Techniques of uniportal video-assisted thoracic surgery-esophageal and mediastinal indications

Uniportal Video-Assisted Thoracoscopic Surgery for Minor Procedures

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.

Uniportal video-assisted thoracoscopic Ivor Lewis oesophagectomy

Standard minimally invasive Ivor Lewis oesophagectomy is performed through a multiport technique using carbon dioxide. However, access to video-assisted thoracoscopic surgery (VATS) is increasingly shifting to a single-port approach due to its proven safety and efficacy in lung surgeries. Therefore, the preamble of this submission is to describe, 'How I do differently' uniportal VATS MIO in three major steps: (a) VATS dissection through a single 4-cm incision in a semi-prone position without artificial capnothorax; (b) fluorescence dye to check conduit perfusion and (c) intrathoracic overlay anastomosis with a linear stapler.

Comparison of McKeown Minimally Invasive Esophagectomy vs sweet esophagectomy for esophageal squamous cell carcinoma: A retrospective study

There are two most widely used transthoracic esophagectomy methods: the McKeown Minimally Invasive esophagectomy (McKeown MIE) and the Sweet Esophagectomy. We evaluated and compared the therapeutic effects of these two methods to determine the appropriate method for the treatment of middle and lower third esophageal cancer patients who received neoadjuvant chemotherapy combined with immunotherapy (NACI). We retrospectively analyzed 43 sweet esophagectomy cases received NACI and 167 cases with McKeown MIE in the fourth hospital of Hebei Medical University from December 2019 to May 2022. This retrospective observational study showed that Sweet esophagectomy and McKeown MIE after NACI therapy for resectable ESCC patients appeared to be safe with low operative mortality and morbidity rate in the current population. In addition, sweet esophagectomy was associated with a lower incidence of severe complications and shorter hospital stay for patients over 70 years of age compared with McKeown MIE. There were no differences were found in length of stay, mortality and complication incidence rate between the two groups. The Sweet approach has advantage in hospital stay for the treatment of the elderly NACI patients with middle or lower third esophageal squamous cell carcinoma. In conclusion, Sweet esophagectomy and McKeown MIE are both safe, effective, and worthwhile approaches for ESCC patients in immunotherapy age.

Esophageal carcinosarcoma comprising undifferentiated pleomorphic sarcoma and squamous cell carcinoma: a case report

Background

Esophageal carcinosarcoma (ECS) is a rare malignant tumor that often presents as an intraluminal polypoid lesion in the esophageal lumen. The pathogenesis of esophageal carcinosarcoma is not clear and its etiology is still being discussed.

Case presentation

We report the case of a 68-year-old male who had dysphagia for approximately three months. Contrast-enhanced computed tomography showed an irregular enhancing mass in the lower esophagus. Endoscopy showed a gray-white mass with a smooth surface that almost filled the esophageal lumen at a location 28 cm from the incisor tooth. Considering the location of the tumor, we opted for Ivor-Lewis esophagectomy with intrathoracic anastomosis through a 5-port laparoscope and uniport video-assisted thoracic surgery (VATS). Pathological analysis showed that the mass comprised carcinoma in situ and pleomorphic sarcoma, without lymphatic metastasis. The postoperative pathological stage was T1bN0M0, stage I (Japanese Classification of Esophageal Cancer 11th Edition). The latest follow-up of the patient was 14 months after the surgery, and no signs of recurrence or metastasis were found.

Conclusion

This case demonstrates a rare esophageal malignancy with a peculiar histological composition. Successful VATS esophagectomy with intrathoracic anastomosis was conducted without recurrence or metastasis at the 14-month follow-up.

Uniportal VATS Approach in Esophageal Cancer - How to Do It Update

The adoption of minimally invasive esophagectomy has been used for over a decade, and the chest part is evolving into a uniportal video-assisted thoracoscopic surgery (VATS) approach. Uniportal esophageal mobilization and anastomosis have many peculiar aspects, which include placement of the incision, alignment of instruments, and anastomosis. The incision is placed over the sixth intercostal space posterior axillary line. The esophagus is usually encircled at the level of the inferior pulmonary vein. The use of curved suction helps in the retraction of the esophagus and the exposure of the left main bronchus deep in the mediastinum. For intrathoracic anastomosis in Ivor Lewis esophagectomy, a completely side-to-side linear-stapled anastomosis is preferred. This anastomotic technique results in a long stapler line. The correct alignment of tissues and adequate anastomotic circumference are of utmost importance to prevent leaks or strictures. Perioperative and oncologic results in several series with uniportal VATS, esophageal mobilization, and anastomosis are comparable with open or other types of minimally invasive esophagectomy. Uniportal VATS for esophagectomy is feasible and fast with good results.