (Single Port) Video-Assisted Thoracic Surgery

BACKGROUND

Video-assisted thoracic surgery (VATS) is usually performed using three ports. Uniportal VATS has not yet been widely developed. We report our single institution experience in uniportal VATS for the surgical management of 351 patients with pneumothorax.

METHODS

Between November 2009 and February 2016, we conducted a study in 351 patients treated for pneumothorax using uniportal VATS. Resection of apical bullae associated with partial pleurectomy, pleural abrasion, or talc effusion was performed.

RESULTS

The mean age was 29.6 ± 10.1 years. Surgical indications were mainly persistence or recurrence of pneumothorax. Sixty-seven patients (19%) presented with complications. At the 30-day control, 60.1% of patients were asymptomatic; 85% of patients were satisfied with the single small scar. The recurrence rate was 3.6% at 24 ± 13 months.

CONCLUSIONS

Uniportal VATS is feasible, safe, and reproducible in the treatment of pneumothorax. Morbidity is similar to multiport VATS. The recurrence rate is comparable with best results after multiport VATS or thoracotomy. Patients were satisfied with the single small scar.

Feasibility of single-incision thoracoscopic surgery using a modified chest wall pulley for primary spontaneous pneumothorax: a propensity score matching analysis

PURPOSE

Recently, single-incision thoracoscopic surgery (SITS) has been recognized as a favorable treatment choice for primary spontaneous pneumothorax (PSP) compared with conventional three-port video-assisted thoracoscopic surgery (VATS). However, conventional SITS bullectomy often results in collisions with surgical devices. Therefore, we devised a method of SITS using a chest wall pulley for lung excision (PulLE) and modified PulLE (mPulLE) system, which substitutes threads to eliminate such collisions. We compared the mPulLE system with conventional procedures using propensity score matching (PSM) to adjust for patient backgrounds.

METHODS

Using PSM, we evaluated the surgical results of 210 PSP patients who underwent VATS, including mPulLE (n = 23) and three-port VATS (n = 102), at our institution between January 2010 and August 2016.

RESULTS

We selected 17 mPulLE cases and 17 three-port VATS. There were no marked differences between the groups in the patient backgrounds or surgical results. However, there was a significant difference between the mPulLE cases and the three-port VATS cases in the operative time (71.7 ± 15.7 vs. 85.9 ± 25.5 min, respectively, P = 0.0388) and the number of autosutures used (3.6 ± 1.2 vs. 4.5 ± 1.2, respectively, P = 0.0178).

CONCLUSION

The surgical results of mPulLE in patients with PSP with multiple lesions were equivalent to those achieved with three-port VATS under the same conditions.

Uniportal video-assisted thoracic surgery for left upper lobe: single-direction lobectomy with systematic lymphadenectomy

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.

Reduced Port Thoracoscopic Surgery for Mediastinal and Pleural Disease: Experiences in a Single Institution

The purpose of this study was to present our current experience with reduced port thoracoscopic surgery (RPTS) for the treatment of mediastinal and pleural disease and thereafter discuss its indications and technical challenges. A total of 11 patients underwent surgery by the RPTS approach for the following conditions: thymoma (n = 2), bronchogenic cyst (n = 2), metastatic pleural tumor, thymic cyst, solitary fibrous tumor, pulmonary sequestration, pericardial cyst, neurinoma, and malignant lymphoma (n = 1). An Endo Relief forceps (Hope Denshi Co, Ltd, Chiba, Japan) was used for three of the surgical procedures. The elements of the data set consisted of gender, age, duration of operation, drain placement, hospital stay, mass location, and mass size. The median surgical time was 45 min (range, 40-78 min). There were no intraoperative complications and no need for a second surgery to open additional ports. The duration until chest tube removal was 1 day for all the cases. The median hospital stay was 4 days (range, 3-6 days). The median mass size was 2.2 cm (range, 1.2-4.2 cm). The median length of skin incision was 2.0 cm (range, 2.0-3.5 cm). In conclusion, RPTS for mediastinal and pleural disease may be a possible alternative approach to conventional multiportal video-assisted thoracoscopic surgery (VATS). Although it is technically plausible and feasible for selected cases, the issues of patient acceptability and cosmetic and oncological results remain to be determined in the future with randomized-controlled trials and long-term follow-up.

Transareolar pulmonary bullectomy for primary spontaneous pneumothorax

BACKGROUND

Conventional 3-port video-assisted thoracoscopic surgery is the classic approach for the diagnosis and treatment of primary spontaneous pneumothorax. Transareolar pulmonary bullectomy rarely has been attempted. This study aimed to evaluate the feasibility and safety of this novel minimally invasive technique in managing primary spontaneous pneumothorax.

METHODS

From January 2013 to December 2014, a total of 112 male patients with primary spontaneous pneumothorax underwent transareolar pulmonary bullectomy by use of a 5-mm thoracoscope.

RESULTS

All procedures were performed successfully, with a mean operating time of 26.5 minutes. The mean length of transareolar incision for the main operation was 2.0 ± 0.2 cm, the mean length of incision for the camera port was 0.6 ± 0.1 cm, and the mean postoperative cosmetic score was 3.0 ± 0.8. All patients regained consciousness rapidly after surgery. One hundred seven patients (95.5%) were discharged on postoperative day 2 or 3, with the remainder discharged on postoperative day 4 or 5. Postoperative complications were minor. At 6 months postoperatively, there was no obvious surgical scar on the chest wall, and no patient complained of postoperative pain. No recurrent symptoms were observed. One-year follow-up revealed an excellent cosmetic result and degree of satisfaction.

CONCLUSIONS

Transareolar pulmonary bullectomy is a safe and effective therapeutic procedure for primary spontaneous pneumothorax caused by pulmonary bullae. The incision is hidden in the areola with excellent cosmetic effects. This novel procedure shows promise as a treatment of primary spontaneous pneumothorax.

Single-port thoracoscopic surgery for pneumothorax under two-lung ventilation with carbon dioxide insufflation

BACKGROUND

The development of single-port thoracoscopic surgery and two-lung ventilation reduced the invasiveness of minor thoracic surgery. This study aimed to evaluate the feasibility and safety of single-port thoracoscopic bleb resection for primary spontaneous pneumothorax using two-lung ventilation with carbon dioxide insufflation.

METHODS

Between February 2009 and May 2014, 130 patients underwent single-port thoracoscopic bleb resection under two-lung ventilation with carbon dioxide insufflation. Access was gained using a commercial multiple-access single port through a 2.5-cm incision; carbon dioxide gas was insufflated through a port channel. A 5-mm thoracoscope, articulating endoscopic devices, and flexible endoscopic staplers were introduced through a multiple-access single port for bulla resection.

RESULTS

The mean time from endotracheal intubation to incision was 29.2±7.8 minutes, the mean operative time was 30.9±8.2 minutes, and the mean total anesthetic time was 75.5±14.4 minutes. There were no anesthesia-related complications or wound problems. The chest drain was removed after a mean of 3.7±1.4 days and patients were discharged without complications 4.8±1.5 days from the operative day. During a mean 7.5±10.1 months of follow-up, there were five recurrences (3.8%) in operated thorax.

CONCLUSIONS

The anesthetic strategy of single-lumen intubation with carbon dioxide gas insufflation can be a safe and feasible option for single-port thoracoscopic bulla resection as it represents the least invasive surgical option with the potential advantages of reducing operative time and one-lung ventilation-related complications without diminishing surgical outcomes.

Single port VATS mediastinal tumor resection: Taiwan experience

BACKGROUND

To present the technique of single-port video-assisted thoracoscopic mediastinal tumor resection, which includes limited thymectomy, extended thymectomy, cyst excision and posterior mediastinal tumor excision, and the early results of resection with the use of this technique.

METHODS

Forty patients with mediastinal tumors were treated with single-port thoracoscopic mediastinal resection at Chang Gung Memorial Hospital between April 2014 and September 2015. The surgical intervention was performed through the fourth or fifth intercostal space at the anterior axillary line. A 5 or 10 mm 30 degree video camera and working instruments were employed simultaneously at this incision site throughout the surgery.

RESULTS

Among the 40 cases included in the final analysis, 10 extended thymectomies, 7 limited thymectomies, nine cyst excisions and 14 tumor excisions were performed successfully without the need for conversion. For the 40 patients who underwent single-port video-assisted thoracoscopic surgery (VATS), the mean operation time was 97.3±31.2 min and the average blood loss was 29.75±39.77 mL. The average length of the incision wound was 3.22±0.79 cm and the average length of postoperative hospital stay was 3.72±1.63 days. There were no mortalities and mobility was achieved within 30 days postoperatively.

CONCLUSIONS

Our preliminary report suggests that uniportal VATS for mediastinal tumor resection is a promising and safe technique within a short-term period.

Video-assisted thoracoscopic surgery for retained hemothorax in blunt chest trauma

Purpose of review

In the last decade, video-assisted thoracoscopic surgery (VATS) has become a popular method in diagnosis and treatment of acute chest injuries. Except for patients with unstable vital signs who require larger surgical incisions to check bleeding, this endoscopic surgery could be employed in the majority of thoracic injury patients with stable vital signs.

Recent findings

In the past, VATS was used to evacuate traumatic-retained hemothorax. Recent study has revealed further that lung repair during VATS could decrease complications after trauma. Management of fractured ribs could also be assisted by VATS. Early VATS intervention within 7 days after injury can decrease the rate of posttraumatic infection and length of hospital stay. In studies of the pathophysiology of animal models, N-acetylcysteine and methylene blue were used in animals with blunt chest trauma and found to improve clinical outcomes.

Summary

Retained hemothorax derived from blunt chest trauma should be managed carefully and rapidly. Early VATS intervention is a well tolerated and reliable procedure that can be applied to manage this complication cost effectively.

Single-Port Video-Assisted Thoracic Surgery for Secondary Spontaneous Pneumothorax: Preliminary Results

Background

The aim of this study was to evaluate the feasibility of single-port video-assisted thoracic surgery (VATS) in the treatment of secondary spontaneous pneumothorax (SSP).

Methods

Twenty-four patients who were scheduled to undergo single-port VATS for SSP were studied. The medical records of the patients were retrospectively reviewed. The mean follow-up duration was 26.1±19.8 months. In order to evaluate the feasibility of single-port VATS for SSP, the postoperative results of single-port VATS (n=15) in patients with emphysema were compared with those of emphysematous patients who underwent three-port VATS (n=15) during the study period.

Results

Single-port VATS was feasible in 19 of 24 patients (79.2%), while an additional port was needed in five patients. In the single-port VATS patients, the median operation time, duration of chest tube drainage, and hospital stay were 84.0 minutes, one day, and two days, respectively. Postoperative complications included prolonged chest tube drainage for more than five days (n=1), wound infection (n=1), and vocal fold palsy (n=1). No recurrence of pneumothorax was observed during the follow-up period. The median operation time, duration of chest tube drainage, and hospital stay of the emphysematous patients who underwent single-port VATS were shorter than those who underwent three-port VATS group (p<0.05 for all parameters).

Conclusion

Single-port VATS proved to be a feasible procedure in the treatment of patients with secondary spontaneous pneumothorax.

Comparative Short-Term Clinical Outcomes of Mediastinum Tumor Excision Performed by Conventional VATS and Single-Port VATS: Is It Worthwhile?

Single-port video-assisted thoracoscopic surgery (VATS) has been widely applied recently. However, there are still only few reports describing its use in mediastinum tumor resection. We present the technique of single-port video-assisted thoracoscopic mediastinum tumor resection and compare it with conventional VATS with regard to short-term outcome.We retrospectively enrolled 105 patients who received mediastinum surgery in Chang Gung Memorial Hospital. Sixteen patients received sternotomy or thoracotomy, 29 patients received single-port VATS, and 60 patients received conventional VATS (3 ports). The operative time, blood loss, postoperation day 1 pain score, discharge day pain score, and postoperative hospital stay were compared. In order to establish a well balanced cohort study, we also use propensity scores match (1:1) to compare the short-term clinical outcome in 2 groups.No operative deaths occurred in this study. Single-port VATS was associated with shorter operative time, lower postoperation day 1 pain score, and shorter postoperation hospital stay in our cohort study (P = 0.001, <0.001, and 0.039), and propensity scores matched cohort study (P = 0.003, <0.001, and <0.001).Single-port VATS for mediastinum tumor appears to be a safe and promising technique with short-term outcome not inferior to conventional VATS in our cohort study. The long-term oncology outcome may require time and more enrolled patients to be further evaluated.

Uniportal Videothoracoscopic Surgery: Our Indications and Limits

Objective

We present our experience with uniportal videothoracoscopic surgery (VATS-U), examining its indications, limits, and results.

Methods

Since January 2009, 66 patients underwent VATS-U for the following indications: pneumothorax (n = 25), lung nodule (n = 15; n = 10 with preoperative radiolocalization), wedge biopsy (n = 15), hyperhidrosis (n = 10), and chest wall schwannoma (n = 1). The conversion rate to conventional video-assisted thoracic surgery (VATS), postoperative pain, complications, residual paraesthesia, and hospitalization were analyzed. Operative time, postoperative pain, and paraesthesia were retrospectively compared with a cohort of 172 cases of conventional multiportal VATS, performed in the same period.

Results

Conversion to traditional VATS was necessary in two cases (pulmonary nodule, n = 1; pneumothorax, n = 1). The mean pain score was 0.8, the mean operation time was 42 minutes, and 10 patients had postoperative paraesthesia that lasted a mean of 7 days. No postoperative complications were reported, and the mean postoperative hospital stay was 3 days (range, 1–6 days). The comparison between the VATS-U and the standard multiportal VATS group showed in the VATS-U group a lower but not statistically significant pain score and paraesthesia as well as a lower and statistically significant operative time.

Conclusions

Uniportal videothoracoscopic surgery has a wide range of indications: lung apex resections and pleurodesis for spontaneous pneumothorax treatment; pulmonary nodule assessment with or without preoperative localization; lung biopsy for interstitial diseases; unilateral or bilateral sympathectomy to treat hyperhidrosis; benign chest wall tumor evaluation. The limits of this technique are linked to pleural adhesions or lung nodules in difficult positions. In our experience, VATS-U results in minimal postoperative pain, allowing for fast functional recovery and a consequent short hospital stay; thus, we suggest that VATS-U is a valid alternative to traditional multiportal VATS for indications beyond cosmetic benefits. Prospective randomized trials are necessary to validate the advantages of uniportal VATS.

Single-port video-assisted thoracoscopic mediastinal tumour resection

OBJECTIVES

To present the technique of single-port video-assisted thoracoscopic mediastinal tumour resection, which includes limited thymectomy, extended thymectomy, cyst excision and posterior mediastinal tumour excision, and the early results of resection with the use of this technique.

METHODS

Twenty-nine patients with mediastinal tumours were treated with single-port thoracoscopic mediastinal resection at Chung Gung Memorial Hospital between April 2014 and May 2015.The surgical intervention was performed through the fourth or fifth intercostal space at the anterior axillary line. A 5- or 10-mm 30° video camera and working instruments were employed simultaneously at this incision site throughout the surgery. The perioperative variables and outcomes were collected and analysed retrospectively.

RESULTS

Among the 29 cases included in the final analysis, 8 extended thymectomies, 5 limited thymectomies, 7 cyst excisions and 9 tumour excisions were performed successfully without the need for conversion. For the 29 patients who underwent single-port video-assisted thoracoscopic surgery (VATS), the mean operation time was 97.3 ± 31.2 min and the average blood loss was 34.1 ± 45.7 ml. The average length of the incision wound was 3.41 ± 0.76 cm and the average length of postoperative hospital stay was 3.75 ± 1.53 days. There were no mortalities, and mobility was achieved 30 days after surgery.

CONCLUSIONS

With regard to oncological concerns, the occurrence of postoperative myasthenia gravis or freedom from tumour recurrence is a paramount issue. Our cohort follow-up time was not long enough to address this, and more time and patients are needed for further evaluation. But our preliminary report showed that uniportal VATS for mediastinal tumour resection was a promising and safe technique with regard to short-term clinical outcome.

Small Single-Incision Thoracoscopic Surgery Using an Anchoring Suture in Patients With Primary Spontaneous Pneumothorax: A Safe and Feasible Procedure

BACKGROUND

Single-incision thoracoscopic surgery is an alternative procedure used to treat primary spontaneous pneumothorax, although conventional three- or four-port video-assisted thoracoscopic surgery is the recognized standard procedure. Single-incision thoracoscopic surgery is not yet popular when a wedge resection is required during general thoracic surgery, including pneumothorax surgery and lung biopsy, because of the danger of collision between instruments during surgery. In addition, introducing all of the instruments through a single incision means that a relatively large incision is required, leading to less than satisfactory cosmetic outcomes. The purpose of this study was to show that our in-house surgical method is a safe, alternative procedure for treating a primary spontaneous pneumothorax.

METHODS

A total of 104 patients underwent our in-house surgical procedure to treat primary spontaneous pneumothorax from October 2012 to October 2014. Mean patient age was 22.7 ± 8.8 years; 91 patients were male and 13 were female. We used a wound protector intraoperatively, and placed an anchoring suture at the point of the bleb lesion, permitting us to retract the lung, which enabled us to create a small skin incision (<2 cm). We only inserted a stapler and the scope through this small incision when we performed the wedge resection; no lung manipulation (normally requiring instrumentation) was necessary. A total of 107 surgeries were performed (3 patients experienced contralateral recurrences). All clinical data were analyzed retrospectively.

RESULTS

Mean operative time (107 surgeries) was 49.7 ± 13.9 minutes, and the mean duration of thoracic catheter insertion was 4.1 ± 1.0 days. Three cases were converted to two- or three-port video-assisted thoracoscopic surgery during the operation. Three patients experienced prolonged air leakage (>5 days). No other complication was recorded. The Wong-Baker pain scores on postoperative days 0, 1, and 2 were 2.4 ± 1.0, 2.3 ± 1.3, and 1.7 ± 0.83, respectively. The mean duration of postoperative hospital stay was 4.8 ± 1.7 days. The mean follow-up period was 11 ± 6 months. Twelve patients experienced chest wall paresthesia (11.2%). One ipsilateral pneumothorax recurrence was encountered during follow-up.

CONCLUSIONS

Small (<2 cm) single-incision thoracoscopic surgery using a wound protector and a bidirectional anchoring suture was safe and feasible and yielded acceptable outcomes for treating primary spontaneous pneumothorax.

ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax

Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required.

Initial Experience of Single-Incision Thoracoscopic Surgery for 100 Patients with Primary Spontaneous Pneumothorax

PURPOSE

The aim of this retrospective study was to evaluate single-incision thoracoscopic surgery (SITS) for primary spontaneous pneumothorax (PSP).

METHODS

Among 141 patients who underwent surgery for PSP from July 2009 to December 2013, a total of 100 patients underwent SITS. Their data were examined for clinical characteristics and surgical results.

RESULTS

More patients with younger age, female sex, and who had social indications were treated by SITS than by three-port video-assisted thoracic surgery (VATS). The mean operative time for SITS was 48.8 min. There were no conversions from SITS to three-port VATS or thoracotomy. After SITS, the median duration of chest drainage was 1 day, and the median hospital stay was 2 days. Early complications included one surgical-site infection and one case of air leakage. Four patients (4.0%) had ipsilateral recurrence of PSP.

CONCLUSION

SITS is feasible when performed for selected patients with PSP. Long-term follow-up and further examinations are required to evaluate patient selection, efficacy, and comparability of SITS with conventional open and three-port VATS approaches.

Nonintubated uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

OBJECTIVE

The objective of the current study was to evaluate the feasibility and safety of nonintubated uniportal video-assisted thoracoscopic surgery (VATS) for the management of primary spontaneous pneumothorax (PSP).

METHODS

From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidural anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6(th) intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months.

RESULTS

The average time of surgery was 49.0 min (range, 33-65 min). No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients (93.75%) and moderate for two patients (6.25%). No recurrences of pneumothorax were observed at follow-up.

CONCLUSIONS

The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.

Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax

BACKGROUND

Like many other countries, including the United States, China faces the problem of rising health care costs, which have become a heavy burden on the state and individuals. Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Therefore, the development of video-assisted thoracic surgery with no disposable consumables will help to control medical cost escalation.

METHODS

Between October 2011 and September 2014, a series of 66 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad.

RESULTS

Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage, and postoperative stay between the two groups. The follow-up period varied from 1 to 35 months and six cases of recurrence were noted.

CONCLUSIONS

The technique that we described appears to offer better economic results than bullectomy with a stapler under three-port video-assisted thoracoscopic surgery for treating primary spontaneous. The clinical outcomes are similar.

Primary pneumothorax: Should surgery be offered after the first episode?

Surgery is the recommended and most effective means of preventing the recurrence of primary spontaneous pneumothorax (PSP). However, the conventional belief amongst most clinicians is that surgery should not be routinely offered to patients with an uncomplicated first episode of PSP. The view that surgery should be reserved for recurrent episodes of ipsilateral PSP is based on an apprehension regarding traumatic thoracic surgery combined with a perception that recurrences after a single episode of PSP are unlikely. Modern advances in minimally invasive thoracic surgery have now dramatically reduced the morbidity of PSP surgery. Such surgery is now safe, effective and causes minimal indisposition for patients. On the other hand, modern clinical data suggests that recurrence rate of PSP is perhaps much higher than previously assumed, with more than half of patients experiencing a second episode within several years of the first. With such new appreciations of the current situation, it is appropriate to now consider offering surgery to patients even after the first episode of PSP.

Uniportal video assisted thoracoscopic lobectomy: primary experience from an Eastern center

BACKGROUND

Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy is an emerging technique for the surgical resection of non-small cell lung cancer (NSCLC). Besides its wide debates on safety and efficacy throughout the world, there were few report on uniportal VATS from the Eastern countries. In this article, we summarized our primary experience on uniportal VATS lobectomy in an Eastern center.

METHODS

From October 2013 till February 2014, 54 consecutive uniportal VATS lobectomy were performed in the Department of Thoracic Surgery, Zhongshan Hospital of Fudan University. Patients' clinical features and operative details were recorded. Post-operatively, the morbidity and mortality were recorded to analyze the safety and efficacy of uniportal VATS lobectomy for NSCLCs.

RESULTS

Among the 54 planned uniportal VATS lobectomy, there was one conversion to mini-thoracotomy due to lymph node sticking. Extra ports were required in two patients. The uniportal VATS lobectomy was achieved in 51 out of 54 patients (94.4%). The average operation duration was 122.2±37.5 min (90-160 min). The average volume of estimated blood loss during the operation was 88.8±47.1 mL (50-200 mL). The mean chest tube duration and hospital stay were 3.2±1.9 days and 4.6±2.0 days, respectively. There was no postoperative mortality in this study. Two patients suffered from prolonged air leakage (5 and 7 days), and one atrial fibrillation was observed in this cohort.

CONCLUSIONS

Based on our primary experience, uniportal VATS lobectomy is a safe and effective procedure for the surgical resection of NSCLCs. The surgical refinements and instrumental improvements would facilitate the technique. Further studies based on larger population are required to determine its benefits towards patients with NSCLCs.

Single-incision thoracoscopic surgery for spontaneous pneumothorax using multi-degrees of freedom forceps

PURPOSE

The objective of this study was to assess the perioperative results of a single-incision approach using multi-DOF forceps for spontaneous pneumothorax, in comparison with the traditional 3-port approach.

METHODS

Between May 2012 and June 2013, 44 patients with spontaneous pneumothorax underwent SITS, and their clinical characteristics and perioperative results were evaluated. We then compared those who had undergone SITS (SITS group) with those who had undergone traditional 3-port surgery before the study period (3-port group).

RESULTS

The two groups were similar in terms of mean patient age and pneumothorax laterality (p = 0.81, 0.38), but the proportion of male patients was higher in the 3-port group than in the SITS group (p = 0.0026). Operation time in the SITS group (52.4 min) was longer than in the 3-port group (35.9 min, p &lt;0.0001). The duration of postoperative drainage and hospital stay did not differ significantly between the groups (p = 0.19, 0.075). Although 14 of the 56 SITS patients (25%) showed mild adhesion in the pleural cavity, none required conversion to a 3-port approach. The bullous region in two or three lobes was resected in 23 patients (41%).

CONCLUSIONS

SITS using multi-DOF forceps is a useful approach for treatment of spontaneous pneumothorax in selected patients.

A preliminary report on the feasibility of single-port thoracoscopic surgery for diaphragm plication in the treatment of diaphragm eventration

Introduction

Thoracoscopic surgery is a popular widely used surgical technique in the treatment of common chest conditions. Conventional thoracoscopic surgery utilizes multiple small wounds for carrying out the procedure. Many procedures can also be performed with a single small port wound. In this study, we performed diaphragm plication using the techniques of single-port thoracoscopic surgery.

Materials and methods

From July 1st, 2008 to December 31th, 2011, there were 21 patients admitted to our hospital due to diaphragm eventration. All of them underwent diaphragm plication. The initial 11 patients underwent two-port thoracoscopic surgery while the subsequent 10 patients underwent single-port thoracoscopic surgery.

Results

The side of diaphragm eventration was on the left in all of the cases. The mean operative time was 87.3 minutes and the mean follow-up time was 17 months. There was no procedure-related complication or mortality. The time required for surgery and the postoperative pain scores were similar in the two groups.

Conclusion

Single-port thoracoscopic surgery for diaphragm plication is a safe procedure. It can serve as an alternative to conventional thoracoscopic approaches to diaphragm surgery.

Feasibility of transumbilical lung wedge resection in a canine model

BACKGROUND

Chronic wound discomfort and intercostal neuralgia are well-known postoperative complications of video-assisted thoracoscopic surgery (VATS). To explore the possibility of a surgical platform that would cause less postoperative discomfort and avoid these complications, this study evaluated the feasibility of transumbilical lung wedge resection in a canine model.

MATERIALS AND METHODS

Twelve dogs (4 in the nonsurvival group and 8 in the survival group) were used in this study. Transumbilical thoracoscopy was performed using a homemade metallic tube via umbilical and diaphragmatic incisions with the animal in a supine position. After thoracic exploration, wedge resection was performed on the lung using an endoscopic stapling device placed through the transumbilical and transdiaphragmatic incisions under direct bronchoscopic guidance. The animals were sacrificed 30 minutes after the procedure (nonsurvival group) or 14 days postsurgery (survival group) for necropsy and histological evaluations.

RESULTS

Eleven preplanned lung wedge resections were completed in a median time of 101 minutes (range, 65-175 minutes) with one exception due to inadequate stapling in the early phase of the experiment. There was one death directly related to postoperative massive airleaks and sepsis in the survival group. The other 7 animals had an uneventful postoperative period. Necropsies at 2 weeks after surgery confirmed successful lung resections and revealed no evidence of vital organ injury. Two animals exhibited complete healing of the diaphragmatic incision. Liver herniation was identified in 1 of 5 animals with partial wound healing.

CONCLUSIONS

This preliminary animal study demonstrates that large lung wedge resection can be performed with mechanical staplers via a single transumbilical incision. Future studies will investigate the cardiopulmonary and immunologic effects of transumbilical VATS compared with conventional VATS.

Single-incision thoracoscopic surgery of pleural effusions for diagnosis and treatment

BACKGROUND

Several procedures such as video-assisted thoracoscopic surgery (VATS) are used to make a definite diagnosis in recurrent pleural effusions so that appropriate treatment can be arranged. Single-incision thoracoscopic surgery (SITS) is the most appropriate procedure that can be used for this purpose. The contribution of SITS to diagnosis and treatment is evaluated in this study that we conducted using a single thoracoport in patients with pleural effusion.

METHODS

Nineteen consecutive patients with pleural effusion that was recurrent or refractory to medical treatment were included in the study to be diagnosed and treated with SITS. Thoracentesis was performed and pleural fluid samples obtained in all patients before the procedure. Pleural effusion drainage was performed from the 11-mm single skin incision by using a 10.5-mm single thoracoport, and biopsy or talc pleurodesis was performed in the same session when needed.

RESULTS

The median age of the patients was 56.68 ± 3.05 years and there were 11 males and 8 females. The total amount of fluid drained by SITS was 1,436 ± 227 mL and the surgery lasted 81.05 ± 5.36 min. In addition, partial decortication and/or deloculation were performed in six patients and talc pleurodesis in nine patients. Fifteen patients were diagnosed with benign and four patients with malignant pleural effusion by thoracentesis, while nine patients were diagnosed with benign and ten patients with malignant pleural effusion by SITS. We therefore had six cases diagnosed as benign with thoracentesis who were diagnosed with malignant disease after SITS.

CONCLUSIONS

SITS presents both diagnosis and treatment options together for pleural effusions. We believe SITS should be preferred to conventional three-port VATS to minimize the spread of infection and tumor cells to the chest wall in infectious and malignant diseases.

Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery

Background

The current trend in thoracoscopic surgery is to use fewer ports to decrease postoperative pain, chest wall paresthesia, and duration of hospital stay. In this study we compared the results of our current experience with single-incision thoracoscopic surgery (SITS) and conventional three-port video-assisted thoracoscopic surgery (3P-VATS).

Methods

From October 2011 to August 2012, 37 consecutive patients underwent thoracoscopic surgery. This is a non-randomized retrospective study. Among these patients, 19 (SITS group) were treated using single port method (SITS), whereas 18 (3P-VATS group) were treated using the conventional three-port methods (3P-VATS). The surgical duration, number of resected lesions, duration of chest drainage, duration of hospital stay, inpatient pain scores, and patient satisfaction scores were compared between both groups.

Results

The mean age at surgery, indication, gender, body mass index, and the side involved were similar in both groups. The procedures performed in the SITS group were similar to those performed in the 3P-VATS group. The mean operative time was longer in the SITS group compared with the 3P-VATS group. Duration of postoperative drainage days and hospital stay was shorter in the SITS group compared with the 3P-VATS group, although these differences were not statistically significant. Pain scores on postoperative days 0,1, and 3 were significantly higher in patients who underwent 3P-VATS compared with those who underwent SITS (p = 0.012, 0.039, and 0.037, respectively). The SITS group reported higher patient satisfaction scores than the 3P-VATS group, patients in the 3P-VATS group tended to receive higher total doses of analgesics (NSAIDs) after surgery compared with those in the SITS group, although these differences were not statistically significant.

Conclusions

Our experience demonstrated that SITS decreased postoperative pain and resulted in higher patient satisfaction compared with the conventional three-port VATS. However, a prospective, randomized study is needed to confirm our preliminary findings. To overcome the technological limitations of SITS, the development of new instruments is needed.

Thoracoscopic wedge resection through a single incision using a thin puncture device

Video-assisted thoracic surgery (VATS) has been enthusiastically used as a less-invasive diagnostic or therapeutic surgical procedure in recent years. VATS results in considerably less postoperative pain than traditional thoracotomy incisions. The current trend is to reduce the number of ports and minimize the length of incisions to further reduce postoperative pain, chest wall paresthesia, and length of hospitalization. Although several accounts of reduced port surgery, such as single-incision laparoscopic surgery (SILS), have been reported, there are few descriptions of single-incision thoracoscopic surgery (SITS) using a thin puncture device for a variety of diseases. Herein, we describe a minimally invasive SITS technique using a thin puncture device.

Needlescopic video-assisted wedge resection combined with the subcostal trans-diaphragmatic approach for undetermined peripheral pulmonary nodules

BACKGROUND

Reduced mortality from lung cancer by computed tomography (CT) screening facilitates the use of video-assisted thoracic surgery (VATS) lung wedge resection to obtain a definite diagnosis and to treat tiny nodules. The authors evaluated their initial experience using novel needlescopic VATS wedge resection combined with the subcostal trans-diaphragmatic (SCTD) approach for managing undetermined peripheral pulmonary nodules.

METHODS

Between 2009 and 2012, 35 patients who had 36 operations underwent needlescopic VATS wedge pulmonary resection with the SCTD approach. Preoperative percutaneous CT-guided marking of the nodule was performed. Two 3-mm miniports were placed in the thorax for the thoracoscopic camera and minigrasper. Just anterior to the 10th rib, a 2-cm subcostal incision was made, and a 12- or 15-mm port was placed trans-diaphragmatically into the chest cavity. Wedge resection of the lung was performed with endostaplers introduced through a subcostal port.

RESULTS

The median tumor size was 1.1 cm. Localization of the tumor was widely distributed. The mean operation time was 51 min, and the mean blood loss was 4.2 mL. No patients required conversion to thoracotomy, and one patient required conversion to conventional VATS. Additional thoracic ports were placed in five patients, and the needlescopic incision was extended to 15 mm in one patient. The median duration of chest drainage was 1 day. Additional analgesia was not required for 22 patients and was used for less than 1 day for three patients, less than 2 days for seven patients, and less than 3 days for seven patients. The pathologic diagnosis of the nodules was malignant for 28 patients and benign for 8 patients. On postoperative day 7 or at admission, 34 patients were free of postoperative neuralgia.

CONCLUSIONS

Needlescopic VATS wedge pulmonary resection combined with the SCTD approach is both safe and feasible and offers the specific advantages of minimal invasiveness and good cosmetic outcomes.

The adequacy of single-incisional thoracoscopic surgery as a first-line endoscopic approach for the management of recurrent primary spontaneous pneumothorax: a retrospective study

BACKGROUND

Thoracoscopic surgery is a commonly used endoscopic surgical treatment approach in patients with primary spontaneous pneumothorax. The conventional thoracoscopic approach utilizes three or more small wounds for surgery. Currently, a single port approach is a potential alternative procedure in general thoracoscopic surgery. We investigated whether a single-port approach is suitable as a first-line endoscopic approach for all patients with primary spontaneous pneumothorax requiring surgery.

METHODS

From July 1st, 2008 to Dec 31, 2009, a total of 62 patients was included in this study. All the patients were admitted to our ward because they had surgical indications for surgery. Twenty-six patients underwent conventional three-port thoracoscopic surgery and thirty-six underwent single-port thoracoscopic surgery. All of the clinical data were analyzed retrospectively. Variables were compared and analyzed to determine the outcomes of the different surgical approaches.

RESULTS

The mean age of the 62 patients was 27.2 years. Forty-nine patients were men and thirteen patients were women. The mean time required for the operation was 61.6 minutes. There was one patient who had a recurrence in single-port group and 2 patients had a recurrence in three-port group during the period of follow-up. The average pain scores at 24 and 48 hrs after the operation were similar, but the pain scores at 72 hrs in the single-port group were better than the three-port group. There was no case that required conversion from a single-port to multiple wound approach in this study. There was no immediate postoperative recurrence. The follow-up duration was greater than 12 months.

CONCLUSION

This study showed that single-port thoracoscopic surgery is a feasible and reasonable first-line endoscopic approach in the surgical treatment of primary spontaneous pneumothorax.

Technical aspects of single-port thoracoscopic surgery for lobectomy

Thoracoscopic Surgery is in common use in routine surgical practice. With the advancement of the various techniques and instruments required, mini wounds and fewer thoracoports become practical in recent years. Here, we report our experience of performing lobectomy with radical lymph node dissection in 3 patients using regular straight endoscopic instruments. We demonstrate the feasibility of such techniques and discuss the key points of effectively performing the procedures. Because of the favorable outcomes, we encourage such procedures to be widely applied in surgical operations of various types.