Single-incision Video-assisted Thoracic Surgery Research Articles

Application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules both lungs: a single-center experience of 10 cases

ObjectiveTo discuss the application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules in both lungs.MethodsA retrospective analysis of 10 patients in Zhengzhou People’s Hospital who underwent single-incision thoracoscopic surgery to treat multiple nodules in both lungs at the same time from September 2019 to January 2021, and analyze the perioperative indicators (general condition, smoking history, family history, follow-up time of pulmonary nodules, size, location, height and weight, pulmonary function, intraoperative blood loss, operation time, color and volume of drainage fluid, catheterization time, perioperative complications, length of stay, pathology, patient satisfaction, etc.).ResultsAll 10 patients used single-incision thoracoscopy to complete bilateral simultaneous sequential operations, aged 32 to 70 years, 8 female patients, 2 male patients, preoperative follow-up time ranging from 1 day to 2 years, a total of 23 lung nodules were removed except for the benign lesions in one nodule in the 2 patients, the other nodules were tumorous lesions (91.3%). The average total hospital stay was 10.5 days (8–14 days), and the average operation time was 194.5 min (145–292 min). The blood loss ranged from 10 to 280 ml, all patients had no serious complications during the perioperative period, and they recovered well and were discharged smoothly, and the satisfaction reached 100%.ConclusionSingle-incision bilateral simultaneous sequential thoracoscopy have certain advantages in the treatment of patients with multiple nodules in both lungs, conforms to the concept of rapid recovery, and is a feasible choice in the shared decision making of doctors and patients.

Single Incision Video-Assisted Thoracic Surgery Pneumonectomy for Centrally Located Lung Cancer

Increasing experience in single-incision video-assisted thoracoscopic (SIVATS) lung resections for lung cancer has made some sophisticated lung resections such as bronchial or vascular sleeve resections, chest wall resections and pneumonectomy possible. There are some case series published in medical literature about the feasibility and safety of multiportal video-assisted thoracic surgery pneumonectomy. However, in this prepubertal period of its evolution the literature data are still immature, and limited only to rare case reports or video presentations for SIVATS pneumonectomy for lung cancer. This article aims to discuss the technique, feasibility and place of SIVATS pneumonectomy in the management of non-small-cell lung cancer.

Single Versus Multi-Incisional Video-Assisted Thoracic Surgery: A Systematic Review and Meta-analysis.

Video-Assisted Thoracic Surgery (VATS) is conventionally performed through multiple small incisions (C-VATS). Recent studies have reported encouraging results with the single-incision VATS (S-VATS) over the conventional technique. However, these studies were either small in size, unfocused, nonuniform, retrospective, lacking follow-up information, or focused on pain. We aim to validate previously reported results in a single large meta-analysis, including only the best evidence studies available. Systematic review of the PubMed archive was conducted to include only full English articles with Newcastle Ottawa Scale score ≥7. The primary outcome was the complications rate while secondary outcomes were operative time, resected lymph nodes (LNs), chest tube duration, estimated blood loss, length of postoperative stay (LOS), and postoperative pain on day 1 after surgery. Odds ratio and standard mean difference were used as effect estimates. Random model and leave-one-out analysis were used. A total of 39 studies were included with 4635 patients (1686 S-VATS versus 2949 C-VATS). S-VATS has resulted in significantly less postoperative pain (P < .001), blood loss (P = .006), LOS (P < .001), and chest tube duration (P < .001). In lung cancer patients, the number of retrieved LNs was similar to that of C-VATS (P > .05). Subgroup comparison of the rate of complications between lung resections versus other intrathoracic procedures, lung cancer versus pneumothorax, and lung cancer versus other lung-only lesions did not show any significant differences between the groups. Performing S-VATS technique has shown superior postoperative outcomes over the C-VATS technique in the treatment of thoracic disorders. Substantial benefit was confirmed in terms of less postoperative pain, blood loss, drainage time, and postoperative hospital stay.

Robotic thoracic surgery: S1+2 segmentectomy of the left upper lobe: advantage of robotic assisted thoracic surgery.

We are grateful for the reviewers’ comments on our manuscript entitled “Robotic thoracic surgery: S1+2 segmentectomy of the left upper lobe” (1). An advantage of robotic assisted thoracic surgery (RATS) is that the robotic arms are flexible and allow the surgeon to move instruments freely inside the chest cavity as needed without geometric limitations. Compared with single-incision video-assisted thoracic surgery (VATS), the flexibility is one of the primary advantages of robotic surgery. Although the literature revealed that RATS does not seem to offer any advantages over VATS with regards to complications, postoperative pain, hospital stay, and oncological outcome for early-stage lung cancer (2,3), the benefit of RATS is that the surgeon feels more comfortable and confident when performing RATS.

Non-intubated single-incision video-assisted thoracic surgery: a two-center cohort of 188 patients.

Non-intubated single-incision procedures are slowly expanding because of high experience and skill required, and stricter selection criteria. The aim of this study is to present the first retrospective two-center series in Taiwan and Spain. We performed a retrospective analysis of 188 patients undergoing non-intubated single-incision video-assisted thoracic surgery (NI-SI-VATS) procedures between July 2013 to November 2015 in two centers in Taiwan (170 patients) and Spain (18 patients) with two different anesthetic methods. Demographic data, clinicopathological features, preoperative tests, and final outcomes were analyzed to compare the outcomes with the two different techniques. Of the 188 patients, 147 (78%) were women, with a mean body mass index (BMI) of 22.7. Of the 196 specimens, 145 (74%) were malignancies with a mean size of 9.7 mm. Wedge resection was performed in 172 patients (91.4%), anatomical segmentectomy with lymphadenectomy in 8 (4.7%), and lobectomy with lymphadenectomy in 5 (2.6%). Three patients (1.6%) required conversion to orotracheal intubation, while 5 patients (2.7%) required additional ports. Complications appeared in 16 patients (8.5%) with air leak as the most frequent in 7 cases (3.7%). Median chest drainage was 1 day, and median postoperative stay was 3 days. There was neither perioperative death nor postoperative readmission. Non-intubated single-incision procedures can be feasible and safe in expert hands and experienced teams, even for anatomical resections. Strict selection criteria, skill and experience are mandatory. Comparative cohorts and randomized trials are needed.

The Athens uniportal video-assisted thoracic surgery masterclass-an ambitious kickstarter.

The shift from open to minimally invasive techniques in thoracic surgery has been dramatic during the past 10 years. Not only the feasibility, safety, reproducibility and oncologic efficacy of these techniques have been clearly demonstrated, but also their superiority concerning mortality, postoperative pain, postoperative quality of life and recovery. Thus, video-assisted thoracic surgery (VATS) is currently the procedure of choice for a wide variety of thoracic interventions, ranging from major pulmonary resections for lung cancer to thymectomy and mediastinal procedures, even to esophageal procedures. Amongst the various minimally invasive techniques, the uniportal or single incision VATS has recently gained great popularity. The concept of a single 2.5 cm incision, despite not being the technique's only advantage, through which major thoracic procedures can be carried out, seems to greatly appeal to surgeons throughout the globe. Appealing as it may be, the technique is also demanding, revealing the need for training. A well organised and structured, fee free training programme that has been running at the Shanghai Pulmonary Hospital for more than 2 years under the inspirational guidance of Dr. Gonzalez Rivas has undoubtedly skyrocketed the technique's adoption worldwide. Of equal significance towards the spread of the technique have proved to be the master classes, 2-day intensive tutorials, hosted by centres all over the world during which Dr Rivas outlines the principles of the technique before performing with the assistance of the local surgical team. We hereby reflect on the experience obtained following Riva's visit to our institution in Athens, Hellas (Greece) for a 2-day uniportal VATS master class, the first held in Hellas.

Preface to the book This is life: the journey of uniportal VATS

Uniportal video-assisted thoracic surgery (VATS), also known as single port VATS or single incision VATS has taken the world of minimally invasive thoracic surgery by storm. The technique originated more than a decade ago for minor procedures and stood still, until recent developments in surgical technique and instrumentation allowed the most complex of thoracic procedures to be performed by the uniportal approach. However, it is also the determination, courage, skill and unshakable belief of an individual, Dr Diego Gonzalez-Rivas that has shaped the uniportal world as we all know it today.

Overview of uniportal video-assisted thoracic surgery (VATS): past and present.

Single incision video-assisted thoracic surgery (VATS), better known as uniportal VATS, has taken the world of thoracic surgery by storm over the previous few years. Through advances in techniques and technology, surgeons have been able to perform increasingly complex thoracic procedures utilizing a single small incision, hence avoiding the inherent morbidity of the standard open thoracotomy. This was a natural extension of what most recognize as the standard of care for early stage lung cancer, the VATS lobectomy, generally performed through a three- or four-incision technique. Improved camera optics have allowed the use of smaller cameras, making the uniportal approach technically easier. Improvement in articulating staplers and the development of other roticulator instruments have also aided working through a small single access point. The uniportal technique further brings the operative fulcrum inside the chest cavity, enabling better visualization, and creates working conditions similar to the open thoracotomy. Currently, uniportal VATS is being used for minor thoracic procedures and lung resections up to complex thoracic procedures typically requiring open approaches, such as chest wall resections, pneumonectomy, and bronchoplastic and pulmonary artery sleeve resections. Uniportal VATS is a clear advance in the field of general thoracic surgery and provides but a glimpse into the untold future.

Left lower sleeve lobectomy and systematic lymph node dissection by single-incision video-assisted thoracic surgery.

Sleeve lobectomy for selected cases of intratracheal tumor has better parenchyma preservation compared to pneumonectomy. And the left lower sleeve lobectomy is considered one of the most complex resections. Thanks to the advancement of equipment and accumulation of skills, video-assisted thoracic surgery (VATS) sleeve lobectomy has become safe and feasible. Typically, 3-4 ports are used, but the surgery can also be completed through one incision. A 51-year-old male patient with left lower central lung cancer underwent sleeve lobectomy and systematic mediastinal lymphadenectomy by single-incision VATS and recovered uneventfully. Sleeve lobectomy by single-incision video-assisted thoracic surgery is feasible and safe.

A 2-cm single-incision thoracoscopic left upper division segmentectomy.

A video-assisted thoracic surgery (VATS) sublobar resection for early lung malignancy has been applied recently in selected patients with the improvement in surgical technique. From 2012, we began VATS segmentectomy with 2-cm single incision in early lung cancer (T1a, tumor size <2 cm) and no lymph node metastasis with preoperative dual localization for lung lesion. In the video clip, we performed a 2-cm single-incisional VATS segmentectomy for early lung cancer at left upper lobe upper divisional segment and lymph node dissection using a 5-mm thoracoscope, articulating or curved endoscopic devices. Dual localization for lung lesion could help to identify the specific location of lung lesion. The potential benefits of single-incisional VATS segmentectomy include less intercostal pain, better postoperative outcomes more over than less incisional scar. A single-incision VATS segmentectomy might be a feasible option for the treatment of early lung cancer in selected patients.

Uniportal and single-incision video-assisted thoracic surgery: the state of the art

Over the past decade, uniportal video-assisted thoracic surgery (VATS) has evolved dramatically into a sophisticated technique capable of performing some of the most complex thoracic procedures. The idea of operating through fewer surgical incisions and, therefore, with potentially better cosmesis, less postoperative pain and paraesthesia, has led to uniportal VATS increasing in popularity worldwide. The uniportal approach demands instrument design to be better suited for operating with multiple instruments through a single small incision. Furthermore, the drive by surgeons and industry to develop novel, smaller, more specialized procedure-specific instruments for uniportal VATS to further allow reduction in incision size is relentless. Refinement of uniportal VATS instruments, angulated and narrower endostaplers, and improvements in video-camera systems, including 3D systems, and 120° articulating lens will make uniportal VATS major lung resection easier to perform and learn. In the future, we could see the development of subcostal or e-NOTES access, endorobotic arms that open and operate within the chest cavity, and cross-discipline imaging assistance for uniportal VATS procedures.

P-130 * UNIPORTAL VIDEO-ASSISTED THORACOSCOPIC MAJOR PULMONARY RESECTIONS: EXPERIENCE WITH 323 CASES

Objectives: Uniportal video-assisted thoracic surgery (VATS) anatomic major pulmonary resections were initially described as an evolution from the conventional approach in our unit. Since then, many thoracic surgical departments have successfuly adopted this technique with good postoperative results. We report our experience with this minimally invasive technique for major pulmonary resections. Methods: In June 2010, we began performing VATS anatomic resections through a uniportal approach (non-rib spreading). By December 2013, 323 patients had undergone major pulmonary resections by this single-incision approach. We have included early stage tumours, advanced non-small-cell lung cancer (NSCLC) (bronchial sleeve or vascular reconstruction), complex pneumonectomies and lobectomies after chemo-radiotherapy induction treatment. Results: Of 323 attempted major resections, 312 were successfully completed by a single-incision approach (conversion rate 2.9%). We have analysed early outcomes of successful uniportal VATS major pulmonary resections. Right upper lobectomy was the most frequent procedure (25%). Mean surgical time was 139.2 ± 48 min (range 40-310 min), mean number of lymph nodes was 14.8 ± 7 (range 5-38 nodes) and mean number of explored stations was 4.7 ± 1.1 (range 3-8 stations) in NSCLC patients. The mean tumour size was 2.8 ± 1.5 cm (0-12). The median chest tube duration was 2 days and the median length of hospital stay was 3 days. There were complications in 60 patients and two patients died during the 60-day postoperative period. Conclusions: Single-incision VATS anatomical resection is a safe procedure with good perioperative results. The success in performing complex lobectomies through a single incision is a result of skills and experience accumulated over time from performing uniportal VATS surgery. Disclosure: No significant relationships.

Current Readings: Redefining Minimally Invasive: Uniportal Video-Assisted Thoracic Surgery

Minimally invasive surgery is clearly dominating the modern surgical era across multiple surgical subspecialties and thoracic surgery is no exception. Video-assisted thoracic surgery (VATS) is a well-established method of performing various interventions, and it continues to gain momentum. Though small differences in VATS methods exist, it is commonly accepted as a non-rib-spreading approach into the thoracic cavity via 2-4 incisions and allows for a wide range of anatomical and nonanatomical pulmonary resections. As more experience is gained with VATS, more complex surgeries take place and greater refinement of the technique occurs. A newer single-incision or uniportal VATS has been described to minimize surgical trauma, to decrease the number and size of thoracic incisions, to reduce the number of complications, and to enable faster recovery. It allows performing a full spectrum of thoracic operations through a single incision adhering to surgical and oncological principles without compromise.

L’endoscope souple en chirurgie thoracique, quel abord : CITES ou cVATS ?

Early pain and persistent parietal disorders remains a major unresolved problem in thoracic surgery. Thoracotomy and the use of multiple ports in most Video Assisted Thoracic Surgery (VATS) procedures are the major cause of this persistent pain. For the last decade, a few publications describing the use of either single incision VATS and cervical thoracic approaches have been reported without significant results in comparison with current used techniques. Intercostals compression during surgery and early after by intercostals chest tube placement, are probably the major cause of postoperative pain. Flexible endoscope is currently used in several surgeries and will take more and more importance in our daily use in thoracic surgery. Instrument flexibility allows its use through minimally invasive approaches and offers a very interesting intra-thoracic navigation. We describe here the first use in France of a flexible endoscope in thoracic surgery through a single cervical incision to perform simultaneous exploration and biopsies of the mediastinum and right pleura using the original approach of Cervical Incision Thoracic Endoscopic Surgery (CITES).

Accessing the Aortopulmonary Window (#5) and the Paraaortic (#6) Lymph Nodes in Patients With Non-Small Cell Lung Cancer

The purpose of this study was to assess the efficacy of the different techniques of lymph node biopsies in patients with suspected metastatic non-small cell lung cancer (NSCLC) in the subaortic (station #5) and paraaortic (station #6) lymph nodes. This was a retrospective cohort study conducted of a prospective database of patients between January 2003 and June 2006 with suspected N2 disease only in the #5 or #6 lymph nodes, or both. All patients had integrated 2-deoxy-2-fluoro-D-glucose positron emission tomography/computed tomography, and nodal biopsy or thoracotomy, or both, with complete thoracic lymphadenectomy. There were 112 patients with clinically suspected N2 disease in lymph node stations #5 or #6, or both. The primary tumor was in the left upper lobe in 98 (88%) and in the left lower lobe in 14 (13%), and 58 had pathologic N2 disease in #5 or #6 lymph node stations only. Mediastinoscopy, used in all patients found, unsuspected N3 disease in 4 patients (3.6%) and N2 (#4L) disease in 12 (11%). Endoscopic ultrasound with fine needle aspiration (EUS-FNA), implemented in 62 patients (56%), correctly identified 41 patients (66%). Left single-incision video-assisted thoracic surgery (VATS) was used in 39 patients and was correct in 100%. Of the 58 patients, 53 (91%) completed neoadjuvant chemoradiotherapy, followed by resection, and their 5-year survival was 64%. EUS-FNA is less accurate for the #5 and #6 lymph node stations than left VATS. We prefer left VATS over the Chamberlain procedure for patients with suspected nodal metastases isolated only to #5 or #6 stations, and if positive, we prefer neoadjuvant therapy. The advantage of neoadjuvant therapy followed by resection compared with resection followed by adjuvant therapy remains controversial; and hence, the role for biopsy of these nodes is also controversial.