Single-incision Video-assisted Thoracoscopic Surgery Research Articles

A case of pericardial cyst removed by single-incision minimally invasive surgery

Pericardial cysts, which are frequently detected incidentally on routine chest scans, are typically considered to be congenital anomalies. They are generally asymptomatic and have a good prognosis. Pericardial cysts are usually located in the cardiophrenic area, have a thin wall, contain clear fluid, and are often not associated with the pericardium. Although it has a low malignant potential, the recommended treatment for these lesions is total excision due to the risk of recurrence. A case of pericardial cyst detected incidentally and to excised with single incision video-assisted thoracoscopic surgery (SIVATS) is presented.

Pleural empyema management: The impact of Video-assisted thoracoscopic surgery

In recent years, Video-assisted Thoracoscopic Surgery (VATS) has caused many changes in thoracic surgery practice. This study aimed to analyze the results of early VATS surgery in patients with empyema. Thirty-two cases of empyema who underwent VATS drainage, debridement, pleural pouch jointing, and partial decortication between November 2018 and June 2022 were included in the study retrospectively. The cases were examined for demographic information, the duration of symptoms, the stages of empyema, treatment outcomes, and complications. Twenty-three (79.9%) cases were male, 9 (28.1%) were female, and the mean age was 46.4±19.9. Preoperative symptom duration was 2.68±1.46 weeks. 28 (87.5%) cases were in stage 2 and 4 (12.5%) cases were in stage 3 empyema. A single incision VATS was performed in 23 (71.9%) cases, and double incision VATS was performed in 9 (28.1%) cases. Postoperative hospital stay was 12.1±3.3 days. Acceptable symptomatic and radiological improvement was observed in 28 (87.5%) cases after VATS. Pleural decortication with thoracotomy was used in four (12.5%) cases of stage 3 empyema. In cases of stage 2 empyema, which occurs within the first four weeks of the onset of symptoms, the VATS procedure with drainage, debridement, pouch jointing, and partial decortication provides curative results. We recommend evaluating VATS as the first-line therapy in treating early-stage empyema.

Outcomes of Uniportal vs Multiportal Video-Assisted Thoracoscopic Lobectomy

The optimal number of incisions for video-assisted thoracoscopic surgery (VATS) lobectomy, the standard treatment for early-stage nonsmall cell lung cancer (NSCLC), is still a matter of great debate. To compare single-incision (uniportal) VATS (U-VATS) with traditional multiportal VATS (M-VATS), we retrospectively reviewed the surgical outcomes of a large cohort of patients. Our prospectively maintained institutional database was queried retrospectively. All patients from 2014 to 2017 who underwent VATS lobectomy as the primary procedure for clinical stage I or II NSCLC were identified. A univariate comparison and a propensity-matched analysis incorporating preoperative variables were performed. The incidence of postoperative complications was compared. During the study period, 722 patients underwent VATS lobectomy for early-stage NSCLC, 62% by M-VATS, and 38% by U-VATS. In the univariate analysis, U-VATS performed by an experienced surgeon was associated with decreased intraoperative bleeding and shortened duration of surgery, duration of chest tube drainage, and length of hospital stay as compared with M-VATS (P < 0.001). Mediastinal lymph node dissection and complete resection were accomplished similarly using U-VATS and M-VATS. When the 2 approaches were compared through propensity matching, U-VATS was associated with fewer pneumonias (P = 0.012), as well as decreased intraoperative bleeding (P < 0.001), faster surgery (P < 0.001), shorter duration of chest tube drainage (P = 0.001), and shorter hospital stay (P < 0.001). At our institution, in the hands of an experienced surgeon, U-VATS lobectomy is safe, feasible, and can result in similar short-term outcomes for early-stage NSCLC as compared with M-VATS.

Thinking uniportal in pediatric thoracic surgery

In 2004, uniportal video-assisted thoracoscopic surgery (VATS) technique was described limited to diagnostic procedures and pneumothorax treatment. Nowadays, the procedure widely extended in complex thoracic surgery in adults. However, the application of this technique in paediatric population is not widespread and reports in literature are limited. Classic approach of these paediatric diseases was open thoracotomy. Thoracic paediatric procedures varies from decortication for empyema and biopsy of intrathoracic lesions up to advanced procedures, such as repair of oesophageal atresia and resection of mediastinal masses. However, uniportal approach is not extended in paediatric surgery and there are only a few cases reported in literature with satisfactory outcomes. We present advantages and indications of uniportal VATS in children as well as a review of reported cases. We emphasize in the reproducibility and safety of single incision VATS in paediatric population in our clinical experience.

Subxiphoid or subcostal uniportal robotic-assisted surgery: early experimental experience.

During the past several years minimally invasive thoracic surgery has evolved from thoracoscopic approaches using 3–4 ports to a single incision video-assisted thoracoscopic surgery (VATS) techniques (1-3). Recently, the experience acquired with the uniportal VATS technique through the intercostal space has allowed the development of use of a uniportal VATS subxiphoid or subcostal approach for major pulmonary resections (4,5).

Subxiphoid approach for video-assisted thoracoscopic surgery: an update.

The transthoracic video-assisted thoracoscopic surgery (VATS) is considered as standard operation for various thoracic diseases. With the development of single-incision VATS, the thoracic surgery becomes less traumatic. However, chronic chest wound pain still an issue despite the less invasive approach. Therefore, subxiphoid VATS was proposed to overcome this problem. In this article, we review current applications, pros and cons, and potential developments of VATS through subxiphoid approach.

Advantages and disadvantages of single incision VATS in major anatomical resection for lung cancer.

Safety and feasibility of lung resections by single incision thoracoscopy have been confirmed in large number of studies. As proponents claim its lesser invasive nature caused by lacking of additional intercostal port(s), opponents question the outcome measures of the approach especially in oncological manner. Since there is no major discussion regarding the superiority of video-assisted thoracoscopic surgery (VATS) on lung resections over the open technique in the surgical management of lung cancer today, advantage and disadvantage of single incision VATS lung resections was reviewed with the comparison of standard, multi-port VATS approach in this article. Overall, results of comparative studies confirm that single incision and multiportal thoracoscopy are similar, or single incision thoracoscopy has more advantages in the lung resection for lung cancer. Currently, the main disadvantage of single incision approach is the lacking of long-term oncological results.

The single-incision versus multiple-incision video-assisted thoracoscopic surgery in the treatment of lung cancer: A systematic review and meta-analysis.

We conducted this meta-analysis to compare the clinical outcomes of single-incision and multiple-incision video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer patients. A literature search was conducted of the Cochrane Controlled Trials Register Databases, Medline, EMBASE, Web of Science databases, and Chinese Biomedical Literature Database. Eleven studies that compared single-incision VATS with multiple-incision VATS in the treatment of lung cancer were analyzed. Statistical analysis was carried out using RevMan 5.1 software. Eleven trials totaling 1273 patients were included. There were statistically significant differences in the duration of chest tube (standardized mean difference [SMD] = -0.42; 95% confidence interval [CI] [-0.78, -0.07], P < 0.02), hospital stays after surgery (SMD = -0.28; 95% CI [-0.41, -0.15], P < 0.0001), hospital stays after surgery in the subgroup analysis of lobectomy (SMD = -0.28; 95% CI [-0.42, -0.14], P < 0.0001), length of wound (P < 0.05), and pain visual analog scale (VAS) in the postoperative 1 day (SMD = -1.19; 95% CI [-1.94, -0.44], P = 0.002) between single-incision VATS group and multiple-incision VATS group. Compared with patients receiving multiple-incision VATS group, there were no statistically significant differences between the two groups with regard to the operative time (OT), blood loss (BL), rate of conversion to thoracotomy, and complication. Compared with multiple-incision VATS on the condition of same lymph nodes retrieved number, single-incision VATS reduced the length of wound, shortened the duration of chest tube, cut down the hospital stays after surgery, alleviated the pain VAS in the postoperative 1 day, did not significantly increase the OT and the BL in operation, and did not increase the rate of conversion to thoracotomy and complication.

Subxiphoid vs intercostal single-incision video-assisted thoracoscopic surgery for spontaneous pneumothorax: A randomised controlled trial

IntroductionThe conventional video-assisted thoracoscopic surgery (VATS) is performed through the intercostals incisions. In this study, we reported our current experience of thoracoscopic surgery using a subxiphoid single-incision and compared it with the intercostal uniport VATS in the operation time and postoperative pain for spontaneous pneumothorax. MethodsFrom July 2014 to September 2015, 43 consecutive patients with spontaneous pneumothorax underwent the unilateral or bilateral bullectomy vie VATS. Among these, 22 patients were treated by the subxiphoid single-incision VATS, and 21 patients were treated using the conventional intercostals uniport VATS. The duration of operation, hospital stay days and inpatient pain scores were compared between each group. ResultsThe postoperative pain scores on postoperative days (POD) 0, 1, 2 and 3 were significantly lower for patients who underwent the subxiphoid single-incision VATS than those who underwent the intercostal uniport VATS (p < 0.05). However, the subxiphoid single-incision VATS needed longer surgical time than the intercostal uniport VATS (p < 0.001). DiscussionThe subxiphoid uniport VATS could decrease the postoperative pain and was safe and effective for performing the unilateral or bilateral bullectomy, but, demanded longer surgical time comparing with the intercostal uniport VATS. ConclusionsSubxiphoid single-incision VATS, as a new method for bullectomy, could provide a good choice of the incision position for these young patients with spontaneous pneumothorax.

Single-incision thoracoscopic right pneumonectomy with primary division of the pulmonary artery.

In recent years video-assisted thoracoscopic surgery (VATS) techniques have gained popularity also for major lung resections. Furthermore, especially in experienced VATS centers, single-incision thoracoscopic surgery is more and more adapted due to its even lesser invasiveness. Most thoracic surgeons still prefer an open approach to perform pneumonectomy, although reports of VATS and even single-incision VATS pneumonectomy are increasing. Unlike other authors we prefer to divide the pulmonary artery (PA) as one of the first steps of the procedure in order to obtain a clear field of vision on one hand and to obtain optimal control of bleeding and total blood loss on the other hand. Herein we describe our technique for single incision thoracoscopic right pneumonectomy and mediastinal lymphadenectomy without rib-spreading and with division of the PA as a first step. Furthermore we prefer to routinely cover the bronchial stump (BS) with an in situ azygos vein (AV) flap during right pneumonectomy.

Modified Incision and Closure Techniques for Single-Incision Thoracoscopic Lobectomy

Single-incision video-assisted thoracoscopic surgery (VATS) lobectomy has recently gained attention due to its various advantages. However, this technique requires direct insertion of the chest tube into the thoracic cage; thus, leakage of intrathoracic fluid or air around the tube frequently occurs. Additionally, cosmetic problems may develop due to direct fixation of the chest tube at the site of the skin incision. To solve these problems we designed new incision and closure techniques for VATS lobectomy. In our technique the skin is incised lower than an intercostal muscle incision, and the chest tube transpierces the chest wall muscle about 1 cm below the incision. Finally, nylon is used for tube fixation and is anchored through the subcutaneous suture.

The feasibility of single-incision video-assisted thoracoscopic major pulmonary resection performed by surgeons experienced with a two-incision technique.

This study evaluated the safety and feasibility of a single-incision video-assisted thoracoscopic surgery (VATS) major pulmonary resection performed by surgeons experienced with the two-incision technique. Consecutive patients who underwent single-incision VATS major pulmonary resection from March 2012 to May 2013 were included. The fifth intercostal space was incised (3-5 cm) at the anterior or posterior axillary line according to the tumour location. In total, 60 patients (39 men, 21 women; median age, 61 years; interquartile range, 53-69 years) were included in this study. Malignant lung disease was diagnosed preoperatively in 56 patients (93%) and benign disease in 4 (7%) patients. Lobectomy was performed in the majority of patients (n = 55), bilobectomy in 1, sleeve lobectomy in 1 and segmentectomy in 3. Four patients (7%) required a second incision, and conversion to thoracotomy was required in 2 (3%). In 50 lung cancer cases completed using a single-incision technique, the median surgical duration was 145 min (interquartile range, 90-182 min), and the total number of dissected lymph nodes per patient was 22 (interquartile range, 10-28 min). The chest tube was removed 5 days (interquartile range, 3-6 days) postoperatively, and there were no cases involving major perioperative morbidity or mortality. Single-incision VATS major pulmonary resection is feasible, and following a two-incision technique learning period, may yield results similar to those obtained with conventional VATS lobectomy.

Single-port video-assisted thoracoscopic lobectomy with pulmonary artery reconstruction

Despite the advances in video-assisted thoracoscopic surgery (VATS), vascular reconstruction of the pulmonary artery (PA) is still infrequently performed by thoracic surgeons because of the technical difficulties and the increased operative risk during thoracoscopy. The few published reports have been performed by using 3-4 incisions. We present the first report of a pulmonary artery reconstruction procedure performed by a single-incision VATS technique. A 73-year old male patient was operated on by the thoracoscopic approach through a single 4-cm incision with no rib spreading. The postoperative recovery was uneventful.