Needlescopic-assisted thoracoscopic pulmonary anatomical lobectomy and segmentectomy for lung cancer: a bridge between multiportal and uniportal thoracoscopic surgery.

Abstract

Needlescopic instruments allow us to perform complex laparoscopic procedures, which are almost painless and scarless postoperatively; however, their utilization in thoracoscopic surgery has been limited to minor procedures, including bullectomy and sympathectomy. We present our initial experience of performing thoracoscopic anatomical lung resection via a single utility incision with additional needlescopic working ports and compare the operative results with those of uniportal video-assisted thorascopic surgery (VATS). We reviewed data on 75 consecutive patients with lung cancer, who underwent anatomical lung resections, including lobectomy and segmentectomy, between February 2015 and September 2017. Of the 75 patients, 39 underwent uniportal VATS (uniportal group), and 36 underwent needlescopic-assisted VATS (n-VATS group). We compared the peri- and postoperative outcomes of the two groups. The clinical characteristics did not differ significantly between the groups, except in the ages of the patients. The n-VATS group had a shorter operation time (mean 159.3min vs. 198.8min, P = 0.023) and lower intraoperative blood loss (mean 40.9mL vs. 143.2mL, P = 0.047). Two major pulmonary arterial bleeding events and one conversion to thoracotomy occurred in the uniportal group. Uniportal VATS can be performed more efficiently and safely with the assistance of additional needlescopic ports and instruments, without compromising the benefits of less postoperative pain and early recovery.