The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy

Linlin Wang,Dabei Liu,Xueying Yang,Jibin Lu,Suning Zhang

doi:10.1186/s12885-017-3069-z

Abstract

BackgroundOngoing improvements in technique and instruments for video-assisted thoracoscopic surgery (VATS) have made minimally-invasive uniportal VATS lobectomy a reality. However, the outcomes of the procedure are still under investigation, and at present, uniportal VATS lobectomy is performed infrequently at most hospitals. We have therefore reviewed our outcomes with this procedure in an attempt to validate its safety, efficacy, and feasibility.MethodsWe retrospectively analyzed and compared perioperative data for patients who underwent uniportal, two-port, and traditional three-port VATS lobectomy between January 2015 and December 2015 at our hospital.ResultsAmong 257 patients who had successful VATS lobectomy during the study period, 73 underwent uniportal VATS, 86 underwent two-port VATS, and 98 underwent traditional three-port VATS. There were no surgical or 30-day postoperative mortalities, and no significant differences in operative times, blood loss, number of lymph nodes retrieved and nodal stations explored, drainage times, length of hospital stay, or postoperative complications among the three groups. The visual analogue scale (VAS) pain scores were significantly lower in the uniportal VATS group after surgery (P < 0.05).ConclusionsUniportal VATS lobectomy is a safe and feasible surgical procedure that is associated with decreased surgical trauma and less postoperative pain compared to traditional VATS. Further long term follow-up analyses in large numbers of patients are ongoing.

Highlights

Ongoing improvements in technique and instruments for video-assisted thoracoscopic surgery (VATS) have made minimally-invasive uniportal VATS lobectomy a reality
Surgical outcomes There were 1, 2, and 2 procedures converted to conventional open thoracotomy in the uniportal, two-port, and three-port VATS groups, respectively, for conversion rates of 1.37%, 2.33%, and 2.04% (P > 0.05)
There were no significant differences in operative times, blood loss, number of lymph nodes retrieved and nodal stations explored, drainage times, or length of hospital stay among the three groups (Table 4)

Summary

Introduction

Ongoing improvements in technique and instruments for video-assisted thoracoscopic surgery (VATS) have made minimally-invasive uniportal VATS lobectomy a reality. The outcomes of the procedure are still under investigation, and at present, uniportal VATS lobectomy is performed infrequently at most hospitals. Conventional threeport video-assisted thoracic surgery (VATS) lobectomy is well established, and many units have successfully adopted this technique over the past two decades [2]. Since 2010, uniportal VATS lobectomy has become a new area of exploration in minimally invasive thoracic surgery [3]. Uniportal VATS is a less invasive approach that allows major thoracic operations to be performed through a single small incision of about 4 cm. The advantages of uniportal VATS can include reduced surgical trauma, decreased postoperative pain, faster rehabilitation, and improved patient satisfaction with a less invasive approach than conventional VATS [6, 7]. The aim of this study is to assess the feasibility and applicability of the uniportal VATS approach in pulmonary lobectomy, and to compare perioperative outcomes of uniportal VATS with those of two-port and traditional three-port VATS

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Results

Conclusion