Abstract
BackgroundThe current state of thoracoscopic technology allows less invasive surgical procedures and requires fewer ports and incisions. Totally video-assisted thoracic surgery with a single port has emerged as the least invasive thoracoscopic approach.However, uniportal video-assisted thoracic surgery brings about considerable difficulties, necessitating the development of skillful techniques as well as specific surgical devices. In such situations as dense pleural adhesion and anatomical abnormality, it may be more burdensome, necessitating the conversion to conventional multiportal video-assisted thoracic surgery or even to thoracotomy. To troubleshoot these situations, we herein propose the use of additional technique which could support to sustain the confident operative field for uniportal video-assisted thoracic surgery. This procedure also provides the same cosmetic outcomes as uniportal video-assisted thoracic surgery.Case presentationA previously healthy, 77-year-old female was referred to our hospital, with a lung adenocarcinoma measuring 28 mm in the right upper lobe. Uniportal video-assisted thoracoscopic surgery was planned to resect the tumor. During operation, we found the incomplete interlobar fissure between the upper and the middle lobe and the abnormal lobulation of the upper lobe. Therefore, the modified marionette technique was introduced to make the procedure safer and easier. This technique proposed herein consists of employing the untethered gripping forceps to retract the lung, not requiring additional traumatic trocars. The postoperative course was uneventful and the patient `was discharged in 1 week after a modified uniportal video-assisted thoracic surgery for the right upper lobectomy.ConclusionsThe modified marionette technique produced sufficient operative views to attain uniportal video-assisted thoracic surgery safely in this case, rendering operative conversion unnecessary.
Highlights
The current state of thoracoscopic technology allows less invasive surgical procedures and requires fewer ports and incisions
uniportal video-assisted thoracic surgery (UVATS) might be appropriate for the case in good condition of the lung, whereas such situations as dense pleural adhesion and anatomical abnormality surrounding the tumor impose severe technical burdens
A good operability of tools based on the confident thoracoscopic views is deemed to be a prerequisite to perform UVATS promptly and accurately
Summary
The modified marionette technique produced sufficient operative views to attain uniportal video-assisted thoracic surgery safely in this case. This method can be achieved at low cost and be readily performed at centers currently performing VATS. Both authors read and approved the final manuscript. Funding The authors declare that they have no sources of funding. Ethics approval and consent to participate The ethics committee of Ebara Hospital approved this study. Competing interests The authors declare that they have no competing interests. Author details 1Department of Thoracic Surgery, Tokyo Shinagawa Hospital, 6-3-22 Higashi-Oi, Shinagawa-ku, Tokyo 140-8522, Japan. Author details 1Department of Thoracic Surgery, Tokyo Shinagawa Hospital, 6-3-22 Higashi-Oi, Shinagawa-ku, Tokyo 140-8522, Japan. 2Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation, Ebara Hospital, Tokyo, Japan
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
