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Han Y, Zhang Z, Feng H, Wen H, Su K, Xiao F, Liang C, Liu D. Uniportal video-assisted anatomical segmentectomy: an analysis of the learning curve. World J Surg Oncol 2023; 21:232. [PMID: 37516847 PMCID: PMC10386600 DOI: 10.1186/s12957-023-03086-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/28/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND This study aimed to demonstrate the learning curve of anatomical segmentectomy performed by uniportal video-assisted thoracoscopic surgery (U-VATS). METHOD We conducted a retrospective study of U-VATS segmentectomies performed by the same surgeon between September 2019 and August 2022. The learning curve was demonstrated using risk-adjusted cumulative sum (RA-CUSUM) analysis in terms of perioperative complications, which reflected surgical quality and technique proficiency. The surgical outcomes were also compared between different phases. RESULT The complication-based learning curve of U-VATS segmentectomy could be divided into two phases based on RA-CUSUM analysis: phase I, the initial learning phase (cases 1-50) and phase II, the proficiency phase (cases 51-141). Significantly higher complication rates (24.0 vs. 8.8%, p=0.013), longer surgical times (119.8±31.9 vs. 106.2±23.8 min, p=0.005), and more blood loss (20 [IQR, 20-30] vs. 20 [IQR, 10-20] ml, p=0.003) were observed in phase I than in phase II. CONCLUSION The learning curve of U-VATS segmentectomy consists of two phases, and at least 50 cases were required to gain technique proficiency and achieve high-quality surgical outcomes.
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Affiliation(s)
- Yu Han
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
| | - Zhenrong Zhang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
| | - Hongxiang Feng
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
| | - Huanshun Wen
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
| | - Kunsong Su
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
| | - Fei Xiao
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China.
- National Center for Respiratory Medicine, Beijing, People's Republic of China.
| | - Chaoyang Liang
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China.
- National Center for Respiratory Medicine, Beijing, People's Republic of China.
| | - Deruo Liu
- Department of General Thoracic Surgery, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China
- National Center for Respiratory Medicine, Beijing, People's Republic of China
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Wang J, Xu M, Zhang C, Wei D. Clinical analysis of subxiphoid single-port thoracoscopic surgery for simultaneous bilateral lung lesion resection. BMC Surg 2022; 22:203. [PMID: 35614417 PMCID: PMC9131547 DOI: 10.1186/s12893-022-01646-4] [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: 03/03/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of simultaneous subxiphoid single-port thoracoscopic resection of bilateral lung lesions. METHODS This retrospective study analyzed the clinical data of 72 patients who underwent resection of bilateral lung lesions at the Department of Thoracic Surgery in the First Affiliated Hospital of University of Science and Technology of China between August 2020 and January 2022. Surgery-related parameters were compared between patients who underwent subxiphoid single-port thoracoscopy (subxiphoid group, 36 patients) and patients who underwent intercostal single-port thoracoscopy (intercostal group, 36 patients). RESULTS Compared to the intercostal group, the subxiphoid group exhibited significantly better postoperative catheterization time (P = 0.013), postoperative thoracic drainage, postoperative visual analog scale pain scores at 24 and 48 h, and incision pain and numbness at 1 and 3 months after surgery (all P < 0.05). There were no significant differences in operation time, intraoperative blood loss, or postoperative complications between the two groups (all P > 0.05). There were no cases of perioperative mortality, conversion to thoracotomy, or serious complications in either group. CONCLUSION Subxiphoid single-port thoracoscopic surgery for simultaneous resection of bilateral lung lesions is safe and effective, reduces postoperative acute and chronic pain, decreases trauma, allows faster recovery, and is more consistent with the concept of minimally invasive surgery than bilateral intercostal single-port thoracoscopy. Thus, this subxiphoid single-port thoracoscopic surgery approach should be considered for clinical application.
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Affiliation(s)
- Jun Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, People's Republic of China.
| | - Meiqing Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, People's Republic of China
| | - Chuankai Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, People's Republic of China
| | - Dazhong Wei
- Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, People's Republic of China
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Sesma J, Bolufer S, García-Valentín A, Embún R, López ÍJ, Moreno-Mata N, Jiménez U, Trancho FH, Martín-Ucar AE, Gallar J. Thoracoscopic segmentectomy versus lobectomy: A propensity score–matched analysis. JTCVS OPEN 2022; 9:268-278. [PMID: 36003470 PMCID: PMC9390783 DOI: 10.1016/j.xjon.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy. Methods From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score–matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan–Meier and competing risks method were used to compare survival. Results In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score–matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan–Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression–related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups. Conclusions Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.
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Affiliation(s)
- Julio Sesma
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
- Address for reprints: Julio Sesma, MD, Pintor Baeza 12. 03013, Alicante, Spain.
| | - Sergio Bolufer
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Antonio García-Valentín
- Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
- Miguel Hernandez de Elche University, Alicante, Spain
| | - Raúl Embún
- Cardiac Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Íker Javier López
- Thoracic Surgery Department, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Nicolás Moreno-Mata
- Thoracic Surgery Department, Hospital Universitario de Donostia, San Sebastián-Donostia, Spain
| | - Unai Jiménez
- Thoracic Surgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Antonio Eduardo Martín-Ucar
- Thoracic Surgery Department, Hospital Clínico San Carlos, Madrid, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Juana Gallar
- Miguel Hernandez de Elche University, Alicante, Spain
- Thoracic Surgery Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
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Tosi D, Palleschi A, Musso V, Mazzucco A, Cattaneo M, Carrinola R, Damarco F, Mendogni P. The European experience. J Thorac Dis 2020; 12:3411-3417. [PMID: 32642267 PMCID: PMC7330796 DOI: 10.21037/jtd.2020.01.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Traditionally, pulmonary lobectomy has always been considered as the gold standard for the treatment of early stage non-small cell lung cancer (NSCLC); limited resections have been proposed in case of "compromised" patients, with relevant comorbidities. In the last years, the interest in anatomical segmentectomies among surgeons has been progressively growing, even for patients fit for lobectomy, in selected cases. In this article we debate the current trends in the treatment of early stage NSCLC around Europe.
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Affiliation(s)
- Davide Tosi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Palleschi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Musso
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Mazzucco
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Margherita Cattaneo
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosaria Carrinola
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Damarco
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Chen J, Volpi S, Ali JM, Aresu G, Wu L, Chen Z, Wang J, Chen B, Yang C, Soultanis KM, Jiang G, Jiang L. Comparison of post-operative pain and quality of life between uniportal subxiphoid and intercostal video-assisted thoracoscopic lobectomy. J Thorac Dis 2020; 12:3582-3590. [PMID: 32802437 PMCID: PMC7399408 DOI: 10.21037/jtd-20-425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Uniportal video-assisted thoracoscopic surgery (VATS) although considered less invasive than the multi-port techniques, is still an intercostal approach, resulting in intercostal nerve injury. Recently, some surgeons have tried to address this problem by attempting a subxiphoid approach. The aim of our study was to assess and compare results between intercostal and subxiphoid uniportal VATS lobectomy in terms of postoperative pain and quality of life (QoL). Methods Patients from January 2014 to January 2018 undergoing subxiphoid and intercostal VATS lobectomy were prospectively assessed for pain and QoL at 1, 3, and 6 months following discharge. Postoperative pain was measured using a numeric rating scale (NRS) and QoL was assessed with the EuroQoL 5-dimension questionnaire (EQ5D) Results Eight hundred and thirty-three patients undergoing lobectomy were included: 373 in the intercostal VATS group and 459 in the subxiphoid group. The proportion of patients with moderate or worse clinical pain was significantly lower at 1 and 3 months after subxiphoid VATS (P<0.01) compared with intercostal VATS. QoL was significantly higher following subxiphoid VATS at these same time points (P<0.001). Conclusions Uniportal subxiphoid VATS is a safe and feasible minimally invasive approach for undertaking pulmonary lobectomy that may result in reduced postoperative pain compared to conventional VATS. There may also be earlier return of QoL. A randomized controlled trial examining this further would provide further insight into our observations.
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Affiliation(s)
- Jian Chen
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
| | - Sara Volpi
- Department of Cardiothoracic Surgery, The Royal Papworth Hospital, Cambridge, UK
| | - Jason M Ali
- Department of Cardiothoracic Surgery, The Royal Papworth Hospital, Cambridge, UK
| | - Giuseppe Aresu
- Department of Cardiothoracic Surgery, The Royal Papworth Hospital, Cambridge, UK
| | - Liang Wu
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
| | - Zhigang Chen
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
| | - Jin Wang
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
| | - Bei Chen
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
| | - Chenlu Yang
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
| | - Kostis Marios Soultanis
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
| | - Gening Jiang
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
| | - Lei Jiang
- Department of Thoracic surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
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Meacci E, Nachira D, Zanfrini E, Triumbari EKA, Iaffaldano AG, Congedo MT, Petracca Ciavarella L, Pogliani L, Chiappetta M, Porziella V, Gonzalez-Rivas D, Vita ML, Margaritora S. Uniportal VATS approach to sub-lobar anatomic resections: literature review and personal experience. J Thorac Dis 2020; 12:3376-3389. [PMID: 32642263 PMCID: PMC7330759 DOI: 10.21037/jtd.2020.01.12] [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] [Indexed: 12/25/2022]
Abstract
Surgical scientific literature contains relatively little information regarding the surgical outcomes of anatomic sublobar resections performed with the uniportal video-assisted thoracoscopic surgery (U-VATS) technique. This paper attempts to evaluate the role of U-VATS segmentectomies in the landscape of a minimally invasive approach to the treatment of early stage non small cell lung cancer (NSCLC).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Diego Gonzalez-Rivas
- Thoracic Surgery Department, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai 200433, China
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Lee J, Lee JY, Choi JS, Sung SW. Comparison of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:141-147. [PMID: 31236373 PMCID: PMC6559186 DOI: 10.5090/kjtcs.2019.52.3.141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 11/16/2022]
Abstract
Background Uniportal video-assisted thoracoscopic surgery (VATS) has proven safe and effective for pulmonary wedge resection and lobectomy. The objective of this study was to evaluate the safety and feasibility of uniportal VATS segmentectomy by comparing its outcomes with those of the multiportal approach at a single center. Methods The records of 84 patients who underwent VATS segmentectomy from August 2010 to August 2018, including 33 in the uniportal group and 51 in the multiportal group, were retrospectively reviewed and analyzed. Results Anesthesia and operative times were similar in the uniportal and multiportal groups (215 minutes vs. 220 minutes, respectively; p=0.276 and 180 minutes vs. 198 minutes, respectively; p=0.396). Blood loss was significantly lower in the uniportal group (50 mL vs. 100 mL, p=0.013) and chest tube duration and hospital stay were significantly shorter in the uniportal group (2 days vs. 3 days, p=0.003 and 4 days [range, 1-14 days] vs. 4 days [range, 1-62 days], p=0.011). The number of dissected lymph nodes tended to be lower in the uniportal group (5 vs. 8, p=0.056). Conclusion Our preliminary experience indicates that uniportal VATS segmentectomy is safe and feasible in well-selected patients. A randomized, prospective study with a large group of patients and long-term follow-up is necessary to confirm these results.
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Affiliation(s)
- June Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Yun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Suk Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sook Whan Sung
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lopez-Pastorini A, Stoelben E, Koryllos A. Editorial on "Trans-inferior-pulmonary-ligament VATS basal segmentectomy: application of single-direction strategy in segmentectomy of left S9+10". J Thorac Dis 2019; 11:S283-S285. [PMID: 30997198 DOI: 10.21037/jtd.2019.01.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, Lung Clinic, Hospital of the City of Cologne, University of Witten-Herdecke, Cologne, Germany
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