Early experience of uniportal video assisted thoracoscopic surgery in a New Thoracic Unit in Hospital Kuala Lumpur, Malaysia

Narasimman Sathiamurthy,Nguk Chai Diong,Benedict Dharmaraj

doi:10.20517/2574-1225.2020.25

Abstract

The evolution of video technology and instrumentation have revolutionised the way lung resections are performed without compromising outcomes. In a new thoracic surgery setup, we have adopted the uniportal video assisted thoracoscopic surgery (U-VATS) technique for lung resections in most of our cases. A retrospective review of operative records from July 2017 till June 2019 in Hospital Kuala Lumpur (HKL) for all thoracic surgeries was done. Patients were divided into two groups: those that underwent U-VATS surgery in the first and second year as part of the learning curve. The operative time, blood loss, lymph node yield, duration of drain placement, and length of hospital stay were compared between the groups. The most common indication for U-VATS surgery was malignant lung tumors (21%) followed by ruptured bullae (20%) and empyema thoracis (15%). The average time taken for lobectomies performed for non-small cell lung cancer was 201 min. U-VATS decortication caused the most amount of blood loss with an average of 350 mL, followed by aspergilloma at 315 mL and bronchoplasty at 250 mL. The rest of the procedures had < 150 mL of blood loss. There was no significant difference in the parameters compared between procedures in the two groups.No mortality was seen.The learning curve of U-VATS was used as a guide to gradually increase the complexity of cases performed in a pyramidal manner. U-VATS is an alternative and promising minimal access approach in thoracic surgery that can be safely performed in Malaysia.

Highlights

Since Giancarlo Roviaro performed the first lung resection with video assistance through small incisions without rib spreading in 1992, the evolution of video technology and instrumentation have revolutionised the way lung resections are performed without compromising outcomes[1]
The recently concluded randomised control trial, Video Assisted Thoracoscopic Lobectomy Versus Conventional Open Lobectomy for Lung Cancer (VIOLET) study confirmed that VATS is not inferior to open thoracotomy in the oncological outcomes of non-small cell lung cancer (NSCLC) resection and provides better post-operative pain control
In 2010, Diego Gonzales Rivaz was the first to perform a lobectomy through the uniportal approach and went on to execute complex lung resections over the few years, including carinal resections[2]

Summary

Introduction

Since Giancarlo Roviaro performed the first lung resection with video assistance through small incisions without rib spreading in 1992, the evolution of video technology and instrumentation have revolutionised the way lung resections are performed without compromising outcomes[1]. Diego Gonzales-Rivas popularised the uniportal video assisted thoracoscopic surgery (U-VATS) technique by demonstrating reproducibility of the surgeries and improving patient outcomes. He performed many complex procedures like segmentectomies and bronchial and arterial sleeves through U-VATS[2]. In a new thoracic surgery setup, we adopted the U-VATS technique for lung resections in most of our cases. This article will describe our experience through the learning curve of adaptating the U-VATS approach in thoracic surgery

Methods

Results

Discussion

Conclusion