1
|
Wang X, Wang Y, Cao M, Fu Y, Pan W, Ye Q, Zhao X, Sun Z. Perioperative comparison of uniportal versus multiportal video-assisted thoracoscopic surgery for complex segmentectomy of the lower lung lobe. BMC Surg 2025; 25:220. [PMID: 40394533 PMCID: PMC12093697 DOI: 10.1186/s12893-025-02944-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 05/05/2025] [Indexed: 05/22/2025] Open
Abstract
BACKGROUND Resection of basal segmentectomy through uniportal video-assisted thoracoscopic surgery (U-VATS) is technically challenging for thoracic surgeons. Compared with multiportal VATS (M-VATS), the safety and feasibility of U-VATS for complex segmentectomy of lower lung lobe need further validation. In this study, we aimed to compare the perioperative outcomes of U-VATS with M-VATS in the treatment of complex segmentectomy of lower lung lobe for stage IA lung cancer. METHODS We conducted a retrospective cohort study of 168 patients (116 U-VATS and 52 M-VATS) undergoing complex lower lobe segmentectomy for stage IA NSCLC from January 2021 to May 2023. The demographics of the enrolled patients were collected and propensity score matching (PSM) was used to reduce the heterogeneity of baseline characteristics. Perioperative outcomes were compared between the two groups. RESULTS After matching, 50 cases were yielded in each group. There was no 30-day postoperative mortality and conversion to open in both groups. The U-VATS exhibited shorter postoperative hospital stays (P = 0.034) and a trend toward reduced postoperative drainage (P = 0.081) compared to the M-VATS group. Pain score on postoperative day 2 in the U-VATS group was lower than M-VATS group (P = 0.004). There were no significant differences in resection margins, operation time and postoperative complications between the two groups. CONCLUSIONS U-VATS provides comparable perioperative safety and efficacy to M-VATS for complex lower lobe segmentectomy, with advantages in accelerated recovery and reduced postoperative pain. U-VATS complex segmentectomy of lower lung lobe is a safe and feasible technique for experienced thoracic surgeons, which deserves support and popularity.
Collapse
Affiliation(s)
- Xinyu Wang
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Yuming Wang
- Shanghai Chest Hospital, Shanghai Lung Cancer Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Min Cao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Yujie Fu
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Wenbiao Pan
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Qing Ye
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China.
| | - Zhiyong Sun
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China.
| |
Collapse
|
2
|
Weksler B, Maxwell C, Drake L, Crist L, Specht K, Kuchta P, DeHaven K, Weksler I, Williams BA, Fernando HC. A randomized study of cryoablation of intercostal nerves in patients undergoing minimally invasive thoracic surgery. J Thorac Cardiovasc Surg 2025; 169:1375-1382.e1. [PMID: 39522714 DOI: 10.1016/j.jtcvs.2024.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 10/16/2024] [Accepted: 10/31/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVES Minimally invasive thoracic surgery can cause significant pain, and optimizing pain control after surgery is highly desirable. We examined pain control after intercostal nerve block with or without cryoablation of the intercostal nerves. METHODS This was a randomized study (NCT05348447) of adults scheduled for a minimally invasive thoracic procedure. Each intercostal space near the incision site was injected with lidocaine and bupivacaine with epinephrine (standard of care). The cryoanalgesia group also had 5 to 6 intercostal nerves ablated. The primary outcome was the amount of narcotics (in morphine milligram equivalents taken during the postoperative hospital stay and the first 2 weeks postdischarge. Secondary outcomes were incentive spirometry volume and pain scores in the hospital and pain and neuropathy scores at 2 weeks. RESULTS Our final cohort contained 103 patients (52 standard of care and 51 cryoanalgesia). There were no differences between the treatment groups in morphine milligram equivalents administered during the hospital stay (44.9 vs 38.4 mg), total morphine milligram equivalents at 2 weeks (108.8 vs 95.2 mg), or pain assessed by visual analog scale on postoperative day 1 (3.8 and 3.3), postoperative day 2 (2 and 3.5), or 2 weeks (2 and 3.5) for standard of care and cryoanalgesia group patients, respectively. The decrease in incentive spirometry during the postoperative period was not significantly different between the 2 groups. Patients in the cryoanalgesia group had higher neuropathy scores (8 vs 13; P = .019) 2 weeks after surgery. CONCLUSIONS In this randomized study, cryoanalgesia did not decrease postoperative pain or narcotic requirements. Cryoanalgesia increased neuropathic pain 2 weeks after surgery.
Collapse
Affiliation(s)
- Benny Weksler
- Division of Thoracic and Esophageal Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pa.
| | - Conor Maxwell
- Division of Thoracic and Esophageal Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pa
| | - Lauren Drake
- Division of Thoracic and Esophageal Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pa
| | - Lawrence Crist
- Division of Thoracic and Esophageal Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pa
| | - Kara Specht
- Division of Thoracic and Esophageal Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pa
| | - Pamela Kuchta
- Division of Thoracic and Esophageal Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pa
| | - Kurt DeHaven
- Division of Thoracic and Esophageal Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pa
| | - Isabella Weksler
- Division of Thoracic and Esophageal Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pa
| | - Brent A Williams
- Division of Thoracic and Esophageal Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pa
| | - Hiran C Fernando
- Division of Thoracic and Esophageal Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pa
| |
Collapse
|
3
|
Zervos M, Park BJ, Marshall MB, Wee JO, Soukiasian HJ, Hartwig MG, Rajaram R, Rice DC. Robotic-assisted single-port system for pulmonary lobectomy: A prospective feasibility study. J Thorac Cardiovasc Surg 2025:S0022-5223(25)00293-4. [PMID: 40216299 DOI: 10.1016/j.jtcvs.2025.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 03/10/2025] [Accepted: 04/02/2025] [Indexed: 05/13/2025]
Abstract
OBJECTIVE To confirm the feasibility and safety of the da Vinci single-port (SP) System to perform pulmonary lobectomy procedures using a subcostal, uniportal approach. METHODS A prospective multicenter, single-arm clinical study evaluating the performance and safety of the da Vinci SP Surgical System for pulmonary lobectomy. RESULTS Nineteen subjects (benign, n = 1; malignant, n = 18) were enrolled at 6 academic medical centers in the United States and underwent robotic-assisted SP subcostal lobectomy. All SP lobectomy procedures were completed without conversion to multiport thoracoscopic/robotic or open approaches. No intraoperative adverse events (AEs) or unanticipated adverse device effects were observed; 13 postoperative AEs commonly experienced after lobectomy were reported, 4 of which were Clavien-Dindo grade III. The rate of complete resection (ie, R0) was 100%. The median number of nodal stations sampled was 6.5 (interquartile range [IQR], 6.0-8.0) with a median of 17.5 (IQR, 7.0-34.0) nodes resected per patient. CONCLUSIONS Robotic SP subcostal lobectomy is feasible and is associated with acceptable perioperative and oncologic quality outcomes. Additional clinical experience and research are needed to determine whether this alternative single incision approach has clinical benefit compared to standard transthoracic, multiport robotic lobectomy.
Collapse
Affiliation(s)
- Michael Zervos
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Blair Marshall
- Department of Surgery, First Physicians Group of Sarasota Memorial Health Care System, Sarasota, Fla; Thoracic Surgery Division, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Jon O Wee
- Thoracic Surgery Division, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Harmik J Soukiasian
- Division of Thoracic Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Matthew G Hartwig
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Health System, Durham, NC
| | - Ravi Rajaram
- Division of Surgery, Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C Rice
- Division of Surgery, Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
| |
Collapse
|
4
|
Ahmadinejad M, Soltani H, Foroohi M, Manesh NY, Mohajerani H, Ahmadinejad I, Bagherpour JZ. A retrospective cross-sectional study of therapeutic results of single port thoracoscopy in patients with lung collapse due to trauma: comparison of entirely recovered and re-thoracoscopy needed patients. BMC Surg 2025; 25:114. [PMID: 40133907 PMCID: PMC11934703 DOI: 10.1186/s12893-025-02834-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 03/07/2025] [Indexed: 03/27/2025] Open
Abstract
INTRODUCTION Lung collapse can occur for various reasons, especially trauma. Single-port thoracoscopy is a treatment method that has not been discussed in detail. This study aimed to investigate the results of single-port thoracoscopy as a treatment for trauma-induced lung collapse. METHODS This descriptive retrospective cross-sectional study included 100 patients with lung collapse following trauma who were referred to the Madani Hospital. Demographic data, underlying causes and injuries, respiratory and consciousness state, pain level, recurrence rate, hospitalization period, complications, and narcotic and non-narcotic analgesics, re-thoracoscopy, and thoracotomy requirements were evaluated. RESULTS The mean age of patients was 38 ± 16 years, and 65% were male. Single port thoracoscopy has suitable therapeutic effects, low complications, less pain, and reduced need for painkillers. Patients with more concomitant injuries, longer duration from trauma to performing thoracoscopy, intubation requirement, bilateral lung involvement, and lower GCS, required re-thoracoscopy, which has been associated with more extended hospitalization, suffering from more pain, need to receive narcotics and thoracotomy, and frequency of narcotic and non-narcotic agents. These results demonstrate the efficacy of the single port thoracoscopy in uncomplicated and initially completely recovered patients, and the re-thoracoscopy requirement and complications are based on the underlying cause and medical circumstances. CONCLUSION Single port thoracoscopy is practical for improving the quality of management of patients with lung collapse following trauma. Future studies should compare different methods.
Collapse
Affiliation(s)
- Mojtaba Ahmadinejad
- Department of General Surgery, School of Medicine, Alborz University of Medical Sciences, Taleghani Boulevard, Karaj, 3149779453, Iran
| | - Hedieh Soltani
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mojtaba Foroohi
- Clinical Research Development Unit of Shahid Madani Hospital, General Surgeon, Alborz University of Medical Sciences, Karaj, Iran
| | - Nafiseh Yousefi Manesh
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Hooravash Mohajerani
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Izadmehr Ahmadinejad
- Student Research Committee, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Zebarjadi Bagherpour
- Department of General Surgery, School of Medicine, Alborz University of Medical Sciences, Taleghani Boulevard, Karaj, 3149779453, Iran.
| |
Collapse
|
5
|
Salati M, Andolfi M, Roncon A, Guiducci GM, Xiumè F, Tiberi M, Nanto AC, Cingolani S, Ricci E, Refai M. Does the Performance of a Six-Minute Walking Test Predict Cardiopulmonary Complications After Uniportal Video-Assisted Thoracic Surgery Anatomic Lung Resection? Cancers (Basel) 2024; 17:32. [PMID: 39796663 PMCID: PMC11718962 DOI: 10.3390/cancers17010032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 12/04/2024] [Accepted: 12/11/2024] [Indexed: 01/13/2025] Open
Abstract
OBJECTIVES The purpose of the present study was to verify if performance in the 6-min walking test (6MWT) during the preoperative evaluation phase is associated with the development of cardiopulmonary postoperative complications in patients who underwent uniportal VATS (U-VATS) for lung cancer. METHODS This retrospective, monocentric study included patients submitted to U-VATS anatomical lung resections (March 2022-December 2023). The patients were enrolled in a preoperative rehabilitation program carried out 15 days before surgery. The 6MWT was performed at counseling (T0) and after pre-habilitation (T1). Univariate analysis followed by logistic regression verified the association of baseline patients' characteristics and performance in the 6MWT (meters walked during T0 and T1 and the difference between T1 and T0-T1-T0 variation) with postoperative cardiopulmonary complications (CPCs). Youde's index was used to establish the optimal cut-offs for ergometric parameters significantly correlated with CPCs. RESULTS We enrolled 212 patients scheduled to undergo U-VATS lung resection (lobectomies: 177; bilobectomies: 2; segmentectomies: 33). Twenty-three (10.8%) patients developed CPCs. None of the baseline patients' characteristics were associated with CPCs. Complicated patients showed more significant differences compared to non-complicated ones for meters walked during the 6MWT T1 (6MWT-T1-complicated: 450 vs. 6MWT-T1-non-complicated: 517; p: 0.01) and for variation-T1-T0 (variation-T1-T0-complicated: 4 m vs. variation-T1-T0-non-complicated: 20 m; p: 0.02). The best cut-offs for discriminating between patients with CPCs and those with uneventful courses were 458 m for 6MWT-T1 and 31 m for variation-T1-T0. After multivariate analysis, 6MWT-T1 < 458 m and variation-T1-T0 < 31 m were the unique parameters independently correlated with CPCs (p: 0.03 and p: 0.05, respectively). CONCLUSIONS The 6MWT results (in particular, 6MWT-T1 < 458 m and variation-T1-T0 < 31 m) in the context of a pre-habilitation program are associated with the development of CPCs after U-VATS lung resection.
Collapse
Affiliation(s)
- Michele Salati
- Unit of Thoracic Surgery, AOU of Marche, 60126 Ancona, Italy (A.C.N.)
| | - Marco Andolfi
- Unit of Thoracic Surgery, AOU of Marche, 60126 Ancona, Italy (A.C.N.)
| | - Alberto Roncon
- Unit of Thoracic Surgery, AOU of Marche, 60126 Ancona, Italy (A.C.N.)
| | | | - Francesco Xiumè
- Unit of Thoracic Surgery, AOU of Marche, 60126 Ancona, Italy (A.C.N.)
| | - Michela Tiberi
- Unit of Thoracic Surgery, AOU of Marche, 60126 Ancona, Italy (A.C.N.)
| | - Anna Chiara Nanto
- Unit of Thoracic Surgery, AOU of Marche, 60126 Ancona, Italy (A.C.N.)
| | - Sara Cingolani
- Unit of Rehabilitation Medicine, AOU of Marche, 60126 Ancona, Italy
| | - Eleonora Ricci
- Unit of Rehabilitation Medicine, AOU of Marche, 60126 Ancona, Italy
| | - Majed Refai
- Unit of Thoracic Surgery, AOU of Marche, 60126 Ancona, Italy (A.C.N.)
| |
Collapse
|
6
|
Trabalza Marinucci B, Siciliani A, Andreetti C, Tiracorrendo M, Messa F, Piccioni G, Maurizi G, D’Andrilli A, Menna C, Ciccone AM, Vanni C, Argento G, Rendina EA, Ibrahim M. Mini-Invasive Thoracic Surgery for Early-Stage Lung Cancer: Which Is the Surgeon's Best Approach for Video-Assisted Thoracic Surgery? J Clin Med 2024; 13:6447. [PMID: 39518587 PMCID: PMC11546881 DOI: 10.3390/jcm13216447] [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: 09/06/2024] [Revised: 10/06/2024] [Accepted: 10/22/2024] [Indexed: 11/16/2024] Open
Abstract
Objectives: The choice of the best Video-Assisted Thoracic Surgery (VATS) surgical approach is still debated. Surgeons are often faced with the choice between innovation and self-confidence. The present study reports the experience of a high-volume single institute, comparing data of uni-portal, bi-portal and tri-portal VATS, to find out the safest and most effective mini-invasive approach, leading surgeon's choice. Methods: Between 2015 and 2022, a total of 210 matched patients underwent VATS lobectomy for early-stage cancer, using uni-portal (fifth intercostal space), bi-portal (seventh space for optic and the fifth), and tri-portal (seventh and the fifth/four) access. Patients were matched for age, BPCO, smoke, comorbidities, lesions (size and staging) to obtain three homogenous groups (A: uni-portal; B: bi-portal; C: tri-portal). The surgeons had comparable expertise. Data were retrospectively collected from institutional database and analyzed. Results: No differences were detected considering time of surgery, length of hospital stay, complications, conversion rate, specific survival, and days of chest tube length of stay. Better results on chest tube removal were described in group A (mean 1.1 days) compared to B (mean 2.6 days) and C (mean 4.7 days); nevertheless, they not statistically significant (p = 0.106). Conclusions: No significant differences among the groups were described, except for the reduction in chest tube permanence in group A. This allows to hypothesize an enhanced recovery after surgery in this group but the different approaches in this series seem to guarantee comparable safety and effectiveness. Considering no superiority of one method above the others, the best suggested approach should be the one for which the surgeon feels more confident.
Collapse
Affiliation(s)
- Beatrice Trabalza Marinucci
- Department of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (A.S.); (C.A.); (M.T.); (F.M.); (G.P.); (G.M.); (A.D.); (C.M.); (A.M.C.); (C.V.); (G.A.); (E.A.R.); (M.I.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Agrafiotis AC, Moraitis SD, Sotiropoulos G. Uniportal Video-Assisted Thoracoscopic Surgery for Minor Procedures. J Pers Med 2024; 14:880. [PMID: 39202070 PMCID: PMC11355067 DOI: 10.3390/jpm14080880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/03/2024] Open
Abstract
INTRODUCTION Uniportal video-assisted thoracoscopic surgery (uVATS) is becoming popular for major lung resections, even for more complex procedures. The technique initially described for minor procedures seems more difficult to reproduce and has a longer learning curve. This review aims to describe the evolution from multiportal to uVATS and to explore its feasibility and reproducibility by identifying its drawbacks and limitations. METHODS Research from PubMed was obtained with the terms [uniportal] AND [surgery] OR [single-port] AND [thoracic surgery] OR [VATS]. Papers concerning pediatric cases and non-English papers were excluded. Individual case reports were also excluded. DISCUSSION uVATS seems to be widely adopted and performed for minor procedures. The applicability of uVATS for different indications is discussed, even though practically all thoracic surgical interventions can be performed through a single incision. CONCLUSIONS The transition from conventional three-port VATS to uVATS is described in this paper. An increasing number of thoracic surgeons worldwide have adopted this approach, even for major complex anatomical lung resections. Regarding the performance of minor thoracic interventions, we believe this technique is easily reproducible with a short learning curve because the instruments do not cross each other, and intraoperative movements remain intuitive. It is therefore a feasible, safe, and efficacious technique. For these reasons, we believe uVATS should be offered to all patients undergoing minor thoracoscopic procedures.
Collapse
Affiliation(s)
- Apostolos C. Agrafiotis
- Department of Thoracic and Vascular Surgery, Wallonie Picarde Hospital Center (Centre Hospitalier de Wallonie Picarde—CHwapi), 7500 Tournai, Belgium
- Department of Thoracic Surgery, Saint-Pierre University Hospital, 1000 Brussels, Belgium
| | - Sotirios D. Moraitis
- Department of Thoracic Surgery, Athens Naval and Veterans Hospital, 115 21 Athens, Greece
| | - Georgios Sotiropoulos
- Department of Thoracic Surgery, Athens Naval and Veterans Hospital, 115 21 Athens, Greece
| |
Collapse
|
8
|
Wang B, Wang J, Sun T, Ding Y, Li S, Lu H. Lu's approach for video-assisted thoracoscopic surgery. PLoS One 2024; 19:e0300632. [PMID: 38917144 PMCID: PMC11198770 DOI: 10.1371/journal.pone.0300632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/27/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVES Lu's approach for video-assisted thoracoscopic surgery (LVATS), which derives from UVATS, is a novel surgical approach for VATS and carries out micro-innovation for lung cancer resection. The objective of this study is to elucidate the safety, feasibility, and efficacy of this novel surgical approach. METHODS The clinical data of patients with non-small cell lung cancer (NSCLC) who underwent a curative thoracoscopic lobectomy between Mar. 2021 and Mar. 2022, were retrospectively collected, and analyzed. According to whether applied Lu's approach during the VATS operation, patients were divided into the LVATS group and the UVATS group. The propensity score (PS) matching method was used to reduce selection bias by creating two groups. After generating the PSs, 1:1 ratio and nearest-neighbor score matching was completed. Perioperative variables, including the operation time, intraoperative blood loss, lymph node stations dissected, total drainage volume, drainage duration, postoperative hospital stay, pain score (VAS, Visual Analogue Scale) on the postoperative first day (POD1) and third day (POD3), and incidence of postoperative complications, were compared between the two groups. The data were analyzed statistically with P<0.05 defined as statistically significant. RESULTS A total of 182 patients were identified, among whom 86 patients underwent LVATS and 96 UVATS. Propensity matching produced 62 pairs in this retrospective study. There were no deaths during perioperative period. Patients in the LVATS group experienced a shorter operation time (88 (75, 106) VS 122 (97, 144)min, P <0.001), less intraoperative blood loss(20 (20, 30) VS 25 (20, 50)ml, P = 0.021), shorten incision length (2.50 (2.50, 2.50) VS 3.00 (3.00, 3.50)cm, P <0.001), and more drainage volume (460 (310, 660) VS 345 (225, 600)ml, P = 0.041) than patients in the UVATS group. There was not significant difference in the lymph node stations dissected(5 (4, 5) VS 5 (4, 5), P = 0.436), drainage duration (3 (3, 4) VS 3 (3, 4)days, P = 0.743), length of postoperative hospital stay (4 (4, 5) VS 4 (4, 6)days, P = 0.608), VAS on the POD1(4 (4, 4) VS 4 (4, 4), P = 0.058)and POD3 (3 (3, 4) VS 4 (3, 4), P = 0.219), and incidence of postoperative complications (P = 0.521) between the two groups. CONCLUSIONS Lu's approach is a safe and feasible approach for video-assisted thoracoscopic surgery for the lobectomy of NSCLC. This approach can shorten surgical time, reduce incision length and intraoperative blood loss.
Collapse
Affiliation(s)
- Baofeng Wang
- School of Clinical Medicine, Shandong Second Medical University, Weifang, China
- Department of Thoracic Surgery, Weifang people’s Hospital, Weifang, China
| | - Jiang Wang
- Department of Thoracic Surgery, Weifang people’s Hospital, Weifang, China
| | - Tongyu Sun
- Department of Thoracic Surgery, Weifang people’s Hospital, Weifang, China
| | - Yilin Ding
- Department of Thoracic Surgery, Weifang people’s Hospital, Weifang, China
| | - Shasha Li
- Clinic, Weifang People’s Hospital, Weifang, China
| | - Hengxiao Lu
- Department of Thoracic Surgery, Weifang people’s Hospital, Weifang, China
| |
Collapse
|
9
|
Fang Z, Li C, Bosinceanu ML, Ding C, Zhao J, Gonzalez-Rivas D. Case Report: Uniportal robot-assisted thoracoscopic double-sleeve lobectomy after neoadjuvant immunotherapy. Front Surg 2024; 11:1360125. [PMID: 38444900 PMCID: PMC10912180 DOI: 10.3389/fsurg.2024.1360125] [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: 12/22/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
Minimally invasive thoracic surgery, including video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery, has been proven to have an advantage over open thoracotomy with less pain, fewer postoperative complications, faster discharge, and better tolerance among elderly patients. We introduce a uniportal robot-assisted thoracoscopic double-sleeve lobectomy performed on a patient following neoadjuvant immunotherapy. Specialized instruments like customized trocars with a reduced diameter, bulldog clamps, and double-needle sutures were utilized to facilitate the maneuverability through the single incision. This technique integrates the merits of multiport robot-assisted thoracic surgery with uniportal video-assisted thoracoscopic surgery.
Collapse
Affiliation(s)
- Ziyao Fang
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Research Center of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Research Center of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mugurel L. Bosinceanu
- Department of Thoracic Surgery, Policlinico di Monza, Oncology Hospital Monza, Bucharest, Romania
| | - Cheng Ding
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Research Center of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Research Center of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Thoracic Surgery and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña University Hospital, Coruña, Spain
| |
Collapse
|
10
|
Nachira D, Bertoglio P, Ismail M, Napolitano AG, Calabrese G, Kuzmych K, Congedo MT, Sassorossi C, Meacci E, Petracca Ciavarella L, Chiappetta M, Lococo F, Solli P, Margaritora S. Are the Efficacy and Safety of Chest Tubes in Uniportal Video-Assisted Thoracic Surgery Related to the Level of Intercostal Space Insertion or to the Drain Type? A Prospective Multicenter Study. J Clin Med 2024; 13:430. [PMID: 38256564 PMCID: PMC10817031 DOI: 10.3390/jcm13020430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVES The aim of this study is to evaluate if the efficacy and safety of chest tube placement are influenced by the level of intercostal space insertion (uniportal VATS vs. biportal VATS) or by the type of drain employed (standard vs. smart coaxial drain). METHODS Data on patients who underwent either uniportal or biportal VATS upper lobectomies with lymphadenectomy were prospectively collected in three European centers. The uniportal VATS group with a 28 Fr standard chest tube (U-VATS standard) was compared with the uniportal VATS group with a 28 Fr smart drain (U-VATS smart), and U-VATS smart was also compared with biportal VATS with a 28 Fr smart drain inserted in the VIII intercostal space (Bi-VATS smart). RESULTS When comparing the U-VATS standard group with the U-VATS smart, a higher fluid output was recorded in the U-VATS smart (p: 0.004) in the III post-operative day (p.o.) and overall (p: 0.027), with a lower 90-day re-admission in the U-VATS smart (p: 0.04). The Bi-VATS smart group compared to U-VATS smart showed a higher fluid output in the I p.o. (p < 0.001), with no difference in total fluid amount or hospitalization. The Bi-VATS smart recorded a lower incidence (p < 0.001) of residual pleural space or effusion (p: 0.004) at chest X-rays prior to drain removal but a higher level of pain and chronic intercostal neuralgia (p: 0.03). CONCLUSIONS Chest tube insertion through the same incision space in uniportal VATS seems to be safe and effective. Smart drains can improve the fluid output in uniportal VATS, as if the drainage were inserted in a lower space (i.e., biportal VATS), but with less discomfort.
Collapse
Affiliation(s)
- Dania Nachira
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Mahmoud Ismail
- Division of Thoracic Surgery, Klinikum Ernst von Bergmann, Academic Hospital of the Charité-Universitätsmedizin, Humboldt University Berlin, 14467 Potsdam, Germany;
| | - Antonio Giulio Napolitano
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Giuseppe Calabrese
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Khrystyna Kuzmych
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Maria Teresa Congedo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Carolina Sassorossi
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Elisa Meacci
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Leonardo Petracca Ciavarella
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Marco Chiappetta
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| | - Piergiorgio Solli
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.G.N.); (G.C.); (M.T.C.); (E.M.); (L.P.C.); (M.C.); (F.L.); (S.M.)
| |
Collapse
|
11
|
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] [Download PDF] [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.
Collapse
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
| |
Collapse
|
12
|
Szabo Z, Fabo C, Szarvas M, Matuz M, Oszlanyi A, Farkas A, Paroczai D, Lantos J, Furak J. Spontaneous Ventilation Combined with Double-Lumen Tube Intubation during Thoracic Surgery: A New Anesthesiologic Method Based on 141 Cases over Three Years. J Clin Med 2023; 12:6457. [PMID: 37892595 PMCID: PMC10607362 DOI: 10.3390/jcm12206457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Non-intubated thoracic surgery has not achieved widespread acceptance despite its potential to improve postoperative outcomes. To ensure airway safety, our institute has developed a technique combining spontaneous ventilation with double-lumen tube intubation (SVI). This study aimed to verify the feasibility and limitations of this SVI technique. METHODS For the SVI method, anesthesia induction involves fentanyl and propofol target-controlled infusion, with mivacurium administration. Bispectral index monitoring was used to ensure the optimal depth of anesthesia. Short-term muscle relaxation facilitated double-lumen tube intubation and early surgical steps. Chest opening preceded local infiltration, followed by a vagal nerve blockade to prevent the cough reflex and a paravertebral blockade for pain relief. Subsequently, the muscle relaxant was ceased. The patient underwent spontaneous breathing without coughing during surgical manipulation. RESULTS Between 10 March 2020 and 28 October 2022, 141 SVI surgeries were performed. Spontaneous respiration with positive end-expiratory pressure was sufficient in 65.96% (93/141) of cases, whereas 31.21% (44/141) required pressure support ventilation. Only 2.84% (4/141) of cases reversed to conventional anesthetic management, owing to technical or surgical difficulties. Results of the 141 cases: The mean maximal carbon dioxide pressure was 59.01 (34.4-92.9) mmHg, and the mean lowest oxygen saturation was 93.96% (81-100%). The mean one-lung, mechanical and spontaneous one-lung ventilation time was 74.88 (20-140), 17.55 (0-115) and 57.73 (0-130) min, respectively. CONCLUSIONS Spontaneous ventilation with double-lumen tube intubation is safe and feasible for thoracic surgery. The mechanical one-lung ventilation time was reduced by 76.5%, and the rate of anesthetic conversion to relaxation was low (2.8%).
Collapse
Affiliation(s)
- Zsolt Szabo
- Doctoral School of Multidisciplinary Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Csongor Fabo
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Matyas Szarvas
- Department of Anesthesiology and Intensive Therapy, University of Szeged, H-6720 Szeged, Hungary
| | - Maria Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, H-6720 Szeged, Hungary
| | - Adam Oszlanyi
- Department of Anesthesiology and Intensive Therapy, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Attila Farkas
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, H-9700 Szombathely, Hungary
| | - Dora Paroczai
- Department of Medical Microbiology, University of Szeged, H-6720 Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary
| | - Jozsef Furak
- Department of Surgery, University of Szeged, H-6720 Szeged, Hungary
| |
Collapse
|
13
|
Qi K, Lin G, Liu H, Zhang X, Huang W, Chen Z, Li J. Safety and feasibility of preferential manual bronchoplasty in 2-3 cm single-port video-assisted thoracoscopic lobectomy. Thorac Cancer 2023; 14:2484-2492. [PMID: 37442784 PMCID: PMC10447174 DOI: 10.1111/1759-7714.15033] [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] [Received: 05/23/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND This retrospective study aimed to compare preferential manual bronchoplasty (PMB) and mechanical stapler closure (MSC) of the bronchial stump after 2-3 cm single-port (SP) video-assisted thoracoscopic surgery (VATS) lobectomy in patients with pathological T1 (pT1) stage lung cancer. METHODS Between January 2019 and March 2022, patients with pulmonary neoplasms who underwent 2-3 cm SP VATS lobectomy were retrospectively screened. After propensity-matched analysis, we compared perioperative outcomes and analyzed the safety and feasibility of PMB and MSC of the bronchial stump while performing VATS lobectomy. RESULTS In this study, 280 and 832 patients were enrolled in the PMB and MSC groups, respectively. Propensity score matching produced 280 pairs. The operation time was shorter in the PMB group, whereas the average number of lymph nodes dissected was higher in the PMB group. The conversion rate was significantly lower in the PMB group. The following were similar between the PMB and MSC groups, respectively: average blood loss volume, postoperative hospital stay, and chest tube removal time. Postoperatively, the incidence of atelectasis was significantly higher in the MSC group. As per subgroup analyses, PMB was associated with a shorter operation time in left and right upper lobectomies. Particularly in left upper lobectomy, PMB had more lymph node dissections and less conversion to open and postoperative atelectasis. CONCLUSIONS In comparison with MSC of the bronchial stump, PMB showed better safety and feasibility in 2-3 cm SP VATS left and right superior lobectomies in patients with pT1 stage lung cancer.
Collapse
Affiliation(s)
- Kang Qi
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Gang Lin
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Haibo Liu
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Xining Zhang
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Weiming Huang
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| | - Zhimao Chen
- Department of Precision Medicine in OncologyErasmus Medical Center Cancer InstituteRotterdamNetherlands
| | - Jian Li
- Department of Thoracic SurgeryPeking University First HospitalBeijingChina
| |
Collapse
|
14
|
Li YT, Chiu HC, Hsiao YC, Hsu HH, Chen JS, Cheng YJ. Efficacy of rigid-angle bronchial blockers for uniportal video-assisted thoracoscopic tumor resection. Ann Card Anaesth 2023; 26:303-308. [PMID: 37470529 PMCID: PMC10451124 DOI: 10.4103/aca.aca_132_22] [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] [Received: 07/31/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 07/21/2023] Open
Abstract
Background For uniportal video-assisted thoracoscopic surgery (VATS), which is greatly dependent on satisfactory lung collapse without lung compression from another port, few reports have elucidated the intraoperative efficacy of bronchial blockers (BBs). We hypothesized that operation time would be prolonged if BBs required more intraoperative repositioning during surgical manipulation. We compared the operation times of different surgical procedures performed using BBs with double-lumen tubes (DLTs) in uniportal VATS. Materials and Methods Patients who underwent intubated uniportal VATS were enrolled retrospectively from March to May 2019. Data on the patient, anesthetic, and surgical factors were collected. Regression analyses were performed to determine the effect of various factors on operation time. Results 317 patients who underwent uniportal VATS were included. Wedge resection constituted 70.7%, and anatomic resection constituted 29.3% of procedures. BBs were applied for left- and right-side wedge resection (85.6% and 78.7%, respectively) and left- and right-side anatomic resection (74.1% and 56.4%, respectively). The surgical factors significantly affecting operation time were operation procedures (P < .01), number of lymph nodes sampled (P < .001), and size of tumors (P < .01). Conclusions The efficacy of BBs was comparable to that of DLTs for uniportal VATS wedge resection. With significantly less preference for right-side anatomic resection, the efficacy of DLTs was comparable with that of BBs, which were applied in more than half of right-side uniportal anatomic VATS. We conclude that even in uniportal VATSs, rigid-angled BBs demonstrate comparable efficacy with feasible alternatives.
Collapse
Affiliation(s)
- Ying-Tzu Li
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Hsin-Chan Chiu
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yueh-Chen Hsiao
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ya-Jung Cheng
- Department of Anesthesiology, National Taiwan University Cancer Center, Taipei, Taiwan
| |
Collapse
|
15
|
Gioutsos K, Hayoz YJ, Dorn P. Clinical and Oncological Outcomes after Uniportal Anatomical Segmentectomy for Stage IA Non-Small Cell Lung Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1064. [PMID: 37374269 DOI: 10.3390/medicina59061064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: The existing literature comparing sublobar and lobar resection in the treatment of stage IA lung cancer highlights the trend and overall need for further evaluation of minimally invasive, parenchymal-sparing techniques. The role of uniportal minimally invasive segmentectomy in the oncological therapy of early-stage non-small cell lung cancer (NSCLC) remains controversial. The aim of this study was to evaluate the clinical and midterm oncological outcomes of patients who underwent uniportal video-assisted anatomical segmentectomy for pathological stage IA lung cancer. Materials and Methods: We retrospectively analyzed all patients with pathological stage IA lung cancer (8th edition UICC) who underwent uniportal minimally invasive anatomical segmentectomy at our institution from January 2015 to December 2018. Results: 85 patients, 54 of whom were men, were included. The median length of hospital stay was 3 days (1.-3. IQR 3-5), whereas 30-day morbidity was 15.3% (13 patients), and the in-hospital mortality rate was 1.2% (1 patient). The 3-year overall survival rate was 87.9% for the total population. It was 90.5% in the IA1 group, 93.3% in the IA2 group, and 70.1% in the IA3 group, respectively. Conclusions: There were satisfactory short-term clinical outcomes with low 30-day morbidity and mortality and promising midterm oncological survival results following uniportal minimally invasive anatomical segmentectomy for pathological stage IA non-small cell lung cancer.
Collapse
Affiliation(s)
- Konstantinos Gioutsos
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Yves J Hayoz
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, 3010 Bern, Switzerland
| |
Collapse
|
16
|
Hu H, Liu Y, Dong P, Zhang S, Liu G, Mao Z. Two-Centimeter Single-Port Incision Minimizing Intercostal Nerve Damage Applied in Video-Assisted Thoracoscopic Surgery Segmentectomy for Pulmonary Ground Glass Nodules. J Laparoendosc Adv Surg Tech A 2023. [PMID: 37015067 DOI: 10.1089/lap.2022.0541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
Purposes: We introduced a novel modified 2-cm single-port incision made by blunt separation minimizing intercostal muscle and nerve damage applied in video-assisted thoracoscopic surgery (VATS) segmentectomy, and compared it with the traditional single-port incision or the novel incision plus a 3-mm tiny port, aiming to explore a more minimally invasive single-port technique for VATS segmentectomy. Materials and Methods: We retrospectively analyzed the clinical data of 174 pulmonary ground glass nodule patients who received single-port VATS segmentectomy (54 modified 2-cm single port, 67 modified single port plus tiny port, and 53 traditional single port, respectively) in our medical center from May 2020 to December 2022. Three kinds of approaches were compared retrospectively, concerning their safety, feasibility, and postoperative pain. Results: There were no serious complications and mortality in either group. The blood loss, tube duration, and hospitalization time were comparable among the three groups (P > .05). The 2-cm single-port and 2-cm single-port plus tiny-port group were obviously more advantageous in the visual analog scores of postoperative pain, the wound numbness, incision healing and appearance than that in the traditional group (P < .05), while they were comparable. Notably, the operation time of the 2-cm plus tiny-port group was shorter than that of the 2-cm group (P < .05) and similar to the traditional single-port group. Conclusions: The 2-cm modified single-port applied for VATS segmentectomy is feasible and safe, and has obviously advantages in postoperative pain, numbness, and appearance of incision. With addition of tiny port, the convenience of the operation can be significantly increased without increasing pain. Our finding could provide a promising new incision mode for VATS segmentectomy.
Collapse
Affiliation(s)
- Haifeng Hu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Yanzhuo Liu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
- Department of Pharmacology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Ping Dong
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Shaowen Zhang
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Gaoli Liu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Zhangfan Mao
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China
| |
Collapse
|
17
|
Li Y, Dai T. Meta-analysis comparing the perioperative efficacy of single-port versus two and multi-port video-assisted thoracoscopic surgical anatomical lung resection for lung cancer. Medicine (Baltimore) 2023; 102:e32636. [PMID: 36637952 PMCID: PMC9839244 DOI: 10.1097/md.0000000000032636] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/21/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND As a new surgical procedure for non-small cell lung cancer, single-port video-assisted thoracoscopic surgery (VATS) has lately gained popularity; nevertheless, it is unknown if single-port VATS offers any advantages over multi-portal. The study aims to assess the different impacts of using single-port VATS versus 2-port or multi-port VATS such as operation and drainage time, blood loss volume, number of resected lymph nodes, and hospital stay in lung cancer patients. METHODS Inclusion criteria included studies from different languages that compare single-port against 2 or multi-port VATS. The outcomes of these studies were analyzed using a random-effect model and it was used to calculate the mean difference with 95 percent confidence intervals to quantify the impact of different surgical techniques on clinical parameters. RESULTS Single or Uni-portal video-assisted thoracoscopic surgery results in significantly lower drainage time after surgery compared with 2-port (P = .03) and multi-port (P < .001) VATS. In contrast to the resection of lymph nodes, there was no significant difference between uni-port and 2-port (P = .49) or multiport (P = .29) VATS. While operation time, blood loss, complications, and hospital stay were significantly lower in uni-port compared with multi-port VATS (P = .04, P = .002, P < .001, respectively), but not with 2-port VATS (P = .44, 0.06, P = .13). There were no significant differences between uni-port and multi-port VATS regarding conversion rate, mortality, and staging. CONCLUSION Single or Uni-portal video-assisted thoracoscopic surgery has high efficacy and lower side effects compared with multi-port regarding the perioperative outcomes. Two-port VATS has similar results with uni-port in several parameters.
Collapse
Affiliation(s)
- Yuan Li
- Department of Thoracic Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Tianyang Dai
- Department of Thoracic Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| |
Collapse
|
18
|
Ahn S, Moon Y. Uniportal video-assisted thoracoscopic surgery without drainage-tube placement for pulmonary wedge resection: a single-center retrospective study. J Cardiothorac Surg 2022; 17:317. [PMID: 36527034 PMCID: PMC9758863 DOI: 10.1186/s13019-022-02053-9] [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: 09/26/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Uniportal video-assisted thoracoscopic surgery without drainage-tube placement has been demonstrated to be safe and feasible for select situations. The purpose of this study is to assess the demographic, baseline, and intraoperative characteristics of patients who developed residual pneumothorax after thoracic surgery without drainage-tube placement. METHODS We reviewed the records of all patients who underwent pulmonary wedge resection via uniportal video-assisted thoracoscopic surgery without drainage-tube placement between May 2019 and May 2022. The decision to omit chest-tube drainage was originally made on a case-by-case basis, using internal criteria. Postoperative chest radiography was performed on the day of surgery, on postoperative day 1, at the first outpatient visit, and at 1 month after surgery. RESULTS A total of 134 patients met the selection criteria; 23 (17.2%) had residual pneumothorax on chest radiography on postoperative day 1, and 5 (3.7%) had residual pneumothorax at the first outpatient visit. Only 1 patient (0.7%) had residual pneumothorax on chest radiography at 1 month after surgery; this patient did not require chest-tube insertion or any other intervention. The presence of partial pleural adhesions independently increased the risk for postoperative residual pneumothorax on chest radiography, whereas older patient age reduced the risk. CONCLUSIONS Uniportal video-assisted thoracoscopic surgery for pulmonary wedge resection without drainage-tube placement is both safe and feasible for carefully selected patients. Most patients with residual pneumothorax in our study experienced spontaneous resolution, and none required reintervention.
Collapse
Affiliation(s)
- Seha Ahn
- grid.411947.e0000 0004 0470 4224Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312 Republic of Korea
| | - Youngkyu Moon
- grid.411947.e0000 0004 0470 4224Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312 Republic of Korea
| |
Collapse
|
19
|
Li Y, Zhang M, Shi A, Liu P, Zhang H, Zhang Y, Lyu Y, Yan X. Magnetic anchor technique-assisted thoracoscopic lobectomy in beagles. Sci Rep 2022; 12:11916. [PMID: 35831463 PMCID: PMC9279439 DOI: 10.1038/s41598-022-16050-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/04/2022] [Indexed: 01/22/2023] Open
Abstract
In single-port thoracoscopic lobectomy, surgical instruments are likely to collide and interfere with each other. We used magnetic anchor technique to design an anchoring device suitable for thoracoscopic surgery, and verified the safety and feasibility of its use in animal experiments. Ten Beagles were used as models, and magnetic anchor technology was used to assist thoracoscopic lobectomy. During the operation, a self-designed magnetic anchored internal grasper was used in place of the traditional laparoscopic grasping forceps. The operation time, intraoperative blood loss, incidence of postoperative complications, and the effect of intraoperative use of the device were analyzed. All 10 beagles were successfully operated; the mean operation time was 19.7 ± 3.53 min (range 15-26 min), and the postoperative blood loss was < 10 mL. No surgical complications occurred. During the operation, the internal grasper was firmly clamped, the auxiliary operation field was well exposed, and the interference of the main operation hole instruments was effectively reduced. We provide preliminary experimental evidence of the safety and feasibility of magnetic anchor technique-assisted thoracoscopic lobectomy.
Collapse
Affiliation(s)
- Yixing Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.,Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Miaomiao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Aihua Shi
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Peinan Liu
- Qide College, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Hanzhi Zhang
- Qide College, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Yong Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China. .,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
| | - Xiaopeng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China. .,National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
| |
Collapse
|
20
|
Essa RA, Ahmed SK, Bapir DH. Uniportal video-assisted thoracoscopic surgery (UVATS) right lower lobectomy for a giant T4 squamous cell lung tumour. J Int Med Res 2022; 50:3000605221097374. [PMID: 35481387 PMCID: PMC9087254 DOI: 10.1177/03000605221097374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
Video-assisted thoracoscopic surgery (VATS) is one of the unique methods that have revolutionized the discipline of minimally-invasive thoracic surgery in the last two decades. Previously, double-port VATS lobectomy has been used for the resection of T4 tumours. This current case report presents a 68-year-old male that presented with a productive cough of 3 months' duration, associated with fever, chest pain and loss of body weight. He was haemodynamically stable. The patient underwent surgery under general anaesthesia using a uniportal VATS (UVATS) approach. A 2-cm incision was made in the mid-axillary line through the right 5th intercostal space with no rib spreading. The tumour was put into a specimen bag, cut into pieces and then removed via the mouth of the bag using a grasper. After good haemostasis, a single chest drain was placed and the small incision was sutured in layers. The postoperative course was uneventful and no complications were observed. On the 6th day postoperative, the patient was discharged home. This current case demonstrated that UVATS resection for T4 tumours might be a viable approach in the hands of skilled surgeons. It should also provide decreased postoperative pain, faster recovery and shorter hospitalization.
Collapse
Affiliation(s)
- Rawand Abdulrahman Essa
- Department of Cardiothoracic and Vascular Surgery, Rania Medical City
Hospital, Rania, Sulaimani, Kurdistan-region, Iraq
- Department of Cardiac Care Unit, Rania Teaching Hospital, Rania,
Sulaimani, Kurdistan-region, Iraq
- Department of Biotechnology, Institute of Science and Modern Technology,
Rojava University, Qamishlo, Syria
| | - Sirwan Khalid Ahmed
- Department of Cardiothoracic and Vascular Surgery, Rania Medical City
Hospital, Rania, Sulaimani, Kurdistan-region, Iraq
- Department of Cardiac Care Unit, Rania Teaching Hospital, Rania,
Sulaimani, Kurdistan-region, Iraq
- Department of Biotechnology, Institute of Science and Modern Technology,
Rojava University, Qamishlo, Syria
| | - Dunya Hars Bapir
- Department of Biotechnology, Institute of Science and Modern Technology,
Rojava University, Qamishlo, Syria
| |
Collapse
|
21
|
Abdel Jalil R, Abou Chaar MK, Al-Qudah O, Al-Edwan A, Almajali O, Ababneh H, U'wais A, Al-Ghazawi M, Al-Najjar H, Abu-Shanab A. Early surgical and oncological outcomes during adoption of a single port VATS lung resection in a tertiary cancer center: a retrospective analysis. J Cardiothorac Surg 2022; 17:26. [PMID: 35236401 PMCID: PMC8890027 DOI: 10.1186/s13019-022-01777-y] [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: 08/27/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Background Video-assisted thoracoscopic surgery (VATS) is a safe and effective surgical approach for pulmonary resection. VATS can be accomplished with only a single incision, resulting in less postoperative pain and paresthesia, better cosmetic results, and greater patient satisfaction. Single-port VATS (spVATS) has become increasingly common for lung resection. We assess the early surgical and oncological outcomes after adopting this new technique at our tertiary cancer center as the first institution to do so in the country. Method Medical records for 257 patients in a tertiary cancer center, with a diagnosis of non-small cell lung cancer, pulmonary metastasis, or other chest-confined pathology, were accessed to obtain perioperative outcomes, pathologic results, post-operative follow-up data, and early surgical and oncological outcomes. All patients underwent spVATS for limited or major lung resection. Simple descriptive analysis was utilized. Results spVATS was either performed with curative intent (79.8%, N = 205), or as a diagnostic procedure (20.2%, N = 52). Resection types were subcategorized for curative intent group as limited (73.6%, N = 151), lobectomy (16.6%, N = 34), and complex (9.7%, N = 20). Resection with a negative margin (R0) rate was 100% for the primary lung cancer (PLC) patients and 97% for the pulmonary metastasectomy (PM) group. The complication rate was 5%. Three-year disease-free survival was 87% and 68.5% for PLC and PM group, respectively. The 3-year overall-survival was 91.3% for the PLC and 82.8% for PM. Operation duration showed a downtrend over the study period in each curative subcategory with a borderline difference in the limited resection (P value = 0.05).
Conclusion All the spVATS procedures were successfully performed without perioperative severe complications or mortality, regardless of complexity. R0 resection was excellent. Middle- and long-term efficacies of spVATS for lung cancer require further follow-up. With proper training, appropriate indication and meticulous application, adopting spVATS is safe and feasible technique that does not compromise surgical and oncological outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01777-y.
Collapse
Affiliation(s)
- Riad Abdel Jalil
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan.
| | | | - Obada Al-Qudah
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Ahed Al-Edwan
- Department of Anesthesia, King Hussein Cancer Center, Amman, Jordan
| | - Omar Almajali
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Hazim Ababneh
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Ahmad U'wais
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Munir Al-Ghazawi
- Department of Research, King Hussein Cancer Center, Amman, Jordan
| | - Hani Al-Najjar
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ahmad Abu-Shanab
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| |
Collapse
|
22
|
Ahmed SK, Essa RA, Bapir DH. Uniportal Video-assisted Thoracoscopic Surgery (u-VATS) for Management of pulmonary hydatid cyst: A systematic review. Ann Med Surg (Lond) 2022; 75:103474. [PMID: 35386784 PMCID: PMC8978088 DOI: 10.1016/j.amsu.2022.103474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hydatid disease of the lung, caused by Echinococcus granulosus, is an unusual parasitic disease. The aim of the current review for managing pulmonary hydatid cysts by uniportal video-assisted thoracoscopic surgery (u-VATS), and their complications, the size of hydatid cyst, length of hospital stay, surgery time, the rate of conversion from u-VATS to thoracotomy or mini-thoracotomy, follow-up, and outcomes. METHODS We conduct the platform searches on the PubMed and Google Scholar electronic databases from inception to January 20, 2022, among patients diagnosed with pulmonary hydatid cyst (PHC) who underwent the u-VATS approach. RESULTS This systematic review comprised five studies reporting 85 cases of PHC underwent (u-VATS) approach. Most patients were adults. The most common location of pulmonary hydatid cyst was the right lower lobe followed by the left lower lobe. The average size of PHC was 8.41 cm in all studies. The length of hospital stay was 3.85 days. The duration of operation time based on the means of the included studies was 86.19 min for each patient. Furthermore, the overall complication occurred in 9.35% of patients (n = 11) from 85 cases. The most complication was emphysema and prolonged air leak. The recurrence of pulmonary hydatid cyst did not occur in all studies. CONCLUSION The feasibility of the video-assisted thoracoscopic surgery (VATS) approach has been proven globally in terms of reducing the overall complication, shorter chest tube duration, shorter surgery time, reduce postoperative pain, shorter chest tube duration, lower chest tube drainage, and less required to pain killers postoperatively.
Collapse
Affiliation(s)
- Sirwan Khalid Ahmed
- Department of Emergency, Rania Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq
- Department of Cardiothoracic and Vascular Surgery, Rania Medical City Hospital, Rania, Sulaimani, Kurdistan-Region, Iraq
- Department of Emergency, Rania Pediatric & Maternity Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq
- Department of Biotechnology, Institute of Science and Modern Technology, Rojava University, Qamishlo, Syria
| | - Rawand Abdulrahman Essa
- Department of Emergency, Rania Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq
- Department of Cardiothoracic and Vascular Surgery, Rania Medical City Hospital, Rania, Sulaimani, Kurdistan-Region, Iraq
- Department of Emergency, Rania Pediatric & Maternity Teaching Hospital, Rania, Sulaimani, Kurdistan-region, Iraq
| | - Dunya Hars Bapir
- Department of Biotechnology, Institute of Science and Modern Technology, Rojava University, Qamishlo, Syria
| |
Collapse
|
23
|
Wang K, Zhang J, Li J, Liu L, Tang Z, Du X. aBVA Procedure by Uniportal Video-Assisted Thoracoscopic Surgery for Right Upper Peripheral Lung Cancer: A Randomized Trial. Front Oncol 2022; 12:828432. [PMID: 35186761 PMCID: PMC8850830 DOI: 10.3389/fonc.2022.828432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/12/2022] [Indexed: 12/25/2022] Open
Abstract
Objective This study aims to determine the optimal dividing order of anatomic pulmonary resection under uniportal video-assisted thoracoscopic surgery (uni-VATS) for patients with right upper peripheral lung cancer. Methods Patients who met the eligibility criteria were randomly allocated into the aBVA and VAB groups. In the aBVA group, the surgical procedure proceeded from the posterior to the anterior region (from the deeper to the superficial site). In the VAB group, the dissection orders were vein first followed by arterial branches, followed by the bronchus. Clinical data were collected and analyzed. Results Sixty patients were randomly allocated to the aBVA group (n = 30) and the VAB group (n = 30). The operation time in the aBVA group (230.500 ± 68.360 min) was significantly shorter than that in the VAB group (305.600 ± 107.821 min) (p = 0.01). The blood loss in the aBVA group (104.000 ± 70.935 ml) was significantly lower than that in the VAB group (391.000 ± 625.175 ml) (p = 0.01). Two patients in the VAB group underwent conversion to 2-portal VATS. The number of lymph nodes (13.367 ± 5.436 vs. 10.333 ± 7.279, p = 0.072) and lymph node stations (5.067 ± 1.574 vs. 4.467 ± 2.345, p = 0.567) were comparable between the two groups. The differences in the postoperative drainage tube time (5.033 ± 3.113 vs. 6.467 ± 4.447 days, p = 0.278) and hospital stay (8.233 ± 3.390 vs. 9.433 ± 4.523 days, p = 0.361) were not significantly different between the two groups. Conclusion Compared with the VBA procedure, aBVA is easier for patients with right upper peripheral lung cancer who undergo uni-VATS lobectomy.
Collapse
Affiliation(s)
- Kaiying Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jian Zhang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jianglun Li
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Langbo Liu
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhongben Tang
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiaojun Du
- Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| |
Collapse
|
24
|
Better intraoperative cardiopulmonary stability and similar postoperative results of spontaneous ventilation combined with intubation than non-intubated thoracic surgery. Gan To Kagaku Ryoho 2022; 70:559-565. [PMID: 34985733 DOI: 10.1007/s11748-021-01768-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/23/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Non-intubated spontaneous ventilation video-assisted thoracic surgery lobectomy is a well-known procedure, but there are doubts regarding its safety. To solve this problem, we developed a safe procedure for spontaneous ventilation thoracic surgery (spontaneous ventilation with intubation). This study analyzed the intraoperative parameters and postoperative results of spontaneous ventilation with intubation. METHODS Between March 11, 2020 and March 26, 2021, 38 spontaneous ventilation with intubation video-assisted thoracic surgery lobectomies were performed. We chose the first 38 non-intubated spontaneous ventilation video-assisted thoracic surgery lobectomy cases with a laryngeal mask performed in 2017 for comparison. RESULTS There were no significant differences between the non-intubated spontaneous ventilation and spontaneous ventilation with intubation groups in postoperative surgical results (surgical time: 98,7 vs. 88,1 min (p = 0.067); drainage time: 3.5 vs. 2.7 days (p = 0.194); prolonged air leak 15.7% vs. 10.5% (p = 0.5); conversion rate to relaxation: 5.2% vs. 13.1% (p = 0.237); failure of the spontaneous ventilation rate: 10.5% vs. 13.1% (p = 0.724); and morbidity: 21% vs. 13.1% (p = 0.364)) and oncological outcomes. Significantly lower lowest systolic and diastolic blood pressure (systolic, 83.1 vs 132.3 mmHg, p = 0.001; diastolic 47.8 vs. 73.4 mmHg, p = 0.0001), lowest oxygen saturation (90.3% vs 94.9%, p = 0.026), and higher maximum pCO2 level (62.5 vs 54.8 kPa, p = 0.009) were found in the non-intubated spontaneous ventilation group than in the spontaneous ventilation with intubation group. CONCLUSIONS Spontaneous ventilation with intubation is a more physiological procedure than non-intubated spontaneous ventilation in terms of intraoperative blood pressure stability and gas exchange. The surgical results were similar in the two groups.
Collapse
|
25
|
Fujita T, Morino S, Nakamura A. Evaluation of Short-Term Outcomes and the Learning Curve Wherein a Thoracic Resident Doctor Performed Video-Assisted Thoracoscopic Anatomical Lung Resection for Lung Cancer. Ann Thorac Cardiovasc Surg 2022; 28:249-254. [PMID: 35095054 PMCID: PMC9433889 DOI: 10.5761/atcs.oa.21-00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tomohiro Fujita
- Department of Thoracic Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Shigeyuki Morino
- Department of Thoracic Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| | - Akihiro Nakamura
- Department of Thoracic Surgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
| |
Collapse
|
26
|
Kang M, Kang D. A pilot study of intraoperative intercostal nerve block during uniportal thoracoscopic wedge resection of the lung. Ann Thorac Med 2022; 17:180-183. [PMID: 35968396 PMCID: PMC9374124 DOI: 10.4103/atm.atm_128_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022] Open
|
27
|
Kang M, Kang D, Woon H, Hwang YH. The feasibility of thoracoscopic-guided intercostal nerve block during uniportal video-assisted thoracoscopic lobectomy of the lung. J Minim Access Surg 2022; 18:567-570. [PMID: 36204936 PMCID: PMC9632717 DOI: 10.4103/jmas.jmas_261_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Uniportal thoracoscopic surgery has become widely accepted for its favourable outcomes with regard to pain. However, post-operative pain is still a concern associated with thoracic surgery. The objective of this study was to evaluate the post-operative pain of patients undergoing uniportal video-assisted thoracoscopic surgery (VATS) lobectomies using an intra-operative intercostal nerve block. Methods: All consecutive patients undergoing uniportal VATS lobectomies between October 2018 and October 2019 were reviewed retrospectively. Twenty consecutive patients in Group A underwent uniportal VATS lobectomies without intra-operative intercostal nerve blocks. The other 20 consecutive patients in Group B underwent uniportal VATS lobectomies with intra-operative intercostal nerve blocks. Numeric Pain Rating Scale (NRS) scores were recorded at 1, 12 and 24 h postoperatively. The number of anti-inflammatory drugs (non-steroidal anti-inflammatory drug [NSAIDs]) consumed until the time of chest tube removal was also recorded. Results: There was no difference between the groups with regard to sex, age, chest tube duration, length of stay, operative time or laterality. There was a significant difference in post-operative NRS scores at 1 h (P < 0.001) and 12 h (P = 0.014) between the groups. The NSAID consumption was significantly lower in Group B than in Group A (P = 0.038). Conclusion: Intra-operative intercostal nerve blocks with bupivacaine provided immediate post-operative pain relief and reduced post-operative opioid consumption in patients who underwent uniportal VATS lobectomies.
Collapse
|
28
|
Matsuura N, Igai H, Kamiyoshihara M. Carinal resection and reconstruction: now and in the future. Transl Lung Cancer Res 2021; 10:4039-4042. [PMID: 34858792 PMCID: PMC8577976 DOI: 10.21037/tlcr-21-731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/18/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| |
Collapse
|
29
|
Aymerich H, Bonome C, González-Rivas D. Non intubated video-assisted thoracoscopic lung resections (NI-VATS) in COVID times. Saudi J Anaesth 2021; 15:362-367. [PMID: 34764844 PMCID: PMC8579503 DOI: 10.4103/sja.sja_421_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/05/2021] [Indexed: 11/04/2022] Open
Abstract
The emergence of epidemic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in December 2019 in Wuhan, China causing Coronavirus Disease 2019 (COVID-19) and its rapid expansion around the world, leading to a global pandemic of dimensions not observed at least since the "Spanish influenza" pandemic in 1917-18, has had great consequences at all levels, including social, health and economic spheres. This pandemic situation forces us, as health care workers, to redefine our medical and surgical actions to adapt them to this new reality. It is important, when the rules of the game change, to rethink and to reevaluate if the balance between risk and benefit have moved to a different point of equilibrium, and if our indications of certain surgical interventions need to be redefined. In this article we try to answer the doubts that arise about the suitability of the NI-VATS technique and assess whether its use in these new pandemic circumstances might add advantages, especially in relation to minimize the risks of virus contagion between patients and all healthcare personnel during the surgical procedure, as well as the known advantages described in many articles the last ten years.
Collapse
Affiliation(s)
- H Aymerich
- Department of Anesthesia, Quironsalud Hospital, Coruña, Spain
| | - C Bonome
- Department of Anesthesia, San Rafael Hospital, Coruña, Spain
| | | |
Collapse
|
30
|
Zhou J, Li C, Zheng Q, Guo C, Lyu M, Pu Q, Liao H, Liu L. Suction Versus Nonsuction Drainage After Uniportal Video-Assisted Thoracoscopic Surgery: A Propensity Score-Matched Study. Front Oncol 2021; 11:751396. [PMID: 34765556 PMCID: PMC8577848 DOI: 10.3389/fonc.2021.751396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/27/2021] [Indexed: 02/05/2023] Open
Abstract
Background Uniportal video-assisted thoracoscopic surgery (UniVATS) was utilized with a rapid growth. The evidence is sparse, however, on whether to add external suction to water-seal drainage for chest drainage after UniVATS. This retrospective propensity score-matched study aimed to identify the necessity of adding external suction to chest drainage after UniVATS. Methods Patients with lung cancer who underwent UniVATS were included from our prospectively maintained database. Patients were divided into two cohorts based on the addition of external suction to postoperative water-seal drainage or not. Propensity score-matched analysis was performed to identify the impact of suction on chest tube duration, incidence of persistent air leak, hospital stay, and hospitalization cost. Multivariable model with interaction terms was constructed to identify impact of covariables on effect of suction. Results The two cohorts matched well on baseline characteristics (nonsuction: 173; suction: 96). Compared with nonsuction group, suction group showed longer median chest tube duration (3 vs. 2 days, p = 0.003), higher incidences of persistent air leak (9.4% vs. 1.2%, p = 0.003), persistent drainage (16.8% vs. 5.8%, p = 0.007), and reduced drainage volume within first 3 postoperative days (386.90 vs. 504.78 ml, p = 0.011). Resection extent was identified to mediate the relationship between suction and chest tube drainage. Conclusions These findings discouraged adding external suction to water-seal drainage after UniVATS regarding longer chest tube duration and more persistent air leak. Patients undergoing lobectomy would benefit more from water-seal drainage without external suction compared with those doing sublobectomy.
Collapse
Affiliation(s)
- Jian Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chuan Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Quan Zheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Chenglin Guo
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mengyuan Lyu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Pu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hu Liao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
31
|
Chang SL, Lai CH, Chen GY, Chou CM, Huang SY, Chen YM, Liu TJ, Lai HC. Case reports of one-lung ventilation using Fuji Uniblocker bronchial blockers for infants under one-year-old in uniportal video-assisted thoracoscopic surgery. Medicine (Baltimore) 2021; 100:e26325. [PMID: 34232168 PMCID: PMC8270611 DOI: 10.1097/md.0000000000026325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Uniportal video-assisted thoracoscopic surgery (VATS) for various pulmonary diseases provides advantages of less postoperative pain and earlier post-operative recovery over traditional open surgery. The inherent limitation of this surgical modality in manipulation of surgical instruments renders intra-operative one-lung ventilation a requisite to increase the substantially restricted working space and thus visibility of the surgical filed. PATIENT CONCERNS Patient 1, an 8-month-old, 9-kg, and 70 cm-in-height male infant was diagnosed as congenital pulmonary airway malformation (CPAM) over left lower lobe.Patient 2, a 9-month-old, 8-kg and 72 cm-in-height male infant was diagnosed as CPAM over right lower lobe.Patient 3, an 8-month-old, 8-kg and 67 cm-in-height female infant was diagnosed as CPAM over left lower lobe.This facilitating one-lung ventilation yet was rarely conducted in infants under one year of age for the extremely small body size, the unavailability of dedicated tools, and therein the very tough techniques demanded. DIAGNOSIS Infants with congenital cystic adenomatoid malformation. INTERVENTIONS Here we report three infants of less than one year of age in whom one-lung ventilation was successfully achieved by intraluminal use of 5-Fr Fuji Uniblocker Bronchial Blocker devices and in turn assisted the completion of uniportal VATS for congenital cystic adenomatoid malformation in unilateral lungs. OUTCOMES Three infants received VATS under uniblocker smoothly. Patient 1 had two episode of balloon dislodgement and desaturation and solved by re-insertion. And he had subglottic tracheal stenosis which treatment with laser coagulation. Patient 2 had overall blood loss 80 ml. Patient 3 had one episode of desaturation after stapling the bronchus and fiberoptic bronchoscope revealed obstruction by blood and secretion which solved by suction. CONCLUSION In conclusion, OLV in infants undergoing uniportal VATs could be successfully achieved by Fuji 5 Fr Uniblocker bronchial blockers for as long as 4 hours, as exemplified by our three cases, and balloon poor sealing and dislodgment can be immediately solved by bronchoscope-guided re-positioning without compromising surgical proceeding or outcome.
Collapse
Affiliation(s)
- Szu-Ling Chang
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
| | - Chih-Hung Lai
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
- Department of Medicine and Cardiovascular Center, Taichung Veterans General Hospital, Taichung
| | - Guan-Yu Chen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taichung
| | - Chia-Man Chou
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital
| | - Sheng-Yang Huang
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital
| | - Yung-Ming Chen
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
| | - Tsun-Jui Liu
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
- Department of Medicine and Cardiovascular Center, Taichung Veterans General Hospital, Taichung
- National Chung-Hsing University, Taichung, Taiwan
| | - Hui-Chin Lai
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung
- Departments of Medicine and Surgery, National Yang-Ming University School of Medicine, Taipei
- National Chung-Hsing University, Taichung, Taiwan
| |
Collapse
|
32
|
Souza JM, Pereira IRPD, Borgmann AV, Chiaradia RE, Boscardim PCB. Uniportal surgical biopsy, without orotraqueal intubation, without thoracic drainage in intersticial pulmonary disease: initial results. Rev Col Bras Cir 2021; 48:e20202914. [PMID: 34133610 PMCID: PMC10683432 DOI: 10.1590/0100-6991e-20202914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/01/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE interstitial lung disease comprises a group of lung diseases with wide pathophysiological varieties. This paper aims to report the video thoracoscopic surgical biopsy in patients with interstitial lung disease through a single minimal chest incision, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers. METHODS this study is a series of 14 cases evaluated retrospectively, descriptively, where patients underwent a pulmonary surgical biopsy from January 2019 to January 2020. The patients included in the study had diffuse interstitial lung disease without a defined etiological diagnosis. RESULTS none of the patients had transoperative complications, there was no need for chest drainage in the postoperative period, and the patients pain, assessed using the verbal scale, had a mode of 2 (minimum value of 1 and maximum of 4) in the post immediate surgery and 1 (minimum value of 1 and maximum of 3) at the time of hospital discharge. The length of hospital stay was up to 24 hours, with 12 patients being discharged on the same day of hospitalization. CONCLUSION therefore, it is concluded in this series of cases that the performance of uniportal video-assisted thoracoscopic surgery procedures to perform lung biopsies, without orotracheal intubation, without chest drainage, and without the use of neuromuscular blockers, bring benefits to the patient without compromising his safety. Further larger studies are necessary to confirm the safety and efficiency of this method.
Collapse
Affiliation(s)
- Juliano Mendes Souza
- - Faculdades Pequeno Príncipe, Curso de Medicina - Curitiba - PR - Brasil
- - Hospital Nossa Senhora das Graças, Departamento de Cirurgia Torácica - Curitiba - PR - Brasil
| | | | | | | | | |
Collapse
|
33
|
The concept of broad exposure facilitates uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection. J Cardiothorac Surg 2021; 16:138. [PMID: 34020671 PMCID: PMC8140417 DOI: 10.1186/s13019-021-01519-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/07/2021] [Indexed: 12/24/2022] Open
Abstract
Background Systematic lymph node dissection is an important part of radical resection for lung cancer. Insufficient incision of the mediastinal pleura results in a tapered or tunnel-like operation surface, which increases the difficulty of uniportal video-assisted thoracoscopic mediastinal lymph node dissection. The objective of this study was to report our concept of broad exposure and investigate the efficacy and safety of this concept in uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection. Methods We retrospectively analyzed the clinical data of the 204 non-small cell lung cancer patients who underwent uniportal video-assisted thoracoscopic surgery for anatomical lobectomy and systematic lymph node dissection following the concept of broad exposure. SPSS 23.0 software was used for statistical analysis. Results All operations were completed under uniportal video-assisted thoracoscopic surgery following the concept of broad exposure. The median surgery time was 102 (range, 76–285) minutes and the median blood loss was 50 (range, 20–900) milliliters. The median chest tube duration time was 2 (range, 1–6) days, the median postoperative hospital duration time was 5 (range, 4–10) days. The median number of dissected lymph node stations and dissected lymph nodes were 8 (range,6–9) and 15(range,12–19), respectively. The median number of dissected mediastinal lymph nodes stations and dissected mediastinal lymph nodes were 5(range,3–6) and 11(range,10–15), respectively. The up-staging rate of N staging was 6.86%. The postoperative complication rate was 10.29% and there was no perioperative death. Conclusions According to our results, it’s effective and safe to perform uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection following the concept of broad exposure. This new concept not only emphasizes sufficient exposure, but also focuses on protection of important tissues.
Collapse
|
34
|
Li S, Wu J, Wan Z, Chen Y, She Y, Xie D, Hu X, Zhao D, Chen C. The learning curve for uniportal video-assisted thoracoscopic anatomical segmentectomy. J Surg Oncol 2021; 124:441-452. [PMID: 33956998 DOI: 10.1002/jso.26517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/24/2021] [Accepted: 04/23/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the time course and caseload required to achieve proficiency by plotting the learning curve of uniportal thoracoscopic segmentectomy. METHODS We retrospectively analyzed the first 238 and 159 cases of uniportal thoracoscopic segmentectomy performed by two surgeons (A and B). The learning curves were assessed using cumulative sum analysis. Perioperative outcomes were evaluated as the learning curve developed. Two subtypes of this surgical approach, simple and complex segmentectomy, were separately analyzed. RESULTS Based on the learning curve, the inflection points occurred at 64 and 90 cases for surgeon A, 71 and 100 cases for surgeon B. Significantly longer operative time (p = .013), length of stay (p = .002), and drainage duration (p = .039) were observed between phase I and phase II compared to phase III for surgeon A. Operative times (p = .001) were significantly reduced for surgeon B. Furthermore, 26-28 and 52-56 cases were necessary to master the simple and complex segmentectomy, respectively. CONCLUSIONS A total 64-71 cases were required to master uniportal thoracoscopic segmentectomy and 90-100 cases were necessary to achieve proficiency.
Collapse
Affiliation(s)
- Shenghui Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Junqi Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Ziwei Wan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yingyao Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
35
|
Matsuura N, Igai H, Ohsawa F, Yazawa T, Kamiyoshihara M. Safety and feasibility of uniportal video-assisted thoracoscopic uncommon segmentectomy. J Thorac Dis 2021; 13:3001-3009. [PMID: 34164191 PMCID: PMC8182544 DOI: 10.21037/jtd-21-292] [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: 11/25/2022]
Abstract
Background In recent years, opportunities to conduct anatomical segmentectomies for early stage lung cancer, metastatic lung tumor, and so on have been increasing. Generally, uniportal video-assisted thoracoscopic surgery (U-VATS) uncommon segmentectomy is technically more complicated because of limited angulation compared to multiportal VATS (M-VATS) and the need to treat peripheral vessels/bronchi compared to common segmentectomy. This study aimed to determine the safety and feasibility of U-VATS uncommon segmentectomy compared with U-VATS common segmentectomy and M-VATS uncommon segmentectomy. Methods We retrospectively reviewed the medical records of 76 patients in the M-VATS group and 45 patients in the U-VATS group who underwent VATS segmentectomy from January 2015 to December 2020. During that period, the perioperative results of U-VATS uncommon (n=22) segmentectomy were compared with those of U-VATS common (n=23) and M-VATS uncommon (n=37) segmentectomy. Uncommon segmentectomy was defined as any segmentectomy other than segmentectomies of the lingual, basilar, or superior segment of the lower lobe (S6), and upper division of the left upper lobe. All patients in our department underwent preoperative three-dimensional computed tomography (3D-CT) angiography and bronchography to image bronchovascular structures and determine the resection line. Results Patients characteristics were similar between the U-VATS uncommon segmentectomy group and the U-VATS common segmentectomy group or the M-VATS uncommon segmentectomy group. In U-VATS, there were no significant differences between common and uncommon segmentectomy in operation time, postoperative drainage, postoperative hospitalization, and postoperative complications. Comparing M-VATS and U-VATS uncommon segmentectomies, operation time (145±35 vs. 185±44 min, P<0.001) and postoperative hospitalization (3.1±1.6 vs. 4.2±1.8 days, P=0.02) were significantly shorter in the U-VATS group than in the M-VATS group. There were no significant differences in blood loss, intraoperative bleeding, duration of postoperative drainage and postoperative complications. Conclusions In U-VATS, both types of segmentectomies can be achieved with similar results. Moreover, U-VATS shortened operation time and postoperative hospitalization in uncommon segmentectomy compared with conventional M-VATS. U-VATS is a useful approach for uncommon segmentectomy.
Collapse
Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Gunma 371-0811, Japan
| |
Collapse
|
36
|
Lin J, Yin Y, Zhuo Y, Li X, Lai F. Transareolar uniportal video-assisted thoracoscopic surgery for the treatment of male patients with peripheral pulmonary nodules: a novel technique in thoracic surgery. Updates Surg 2021; 73:1541-1548. [PMID: 33394357 DOI: 10.1007/s13304-020-00945-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/07/2020] [Indexed: 11/24/2022]
Abstract
In this study, we report the use of transareolar uniportal video-assisted thoracoscopic surgery (VATS) in thoracic surgery for the treatment of male patients with peripheral pulmonary nodules. From February 2014 to September 2018, 46 male patients with small PPNs underwent VATS, of whom 41 underwent unilateral VATS, and five underwent bilateral VATS. All procedures were successfully performed. Patients received 1 year of outpatient follow-up postoperatively. The data indicated that the average operation times were 32.7 min (unilateral) and 58.6 min (bilateral). The mean length of the incision was 2.7 ± 0.3 cm, with a mean cosmetic score of 3.2 ± 0.7 at the time of discharge. All patients rapidly recovered consciousness postoperatively. The length of postoperative hospitalization (LOH) was 3.4 ± 1.4 days. There was no obvious surgical scarring on the chest wall, and no patients complained of postoperative pain at 6 months postoperatively. No recurrence or metastasis was found during the 1-year follow-up. Transareolar uniportal VATS for peripheral pulmonary nodules resulted in good cosmetic outcomes and high patient satisfaction. Transareolar uniportal VATS is a safe and effective therapeutic procedure for male patients with small PPNs and especially produces good cosmetic outcomes.
Collapse
Affiliation(s)
- Jianbo Lin
- Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, Fujian, 350005, People's Republic of China
| | - Yinhe Yin
- Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, Fujian, 350005, People's Republic of China
| | - Yi Zhuo
- Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, Fujian, 350005, People's Republic of China
| | - Xu Li
- Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, Fujian, 350005, People's Republic of China
| | - Fancai Lai
- Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, Fujian, 350005, People's Republic of China.
| |
Collapse
|
37
|
Matsuura N, Igai H, Ohsawa F, Yazawa T, Kamiyoshihara M. Uniport vs. multiport video-assisted thoracoscopic surgery for anatomical lung resection-which is less invasive? J Thorac Dis 2021; 13:244-251. [PMID: 33569204 PMCID: PMC7867835 DOI: 10.21037/jtd-20-2759] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) has been recognized as a standard procedure, but whether uniport VATS (U-VATS) is a more effective and minimally invasive approach compared with multiport VATS (M-VATS) is controversial. Methods The medical records of 184 patients in the M-VATS group and 69 patients in the U-VATS group who underwent anatomical lung resection from April 2017 to July 2020 at our institution were retrospectively reviewed. Postoperative outcomes were compared among U-VATS and M-VATS. Multivariate analysis was performed to identify factors that reduce postoperative pain. Results The mean operation time was significantly shorter in U-VATS than in M-VATS (172±43 min in M-VATS vs. 143±43 min in U-VATS, P<0.0001). Duration of postoperative drainage (2.2±1.2 days in M-VATS vs. 1.6±1.0 days in U-VATS, P=0.0002) and hospitalization (4.0±1.6 days in M-VATS vs. 3.1±1.6 days in U-VATS, P=0.0003) were significantly shorter in U-VATS than in M-VATS. The rate of postoperative complications was not significantly different between the groups (P=0.732). The number of analgesic prescriptions over 10 days postoperatively was significantly less in U-VATS than in M-VATS [68 (37.0%) in M-VATS vs. 8 (11.6%) in U-VATS, P<0.0001]. A multivariate logistic regression model showed that U-VATS was the only significant predictor for reduction of postoperative pain (odds ratio =0.204, P=0.0001). Conclusions U-VATS shortened the operation time, postoperative drainage duration, and hospitalization compared with conventional M-VATS, and it significantly reduced the use of analgesics. There were no differences in perioperative results such as blood loss and the postoperative complication rate. U-VATS can be said to be a safe and minimally invasive surgical procedure.
Collapse
Affiliation(s)
- Natsumi Matsuura
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Fumi Ohsawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Tomohiro Yazawa
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Asakura, Maebashi City, Gunma, Japan
| |
Collapse
|
38
|
Starke H, Zinne N, Leffler A, Zardo P, Karsten J. Developing a minimally-invasive anaesthesiological approach to non-intubated uniportal video-assisted thoracoscopic surgery in minor and major thoracic surgery. J Thorac Dis 2020; 12:7202-7217. [PMID: 33447409 PMCID: PMC7797846 DOI: 10.21037/jtd-20-2122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Non-intubated uniportal video-assisted thoracoscopic surgery (niVATS) is a novel approach to major and minor lung resection. It benefits from a holistic anesthesiological concept with adequate pain relief and sedation in a minimal-invasive setup allowing thoracic procedures under spontaneous breathing. At present no anesthesiological gold standard for niVATS exists. The primary aim of our retrospective observational study was to evaluate feasibility and safety of minimally invasive niVATS for both minor and major pulmonary resections at our institution. Methods All 88 consecutive patients scheduled for niVATS minor or major thoracic procedures were included into the study. Anaesthesia was performed according to a departmental niVATS algorithm including both regional anaesthesia and sedation. Patient characteristics and early outcome data including intraoperative and postoperative findings were compared between groups. Prediction scores for postoperative complications (LAS VEGAS, ARISCAT, ThRCRI) were calculated and compared. Results No early mortality and a low overall morbidity rate of 28.4% were encountered. Conversion to orotracheal intubation was required in 6.8% of all cases. Postoperative pulmonary complications occurred in 15.9% of total cases and were lower than predicted by both LAS VEGAS and ARISCAT respectively. Cardiac complications were found in 1.1% and lower than predicted by ThRCRI. A persistent air leak occurred in 11.4% of total cases and was significantly higher in major resection. Postoperative chest tube duration and hospital length of stay in the major resection group exceeded times reported by other groups. Conclusions niVATS appears to be safe in both minor and major thoracic procedures. A minimally invasive anaesthesiological approach foregoing central iv lines, arterial blood pressure measurement and urinary catheterization is feasible. Our niVATS protocol appears to be a viable alternative for both minor and major thoracic procedures in selected patients.
Collapse
Affiliation(s)
- Henning Starke
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Norman Zinne
- Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany
| | - Andreas Leffler
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Patrick Zardo
- Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany
| | - Jan Karsten
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| |
Collapse
|
39
|
Wang Y, Wang Z, Yao F. The safety and feasibility of three-dimension single-port video-assisted thoracoscopic surgery for the treatment of early-stage lung cancer. J Thorac Dis 2020; 12:7257-7265. [PMID: 33447414 PMCID: PMC7797815 DOI: 10.21037/jtd-19-3465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Video-assisted thoracoscopic surgery (VATS) has been widely used in the lung resections. Reports regarding three-dimension (3D) single-port VATS are very limited. The purpose of this study is to evaluate the perioperative outcomes of 3D single-port VATS in a single medical center. Methods Totally 523 clinical stage I lung cancer patients underwent surgical resection through VATS operation between September 2016 and October 2017 in our single institution were retrospectively collected and 374 were enrolled. The comparison between 3D single-port VATS and conventional VATS (c-VATS), single-port VATS was conducted focusing on intraoperative and postoperative outcomes. Continuous and categorical variables were analyzed through SPSS software. Results The 3D singe-port VATS demonstrated no significant difference neither on the intraoperative outcomes including the operative time and the intraoperative blood loss nor the postoperative outcomes including the length of drainage duration and postoperative complications when against c-VATS and single-port VATS. Besides, 3D singe-port VATS elucidated comparable ability of lymph node dissection with c-VATS in subgroup analysis (P=0.192), both of which were better than single-port VATS group (P<0.001). What’s more, the rate of conversion as well as hospital stays of 3D single-port group were also comparable. In subgroup analysis, 3D singe-port VATS also elucidated its safety and feasibility when dealing with routine thoracic surgeries including lobectomy and segmentectomy. Conclusions 3D single-port VATS, integrating the advantages of single-port VATS and three-dimensional vision of 3D VATS, is a safe and feasible technique and is promising for next-generation thoracoscopic surgery.
Collapse
Affiliation(s)
- Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhexin Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
40
|
Furák J, Paróczai D, Burián K, Szabó Z, Zombori T. Oncological advantage of nonintubated thoracic surgery: Better compliance of adjuvant treatment after lung lobectomy. Thorac Cancer 2020; 11:3309-3316. [PMID: 32985138 PMCID: PMC7606006 DOI: 10.1111/1759-7714.13672] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Video-assisted thoracoscopic (VATS) surgery contributes to improved survival, adjuvant chemotherapy delivery and less postoperative complications. Nonintubated thoracic surgery (NITS) VATS procedures improves immunological responses in lung cancer patients; however, there is no data regarding adjuvant chemotherapy delivery effectiveness following NITS lobectomies. In this study, we aimed to compare protocol compliance and toxic complications during adjuvant chemotherapy after intubated and nonintubated VATS lobectomies in non-small cell lung cancer (NSCLC). METHODS We retrospectively reviewed the medical records of 66, stage IB-IIIB NSCLC patients who underwent intubated or nonintubated VATS lobectomy and received adjuvant chemotherapy. RESULTS A total of 38 patients (17 males, mean age 64 years) underwent conventional VATS and 28 (7 males; mean age 63 years) uniportal VATS NITS. Both groups had comparable demographic data, preoperative pulmonary function, and Eastern Cooperative Oncology Group (ECOG) status. Among the intubated and nonintubated patients, 82% and 75% were diagnosed with adenocarcinoma, respectively. The incidence of adenocarcinoma and squamous cell carcinoma cases were similar in both groups; however, the pathological staging showed significant differences, as 5 (18%) nonintubated patients had stage IB lung cancer, compared with the intubated group (P = 0.01). Further distribution of stages was similar between the groups. We observed significant differences in chest tube duration and operation time in the nonintubated group (P < 0.01). Among nonintubated patients, 92% completed the planned chemotherapy protocol, compared to 71% of the intubated group (P = 0.035). Grade 1/2 toxicity occurred significantly more often in the intubated group (16% vs. 0%, P = 0.03) and there was a lower incidence of grade 4 neutropenia in the nonintubated group (0% vs. 16%, P = 0.03). CONCLUSIONS Our results showed that the nonintubated procedure resulted in improved adjuvant chemotherapy compliance and lower toxicity rates after lobectomy. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Oncological advantage of the non-intubated thoracic surgery: better compliance with therapy protocol. What this study adds NITS lobectomies contribute to better administration of adjuvant chemotherapy with the planned cycle number and dosage.
Collapse
Affiliation(s)
- József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Dóra Paróczai
- Department of Pulmonology, University of Szeged, Deszk, Hungary.,Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Szeged, Hungary
| |
Collapse
|
41
|
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: 24] [Impact Index Per Article: 4.8] [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.
Collapse
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
| |
Collapse
|
42
|
Liu HY, Chiang XH, Hung MH, Wang ML, Lin MW, Cheng YJ, Hsu HH, Chen JS. Nonintubated uniportal thoracoscopic segmentectomy for lung cancer. J Formos Med Assoc 2020; 119:1396-1404. [DOI: 10.1016/j.jfma.2020.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/25/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022] Open
|
43
|
Lee DK, Kang SW, Kim HK, Kim HS, Kim H. Effect of sugammadex on chest radiographic abnormality in the early postoperative period after video-assisted thoracoscopic lobectomy. Turk J Med Sci 2020; 50:1236-1246. [PMID: 32366060 PMCID: PMC7491306 DOI: 10.3906/sag-2001-26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/04/2020] [Indexed: 11/18/2022] Open
Abstract
Background/aim Sugammadex, which offsets the effects of neuromuscular blocking agents (NMBs), has advantages over traditional reversal agents like pyridostigmine, as it enables fast and reliable recovery from neuromuscular blockade. This study compared the incidence of early postoperative chest radiographic abnormalities (CRA) between sugammadex (group S) and pyridostigmine (group P) following video-assisted thoracoscopic (VAT) lobectomy for lung cancer. Materials and methods We performed a retrospective cohort analysis by reviewing the medical records of patients who underwent VAT lobectomy at a single university medical center. We defined the early postoperative CRA as a characteristic appearance on chest radiograph up to 2 days after surgery. Arterial blood gas analysis (ABGA), surgical time, anaesthesia time, extubation time, and the total dose of rocuronium were analysed. Postoperative nausea and vomiting (PONV) and pain scores were observed until 2 days after surgery. Results A total of 257 patients underwent VAT lobectomy during the study period; 159 were included in the final analysis. Ninety patients received sugammadex while 69 received pyridostigmine. The incidence of early postoperative atelectasis was significantly lower in group S than in group P (26.7%, 95% CI: 17.5%‒35.8% and 43.5%, 95% CI: 31.8%‒55.2%, respectively, P = 0.013). The median dose of rocuronium was higher in group S than in group P (120 mg vs. 90 mg, P < 0.001). ABGA, extubation time, and PONV were similar in both groups. Conclusion Sugammadex decreased the incidence of CRA in the early postoperative period despite higher NMB consumption.
Collapse
Affiliation(s)
- Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung Wook Kang
- Department of Anesthesiology and Pain Medicine, Nowon Chuck Hospital, Seoul, Republic of Korea
| | - Hyun Koo Kim
- Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyo Sung Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heezoo Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
44
|
Sihoe ADL. Developing training for uniportal video-assisted thoracic surgery: a commentary. Eur J Cardiothorac Surg 2020; 58:i1-i5. [PMID: 32529233 DOI: 10.1093/ejcts/ezaa140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Today, thoracic surgeons have many possible pathways to advance their training in video-assisted thoracic surgery (VATS). For uniportal VATS (uVATS) in particular, what are the training options available and does regulating training matter? METHODS The relevant literature pertaining to uVATS training is reviewed. RESULTS Current options for surgeons looking to train in uVATS range from videos on the internet, through 'experts' demonstrating live surgery, to symposia and hands-on wet labs being held in all regions of the world. All have merits, and the aspiring VATS surgeon can choose from a range of preceptorship and proctorship modules to suit his/her own training needs. However, issues in the formalizing training in uVATS remains unresolved. Is there an ideal pathway through uVATS training? At what point can a trainee be considered to have 'graduated' to become an expert in uVATS? Who indeed trains the trainer, and certifies the competence of a training centre? CONCLUSIONS Although a plethora of training options exist, formulation of a robust training curriculum can further bolster the status of uVATS as a sustainable surgical approach that can be delivered with consistent quality.
Collapse
Affiliation(s)
- Alan D L Sihoe
- Gleneagles Hong Kong Hospital, Hong Kong SAR, China.,International Medical Centre, Hong Kong SAR, China
| |
Collapse
|
45
|
Menna C, Poggi C, Andreetti C, Ciccone AM, Baccarini AE, Maurizi G, D'Andrilli A, Vanni C, Cascone R, Fiorelli A, Santini M, Venuta F, Rendina EA, Ibrahim M. The use of Transcollation Technology for Video-Assisted Thoracic Surgery lobectomy. J Cardiothorac Surg 2020; 15:190. [PMID: 32723360 PMCID: PMC7385716 DOI: 10.1186/s13019-020-01230-y] [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: 03/31/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background Video-Assisted Thoracic Surgery (VATS) lobectomy is now considered the preferred approach at many centers for early stage lung cancer. However, it needs an adequate learning curve, and it may be challenging in non-expert hands. The aim of this study was to evaluate the effectiveness of Transcollation Technology over Traditional Electrocautery to perform hilar and mediastinal dissection during VATS lobectomy. Methods This is a single-center retrospective study including consecutive patients undergoing VATS lobectomy for lung cancer. Patients were divided in two groups based on whether Transcollation Technology (TT Group) or Traditional Electrocautery (TE Group) was used for hilar and mediastinal lymphadenectomy. Operative time and surgical outcome, including number of transfusions, length of chest drainage, length of hospital stay, morbidity and mortality were registered, and the inter-group differences were statistically analyzed. Results 53 patients were included in the final analysis. The TT Group (n = 24) compared to the TE Group (n = 29) showed significant shorter operative time (75.2 ± 25.8 min versus 98.1 ± 33.3 min; p = 0.023), and reduction of length of chest tube stay (4.7 ± 0.8 days vs. 6.8 ± 1.1 days, p = 0.013) and length of hospital stay (5.3 ± 1.9 days vs. 6.8 ± 1.1 days, p = 0.007). No intraoperative or major postoperative complications were observed in either groups. Conclusions Transcollation Technology represents a valid alternative to standard electrocautery instruments during VATS lobectomy. It contributes to reduce the operative time and length of hospital stay. Further larger prospective studies are required to confirm our data.
Collapse
Affiliation(s)
- Cecilia Menna
- Division of Thoracic Surgery, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Camilla Poggi
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, I-80138, Naples, Italy
| | - Claudio Andreetti
- Division of Thoracic Surgery, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Anna Maria Ciccone
- Division of Thoracic Surgery, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | | | - Giulio Maurizi
- Division of Thoracic Surgery, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Antonio D'Andrilli
- Division of Thoracic Surgery, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Camilla Vanni
- Division of Thoracic Surgery, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Roberto Cascone
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, I-80138, Naples, Italy
| | - Alfonso Fiorelli
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, I-80138, Naples, Italy.
| | - Mario Santini
- Division of Thoracic Surgery, University of Campania Luigi Vanvitelli, Piazza Miraglia, 2, I-80138, Naples, Italy
| | - Federico Venuta
- Division of Thoracic Surgery, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| |
Collapse
|
46
|
Sperandeo M, Venuti M, Quarato CMI. Uniportal versus multiportal video-assisted thoracic surgery for lung cancer: safety and advantages in employing complementary intraoperative lung ultrasound. J Thorac Dis 2020; 12:3013-3017. [PMID: 32642222 PMCID: PMC7330758 DOI: 10.21037/jtd.2020.03.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound of Internal Medicine IRCCS Fondazione "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Mariapia Venuti
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy
| |
Collapse
|
47
|
Menna C, Poggi C, Andreetti C, Maurizi G, Ciccone AM, D'Andrilli A, Vanni C, Vestri AR, Fiorelli A, Santini M, Venuta F, Rendina EA, Ibrahim M. Does the length of uniportal video-assisted thoracoscopic lobectomy affect postoperative pain? Results of a randomized controlled trial. Thorac Cancer 2020; 11:1765-1772. [PMID: 32379396 PMCID: PMC7327668 DOI: 10.1111/1759-7714.13291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy has become a common approach for the treatment of early stage lung cancer. Here, we aimed to establish whether the length of uniportal incision could affect postoperative pain and surgical outcomes in consecutive patients undergoing uniportal VATS lobectomy for early stage lung cancer. METHODS This was a unicenter Randomized Control Trial (NCT03218098). Consecutive patients undergoing uniportal VATS lobectomy for Stage I lung cancer were randomly assigned to a Small Incision group or Long Incision group in 1:1 ratio based on whether patients received a 4 cm or 8 cm incision. The endpoints were to compare the intergroup difference regarding (i) postoperative pain measured by brief pain inventory (BPI) questionnaire (first endpoint); (ii) operative time; (iii) length of chest drainage; (iv) length of hospital stay; (v) postoperative complications; and (vi) pulmonary functional status (secondary endpoints). RESULTS A total of 48 patients were eligible for the study. Four patients were excluded; the study population included 44 patients: 23 within the Small Incision group, and 21 within the Long Incision group. The 11 BPI scores between the two groups showed no significant difference. Small Incision group presented higher operative time than Long Incision group (138.69 vs. 112.14 minutes; P = 0.0001) while no significant differences were found regarding length of hospital stay (P = 0.95); respiratory complications (P = 0.92); FEV1% (P = 0.63), and 6-Minute Walking Test (P = 0.77). CONCLUSIONS A larger incision for uniportal VATS lobectomy significantly reduced the operative time due to better exposure of the anatomical structures without increasing postoperative pain or affecting the surgical outcome. KEY POINTS A larger incision for uniportal VATS lobectomy significantly reduced the operative time due to better exposure of the anatomical structures without increasing postoperative pain or affecting the surgical outcome. To perform a larger incision could be a valuable strategy, particularly in nonexpert hands or when the patient's anatomy or tumor size make exposure of anatomic structures through smaller incisions difficult.
Collapse
Affiliation(s)
- Cecilia Menna
- Division of Thoracic Surgery, Sant'Andrea HospitalUniversity of Rome “Sapienza”RomeItaly
| | - Camilla Poggi
- Division of Thoracic Surgery, Policlinico Umberto IUniversity of Rome “Sapienza”RomeItaly
| | - Claudio Andreetti
- Division of Thoracic Surgery, Sant'Andrea HospitalUniversity of Rome “Sapienza”RomeItaly
| | - Giulio Maurizi
- Division of Thoracic Surgery, Sant'Andrea HospitalUniversity of Rome “Sapienza”RomeItaly
| | - Anna Maria Ciccone
- Division of Thoracic Surgery, Sant'Andrea HospitalUniversity of Rome “Sapienza”RomeItaly
| | - Antonio D'Andrilli
- Division of Thoracic Surgery, Sant'Andrea HospitalUniversity of Rome “Sapienza”RomeItaly
| | - Camilla Vanni
- Division of Thoracic Surgery, Sant'Andrea HospitalUniversity of Rome “Sapienza”RomeItaly
| | - Anna Rita Vestri
- Department of Public Health and Infectious DiseaseUniversity of Rome “Sapienza”RomeItaly
| | - Alfonso Fiorelli
- Thoracic surgery UnitUniversity of Campania Luigi VanvitelliNaplesItaly
| | - Mario Santini
- Thoracic surgery UnitUniversity of Campania Luigi VanvitelliNaplesItaly
| | - Federico Venuta
- Division of Thoracic Surgery, Policlinico Umberto IUniversity of Rome “Sapienza”RomeItaly
- Fondazione Eleonora Lorillard Spencer CenciRomeItaly
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sant'Andrea HospitalUniversity of Rome “Sapienza”RomeItaly
- Fondazione Eleonora Lorillard Spencer CenciRomeItaly
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sant'Andrea HospitalUniversity of Rome “Sapienza”RomeItaly
| |
Collapse
|
48
|
Yoon DW, Choi YS, Sung K, Kim H. Comparison of oncological outcomes of single-port versus multi-port video-assisted thoracoscopic surgery for non-small-cell lung cancer: a propensity-matched analysis. PRECISION AND FUTURE MEDICINE 2020. [DOI: 10.23838/pfm.2020.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
49
|
Abstract
The number of interventions using robot-assisted thoracic surgery (RATS) is increasing in Germany, following the previous international development. Robot-assisted surgery provides some technical advantages and can overcome existing limitations of video-assisted thoracic surgery (VATS), especially in the case of extended resections, thus enabling the proportion of minimally invasive operations to be further increased. The safety of the procedure, even in extended resections, has repeatedly been demonstrated but whether there are clinically relevant benefits from RATS is currently the subject of scientific discussions. In addition, a further technical evolution of the RATS can be postulated by the upcoming market introduction of new robotic systems.
Collapse
Affiliation(s)
- Thorben Möller
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - Matthias Steinert
- Klinik für Herz- und Thoraxchirurgie - Sektion Thoraxchirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Thomas Becker
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - Jan-Hen Drik Egberts
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| |
Collapse
|
50
|
Choi JS, Lee J, Moon YK, Moon SW, Park JK, Moon MH. Nodal Outcomes of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Clinical Stage I Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:104-113. [PMID: 32551290 PMCID: PMC7287225 DOI: 10.5090/kjtcs.2020.53.3.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 10/30/2019] [Indexed: 12/19/2022]
Abstract
Background Accurate intraoperative assessment of mediastinal lymph nodes is a critical aspect of lung cancer surgery. The efficacy and potential for upstaging implicit in these dissections must therefore be revisited in the current era of uniportal video-assisted thoracoscopic surgery (VATS). Methods A retrospective study was conducted in which 544 patients with stage I (T1abc–T2a, N0, M0) primary lung cancer were analyzed. To assess risk factors for nodal upstaging and to limit any imbalance imposed by surgical choices, we constructed an inverse probability of treatment-weighted (IPTW) logistic regression model (in addition to non-weighted logistic models). We also evaluated risk factors for early locoregional recurrence using IPTW logistic regression analysis. Results In the comparison of uniportal and multiportal VATS, the resected lymph node count (14.03±8.02 vs. 14.41±7.41, respectively; p=0.48) and rate of nodal upstaging (6.5% vs. 8.7%, respectively; p=0.51) appeared similar. Predictors of nodal upstaging included tumor size (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.12–2.70), carcinoembryonic antigen level (OR, 1.11; 95% CI, 1.04–1.18), and histologically confirmed pleural invasion (OR, 3.97; 95% CI, 1.89–8.34). The risk factors for locoregional recurrence within 1 year were found to be number of resected N2 nodes, age, and nodal upstaging. Conclusion Uniportal and multiportal VATS appear similar with regard to accuracy and thoroughness, showing no significant difference in the extent of nodal dissection.
Collapse
Affiliation(s)
- Jung Suk Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jiyun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyu Moon
- Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Hyoung Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|