Uniportal Technique Research Articles

Meta-Analysis of Learning Curve in Endoscopic Spinal Surgery: Impact on Surgical Outcomes.

Systematic review and meta-analysis. This meta-analysis aimed to evaluate the learning curve in endoscopic spinal surgery, including the time to mastery and challenges faced by novice surgeons, to improve learning and surgical outcomes. Data extraction included the learning curve period and a comparison of surgeons with more experience or late period of the learning curve (late) and surgeons with less experience and in the early period of the learning curve (early) with respect to demographic, surgical, hospitalization, functional, and complication variables. Statistical analysis was performed using Review Manager 5.4.1 software. This meta-analysis included 16 studies (n = 1902). The average number of cases required to reach the learning curve was 32.5 ± 10.5. The uniportal technique required fewer cases (30.1 ± 10.2) than biportal technique (38.7 ± 10.3). There were no significant differences in demographic variables, operation level, or duration of symptoms between the advanced and novice surgeons. Advanced surgeons showed better outcomes in VAS leg pain at less than 6 months (SMD 0.18, 95% CI 0.01-0.34) and >6 months (SMD 0.14, 95% CI 0.02-0.27), as well as VAS back pain at > 6 months (SMD 0.16, 95% CI 0.04-0.29). The incidence of total complications was significantly higher in the novice surgeon group. The specific complications did not differ significantly between the 2 groups. The average number of cases required to reach the learning curve was 32.5 ± 10.5. Experienced surgeons had shorter surgery and fluoroscopy times, better outcomes in leg and back pain, and a lower incidence of complications than novice surgeons.

Periareolar approach in video-assisted thoracoscopic surgery for right middle lobectomy: a novel technique

BackgroundUniportal thoracoscopic right middle lobectomy (RML) poses greater technical challenges than other lobectomies. Although two-port thoracoscopy offers convenience, it results in heightened surgical trauma and scarring. The periareolar incision is rarely used in lobectomy while known for its cosmetic advantages. This study presents the periareolar access (combining a periareolar port and a 1-cm port) for video-assisted thoracoscopic surgery (VATS) in RML, comparing it with the traditional uniportal technique in both male and female patients.MethodsEighty patients who underwent RML were randomly divided into two groups: the periareolar VATS (PV) approach (n = 40) and the uniportal VATS (UV) approach (n = 40) from August 2020 to February 2023. All patients were followed up for 1 year and clinical data were collected and analyzed.ResultsNo significant differences in complications, blood loss, duration of chest tube placement, and length of postoperative hospital stay were observed between two methods. However, the PV group exhibited significantly shorter operative time, reduced postoperative visible scarring and lower visual analogue scores (VAS) for postoperative pain (P < 0.05). Additionally, the PV group demonstrated significantly higher cosmetic and satisfaction scores at the 6-month postoperative assessment (P < 0.05). Notably, breast ultrasound follow-up revealed two cases injuries of the mammary glands in female patients, and sensory function of most nipple and areola remained intact except two cases in all PV group patients.ConclusionsPeriareolar VATS emerges as a promising alternative approach for RML, providing clear benefits in pain management and cosmetic outcomes, while maintaining safety and convenience.Graphical

Efficacy of serratus posterior superior intercostal plane block (SPSIPB) on post-operative pain and total analgesic consumption in patients undergoing video-assisted thoracoscopic surgery (VATS): A double-blinded randomised controlled trial.

Serratus posterior superior intercostal plane block (SPSIPB) is a novel technique that can provide analgesia in the hemithorax, shoulder, and back of the neck. This study aimed to evaluate the post-operative analgesic effect of SPSIPB in patients undergoing video-assisted thoracoscopic surgery (VATS). It is a double-blind, randomised controlled trial. Twenty-four adult patients who underwent VATS via the uniportal technique were randomised into two groups: the SPSIPB group (n = 12) received SPSIPB along with intravenous patient-controlled analgesia (PCA) with tramadol, whereas the control group (n = 12) received only PCA with tramadol. At the end of the surgery, patients in the SPSIPB group received a unilateral SPSIPB under ultrasound guidance with the use of 30-mL bupivacaine 0.25%. The primary outcome was the numerical rating scale (NRS) scores of the patients. Secondary outcomes included the amount of tramadol and rescue analgesic (paracetamol) consumed by the patients, followed up for post-operative 24 hours. Categorical variables were compared using the Chi-Square Test. Mann-Whitney U Test was used to compare groups of variables that were not normally distributed. The SPSIPB group had lower NRS values during post-operative 24 hours (P < 0.001). Mean (standard deviation) total tramadol consumption was 58.33 (26.23) mg in the SPSIPB group and 144.17 (13.11) mg in the control group (P < 0.001). Rescue analgesic need was lower in the SPSIP group in the first 18 post-operative hours (P < 0.05). Serratus posterior superior intercostal plane block provides good analgesia in the thoracic region after video-assisted thoracoscopic surgery.

The transition to uniportal robotic surgery in the second decade of uniportal surgery.

Uniportal robotic surgery was created by Dr. Diego Gonzalez-Rivas as a fusion of his decade of experience with uniportal video-assisted thoracoscopic surgery (VATS) and his recent experience with the Intuitive Robotic System. It represents, in his view, the natural evolution of the uniportal technique in the era of robotic surgery. In this article, we discuss some of the novel issues that this raises, including capacitive coupling, and we describe the technique in detail to help surgeons who may be interested in starting uniportal robotic surgery. We go through case selection, which should start with wedge resections and lymphadenectomy. We look at port placement, which is more posterior and lower than the usual uniportal VATS approach, and we discuss the optimal instruments and ports for the technique. We discuss the role of the assistant in uniportal robotic surgery, which is a key part of the operation as we regard this as a two-surgeon technique. We then discuss the future and other possible robotic platforms that might be suitable for uniportal robotic surgery. It is an exciting new development for robotic surgery, and we recommend that this technique is suitable for advanced surgeons who are experienced in uniportal VATS lobectomy and in multiportal robotic surgery.

Unilateral biportal endoscopic laminectomy with lateral mass screw fixation for treating cervical spinal stenosis.

The unilateral biportal endoscopic (UBE) technique is less invasive and has a faster recovery time than open surgery. Compared with the uniportal technique, the biportal technique has a larger field of vision and a wider operation range. We attempted the posterior UBE approach for cervical stenosis at the C4-C6 levels. UBE decompression of C4-C6 with unilateral lateral mass screw fixation at the C4-C5 levels was performed under general anesthesia. We successfully performed cord decompression at the C4-C6 levels using the UBE technique. This approach could be used as an alternative method to treat cervical stenosis with instability.

Uniportal Video-Assisted Thoracic Surgery in a Pediatric Hospital: Early Results and Review of the Literature

Background: Uniportal video-assisted thoracic surgery (U-VATS) is an implemented technique in adult surgery that may aid to extend offer the benefits of thoracoscopy to a wide number of pediatric patients. Materials and Methods: Consecutive cases treated between July 2019 and July 2021 were retrospectively analyzed. Simultaneously, a MEDLINE systematic search was conducted. Results: Twelve patients (median age 13 years, median weight 44.5 kg) underwent 4 major procedures (n = 2 lobectomy, n = 2 segmentectomy) and 11 minor procedures (n = 1 bronchogenic cyst resection, n = 4 apical wedge resections and pleurodesis for pneumothorax, n = 4 wedge resections for lung nodules, and n = 2 debridement for empyema). The median observed operative time was 77 minutes. We recorded one conversion to biportal VATS. No intraoperative complications or 30-day morbidity-mortality was reported. A rate of 40% adverse postoperative events was observed (Clavien-Dindo grade I-IVa). Visual analog scale for postoperative pain recorded a median value of 0 on days 1, 2, and 3. The systematic review provided 15 full-text articles reporting 76 pediatric interventions (4 major and 72 minor procedures); among them, 1 biportal conversion, 3 mild postoperative complications, and 1 redo surgery are presented. Conclusions: As emerged from the literature review, U-VATS remains scarcely adopted by pediatric surgeons. Its feasibility is supported by the four reported major lung resections plus the four cases added on by our series. Thanks to a more rapid learning curve over conventional VATS, the uniportal technique could be accessible to a wider number of centers.

The following surgery was performed using the Uniportal VATS technique. During the exploration of the pleural cavity, we have found numerous adhesions that were cut. We confirmed the presence of the cystic lesion in the posterior mediastinum, which was developed from the esophageal wall, with the greater extension from the diaphragm to the neck as shown by the chest CT

The following surgery was performed using the Uniportal VATS technique. During the exploration of the pleural cavity, we have found numerous adhesions that were cut. We confirmed the presence of the cystic lesion in the posterior mediastinum, which was developed from the esophageal wall, with the greater extension from the diaphragm to the neck as shown by the chest CT

Uniportal Video-Assisted Thoracoscopic Lung Resection: A Single-Surgeon Experience and Comparison with Multiportal Technique in the Veteran Population.

Background: Uniportal video-assisted thoracoscopic surgery (VATS) has been shown to offer improved postoperative outcomes compared with multiportal technique. Shorter operative time has rarely been described. Our objective was to compare operative time and clinical outcomes between uniportal and multiportal VATS approaches for lung resection. Methods: This is a retrospective review of patients that underwent video-assisted thoracoscopic lung resection at United States Veterans Affairs centers between 2008 and 2018 using the Veteran Affairs Surgical Quality Improvement Program. Cases were assigned to uniportal (single surgeon) or multiportal cohorts. Multivariable analysis of clinical outcomes was performed, adjusting for preoperative confounding covariates. Temporal trend in operative time in uniportal cohort was analyzed in the context of cumulative operative volume using Spearman's rank correlation coefficient, rho (ρ). Results: In total, 8,212 cases were selected from 2008 to 2018 at Veterans Affairs centers: 176 (2.1%) uniportal and 8036 (97.9%) multiportal cases. Uniportal cohort was significantly associated with shorter operative time (1.7 hours versus 3.1 hours, P < .001), higher adjusted odds of surgical site infection (adjusted odds ratio = 2.76; P = .005), and longer length of stay (6 days versus 5 days; P = .04). Uniportal cohort operative time decreased over time (ρ = -0.474), with most significant change corresponding with increased cumulative operative volume from 25 to 44 cases. Conclusions: Uniportal technique offered shorter operative duration in veterans compared with multiportal approach, validating its technical advantages. Operative time decreased as cumulative operative volume increased, demonstrating a learning curve. Future studies should prospectively investigate any association between operative time and clinical outcomes after thoracoscopic lung resection.

Clinical Tip: Modified Uniportal Endoscopic Gastrocnemius Recession for Treatment of Gastrocnemius Equinus Contracture

Gastrocnemius recession was first described by Vulpius and Stoffel in 1913 for gastrocnemius equinus contracture. Equinus contracture alters the biomechanics of the foot–ankle complex and affects other musculotendinous and ligamentous constrains in the ankle, contributing to many foot and ankle pathologies. The commonly used Strayer's technique has been modified, with the use of endoscopic approaches, to try to reduce the poor cosmesis and reduce the risk of iatrogenic injury to the sural nerve. This article aims to describe a simple uniportal technique that uses readily available arthroscopic instruments to perform endoscopic gastrocnemius recessions (EGRs). The leg is prepped and draped with a rolled towel under the lateral malleolus. A 10 mm incision is made over this point. The dissection is carried bluntly to the gastrocnemius aponeurosis. The fascia is opened and a McDonald or Freer elevator is introduced between the aponeurosis and the fascia of the soleus. A 4.0 mm 30° arthroscope is inserted beneath the elevator. A half-pipe (Karl Storz, Tuttlingen) is introduced over the scope which protects the sural nerve. The length of the aponeurosis is identified from proximal to distal. At this point, the sural nerve may be visualized at the end of the pipe. A triangle knife (Smith and Nephew, Andover, MA, USA) is then introduced with the sharp edge facing the half-pipe. The knife is then flipped 180° and tension is applied to the aponeurosis by dorsiflexing the foot. The aponeurosis is then released under direct arthroscopic vision. Chua KH, Yeap EJ, Chong KW, et al. Clinical Tip: Modified Uniportal Endoscopic Gastrocnemius Recession for Treatment of Gastrocnemius Equinus Contracture. J Foot Ankle Surg (Asia Pacific) 2020;7(1):28–31.

Uniportal VATS technique for primary spontaneous pneumothorax: An analysis of 46 cases.

Objective:In the treatment of primary spontaneous pneumothorax (PSP), the influence of safety and applicability of uniportal video assisted thoracoscopic surgery (VATS) bullectomy/blebectomy and pleurectomy method were evaluated in 46 patients.Methods:Between November 2010 and January 2019, 46 patients (36 males, 10 females; mean age 24.2 years; range 16-36 years) undergoing uniportal video thoracoscopic bullectomy/blebectomy and apical pleurectomy for primary spontaneous pneumothorax were evaluated retrospectively at Canakkale Onsekiz Mart University (COMU). One patient underwent surgery for the second time after three months for contralateral pneumothorax and counted as two different patients, hence forty seven operations were performed in total. The cases were evaluated in terms of age, gender, comorbidity, duration of hospital stay, histopathological diagnosis, postoperative morbidity and mortality.Results:Right surgical intervention was performed in 20 cases (42.6%) and left surgical intervention in 27 cases (57.6%). A total of 15 (31.9%) surgical operations were performed during the first attack, 30 (63.8%) during the second attack and 2 (4.3%) during third and more attacks. There was prolonged air leakage in all patients operated during the first episode. All cases underwent wedge resection and pleurectomy with endoscopic stapes. None of the patients required thoracotomy. Postoperative drainage period was between 2-7 days (mean: 4.1) and the duration of hospitalization was between three to eight days. Postoperative pain and paraesthesia were observed in eight cases. Prolonged air leakage was observed in five cases.Conclusion:With video thoracoscopic uniportal technique, not only lung biopsy and resection but also bullectomy/blebectomy and pleurectomy operations can be performed safely in the treatment of PSP. In view of this information, minimally invasive techniques are seen as more advantageous than conventional techniques.

Preliminary experience in uniportal video-assisted thoracoscopic surgery (VATS)

Background: In recent years, technical evolution in the field of minimally invasive thoracic surgery has allowed a progressive reduction of invasiveness of major lung resection. The uniportal technique aims to decrease surgical trauma to a minimum, while ensuring a correct oncological procedure. We describe our initial approach to uniportal video-assisted thoracoscopic surgery (VATS). Methods: A gradual approach to uniportal VATS was provided by means of specialized courses between 2016 and 2018. Dedicated instruments for uniportal VATS lobectomy (UVL) were made available in 2017. Uniportal VATS procedures between March 2017 and Lune 2018 were evaluated. Type of procedure, conversion rate to multiportal VATS or thoracotomy, post-operative complications and hospital stay were described. Results: We performed 52 procedures (49 minor resections, 1 thymectomy for thymic hyperplasia, 2 lobectomies). Conversion to multiportal VATS was required in 15 cases (14 wedge resections, and 1 thymectomy). No major complications occurred intra- and post-operatively. Median post-operative stay was 3 days for wedge resection (range, 2–5 days) and 6 and 7 days for lobectomies. Conclusions: Uniportal VATS proved to be a safe and feasible procedure even in the preliminary phase of learning. A structured approach, entailing intensive exposure in ultra-high-volume centers, specialized courses, employment of dedicated instrumentation may help surgeons overcoming initial difficulties.

Liposomal Bupivacaine Enhances the Pain-Control Benefits of Uniportal Thoracoscopic Lobectomy

Liposomal bupivacaine field block is gaining popularity as a critical element of enhanced recovery after surgery protocols in thoracic surgery. Uniportal thoracoscopic surgery has been reported to result in less narcotic consumption compared with traditional video-assisted thoracoscopic surgery. The objective of this study was to evaluate the postoperative narcotic consumption of patients undergoing uniportal thoracoscopic lobectomy with the use of 0.25% bupivacaine vs patients treated with liposomal bupivacaine. All consecutive patients undergoing uniportal thoracoscopic lobectomy at an academic medical institution were recorded between October 2015 and February 2018. Narcotic consumption was converted to oral morphine equivalents by using standard formulas. Patients underwent posterior serratus and intercostal nerve blocks with 0.25% bupivacaine or liposomal bupivacaine, transitioning to liposomal bupivacaine in March2017. Other adjuncts such as gabapentin or cyclooxygenase-2 inhibitors were not administered. Data were reviewed on 32 patients receiving field blocks with 0.25% bupivacaine and on 50 patients receiving liposomal bupivacaine. There was no difference between groups with regard to age, sex, chest tube duration, or length of stay. Patients undergoing field blocks with liposomal bupivacaine consumed less narcotic medication. The study investigators have previously demonstrated decreased narcotic consumption with the use of uniportal technique over traditional multi-incision thoracoscopic surgery. The use of liposomal bupivacaine for posterior serratus and intercostal field blocks enhanced pain control and decreased narcotic consumption.

The full-endoscopic uniportal technique for decompression of the anterior craniocervical junction using the retropharyngeal approach: an anatomical feasibility study in human cadavers and review of the literature.

Acute or progressive myelopathy may necessitate direct anterior decompression of the craniocervical junction and odontoidectomy. Different techniques with individual advantages and disadvantages can be used. In addition to the gold standard-the transoral approach-there is also increasing experience with the endoscopic transnasal technique. Other alternative methods are also being developed to reduce technical and perioperative problems. The aim of this anatomical study was to investigate the feasibility of the full-endoscopic uniportal technique with a retropharyngeal approach for decompression of the craniocervical junction, taking into consideration the specific advantages and disadvantages compared with conventional methods and the currently available data in the literature. Five fresh adult cadavers were operated on. The endoscope used has a shaft cross-section of 6.9 × 5.9 mm and a 25° viewing angle. It contains an eccentric intraendoscopic working channel with a diameter of 4.1 mm. An anterior retropharyngeal approach was used. The anatomical structures of the anterior craniocervical junction were dissected and the bulbomedullary junction was decompressed. The planned steps of the operation were performed in all cadavers. The retropharyngeal approach allowed the target region to be accessed easily. The anatomical structures of the anterior craniocervical junction could be identified and dissected. The bulbomedullary junction could be adequately decompressed. No resections of the anterior arch of the atlas were necessary in the odontoidectomy. Using the full-endoscopic uniportal technique with an anterior retropharyngeal approach, the craniocervical region can be adequately reached, dissected, and decompressed. This is a minimally invasive technique with the known advantages of an endoscopic procedure under continuous irrigation. The retropharyngeal approach allows direct, sterile access. The instruments are available for clinical use and have been established for years in other operations of the entire spine.

Full-endoscopic uniportal retropharyngeal odontoidectomy for anterior craniocervical infection

Background: Infections of the anterior craniocervical junction may require surgery. There are various techniques with individual advantages and disadvantages. This study evaluates the full-endoscopic uniportal technique via the anterior retropharyngeal approach for odontoidectomy, decompression, and debridement.Material and methods: Three patients with an infection of the anterior craniocervical junction with retrodental involvement were operated on between 2014 and 2016 using the full-endoscopic uniportal technique. Posterior stabilization was also performed with the same procedure for all patients.Results: The operation was technically satisfactory in all cases. No problems due to swelling of the pharyngeal soft tissue occurred. No other complications were observed. All patients had a satisfactory outcome with stable regression of the myelopathy symptoms and/or complete healing of the infection. The follow-up images showed sufficient decompression of bone and soft tissues in all cases.Conclusions: The full-endoscopic uniportal technique with an anterior retropharyngeal approach can be an adequate and minimally invasive surgical technique for odontoidectomy, decompression, and debridement in infections of the craniocervical junction and can reduce access-related problems. The transoral, transnasal, and retropharyngeal approaches have different surgical fields due to the access trajectories, which must be taken into consideration depending on the anatomy and pathology when selecting a suitable technique.

Full-endoscopic Uniportal Odontoidectomy and Decompression of the Anterior Cervicomedullary Junction Using the Retropharyngeal Approach.

A study of a series of consecutive full-endoscopic uniportal decompressions of the anterior craniocervical junction with retropharyngeal approach. The aim of this study was to evaluate the direct anterior decompression of the craniocervical junction in patients with bulbomedullary compression using a full-endoscopic uniportal technique via an anterolateral retropharyngeal approach. Acute or progressive myelopathy may necessitate direct anterior decompression of the craniocervical junction and odontoidectomy. Different techniques with individual advantages and disadvantages can be used. In addition to the gold standard - the transoral approach - there is increasing experience with the endoscopic transnasal technique. Other alternative procedures are also being developed. Between 2013 and 2016, eight patients with basilar impression, retrodental pannus, or retrodental infection were operated in the full-endoscopic uniportal technique with a retropharyngeal approach. Anterior decompression of the bulbomedullary junction with odontoidectomy was performed. All patients additionally underwent posterior stabilization. Imaging and clinical data were collected in follow-up examinations for 1 year. The bulbomedullary junction was adequately decompressed. No problems due to swelling of pharyngeal soft tissue occurred. One patient required revision due to secondary bleeding. No other complications were observed. All patients had a good clinical outcome with stable regression of the myelopathy symptoms and/or healing of the infection. The imaging follow-up showed sufficient decompression of bone and soft tissue in all cases. No evidence was found of increasing instability or failure of posterior fusion. In the operated patients, the full-endoscopic uniportal surgical technique with anterior retropharyngeal approach was found to be a sufficient and minimally invasive method with the known advantages of an endoscopic procedure under continuous irrigation. It should not be viewed only as competition for other surgical techniques - due to its individual technical parameters, it can also be considered to be an alternative or complementary procedure. 4.

Operation of Soft or Calcified Thoracic Disc Herniations in the Full-Endoscopic Uniportal Extraforaminal Technique

Surgery for thoracic disc herniation and stenosis is comparatively rare and often demanding. The goal is to achieve sufficient decompression without manipulating the spinal cord and to minimize surgical trauma and its consequences. Individual planning and various surgical techniques and approaches are required. The key factors for selecting the technique are anatomical location, consistency of the pathology, general condition of the patient, and the surgeon's experience. The objective of the study was the evaluation of the technical implementation and outcomes of a full-endoscopic uniportal technique via the extraforaminal approach in patients with symptomatic soft or calcified disc herniation of the thoracic spine, taking specific advantages and disadvantages and literature into consideration. Retrospective study. A center for spine surgery and pain medicine. Between 2009 and 2015, decompression was performed on 26 patients with thoracic disc herniation or stenosis with radicular or myelopathic symptoms in a full-endoscopic uniportal technique with an extraforaminal approach. No patients underwent additional posterior stabilization. Imaging and clinical data were collected in follow-up examinations for 18 months. Sufficient decompression was achieved in the full-endoscopic uniportal technique in all cases. The individual selection of the respective approach made it possible to reach the target area without manipulating the spinal cord. One patient experienced deterioration of a myelopathy. No other serious complications were observed. All patients, except one, experienced regression or improvement of symptoms. No evidence of increasing instability was found in imaging. This is a retrospective study. The limited number of cases must be considered. The full-endoscopic uniportal technique with an extraforaminal approach was found to be a sufficient and minimally invasive method with the known advantages of an endoscopic procedure under continuous irrigation for monosegmental disc herniations. The inclusion criteria must be taken into consideration. If they are not met, an alternative full-endoscopic approach (interlaminar, transthoracic retropleural) or decompression in a conventional method must be selected. Additional stabilization does not appear to be necessary due to the low level of trauma. Extraforaminal approach, thoracic disc herniation, giant disc herniation, Full-endoscopic, minimally invasive, thoracic spine.

Full-endoscopic uniportal decompression in disc herniations and stenosis of the thoracic spine using the interlaminar, extraforaminal, or transthoracic retropleural approach.

OBJECTIVE Surgery for thoracic disc herniation and spinal canal stenosis is comparatively rare and often challenging. Individual planning and various surgical techniques and approaches are required. The key factors for selecting the technique and approach are anatomical location, consistency of the pathology, general condition of the patient, and the surgeon's experience. The objective of the study was to evaluate the technical implementation and outcomes of a full-endoscopic uniportal technique via the interlaminar, extraforaminal, or transthoracic retropleural approach in patients with symptomatic disc herniation and stenosis of the thoracic spine, taking specific advantages and disadvantages and literature into consideration. METHODS Between 2009 and 2015, decompression was performed in 55 patients with thoracic disc herniation or stenosis using a full-endoscopic uniportal technique via an interlaminar, extraforaminal, or transthoracic retropleural approach. Imaging and clinical data were collected during follow-up examinations for 18 months. RESULTS Sufficient decompression was achieved in the full-endoscopic uniportal technique. One patient required revision due to secondary bleeding, and another exhibited persistent deterioration on myelopathy. No other serious complications were observed. All but one patient experienced regression or improvement of their symptoms. CONCLUSIONS The full-endoscopic uniportal technique with an interlaminar, extraforaminal, or transthoracic retropleural approach was found to be a sufficient and minimally invasive method. To cover the entire range of thoracic disc herniations and stenosis within the criteria named, all full-endoscopic approaches are required.

An alternative chest tube placement after uniportal video-assisted thoracic surgery.

The field of video-assisted thoracic surgery (VATS) is still in continuous development. The advent of uniportal technique has added a versatile tool for thoracic surgeons; currently, it is used for minor thoracic procedures including lung wedge resections up to complex thoracic operations (i.e., chest wall resection, pneumonectomy or bronchoplastic resection) demonstrating the versatile nature of this technique (1).

Surgical treatment of cervical subaxial intraspinal extradural cysts using a full-endoscopic uniportal posterior approach

Symptomatic intraspinal extradural cysts of the cervical subaxial spine are rare, but usually require surgery. Conventional posterior decompression is the gold standard. However, there is increasing experience with endoscopic surgical techniques. The purpose of the study is to evaluate the technical implementation and outcomes of a full-endoscopic uniportal technique via the posterior approach in patients with symptomatic intraspinal extradural cysts of the cervical subaxial spine. Seven consecutive patients with a subaxial location of symptomatic intraspinal extradural cysts were decompressed in a full-endoscopic uniportal technique via the posterior approach between 2009 and 2015. Imaging and clinical data were collected in follow-up examinations for 18 months. In all cases, the cyst was completely removed and adequate decompression was achieved using the full-endoscopic uniportal technique. One patient developed a dural leak that was sutured and covered intraoperatively. No other complications requiring treatment were observed. All patients had a good clinical outcome with stable regression of the radicular and central nerve pain or neurological deficits. The imaging follow-up showed sufficient decompression in all cases. No evidence was found of increasing instability during the follow-up period. The full-endoscopic uniportal operation with a posterior approach allows the resection of the cyst and can minimize trauma and destabilization and has technical benefits and a low complication rate. It is an alternative surgical method that can offer advantages and is considered by the authors to be the surgical technique of choice for cervical subaxial intraspinal extradural cysts.

Decompression of the anterior thoracic spinal canal using a novel full-endoscopic uniportal transthoracic retropleural technique-an anatomical feasibility study in human cadavers.

Surgery for thoracic disc herniation and spinal stenosis is comparatively rare and often demanding. The goal is to achieve sufficient decompression without manipulating the spinal cord. Individual planning and various surgical techniques and approaches are required. This anatomical study examines the feasibility of a novel full-endoscopic uniportal technique with a transthoracic retropleural approach for decompression of the anterior thoracic spinal canal. Operations were performed on three fresh adult cadavers. The endoscope used, from RIWOspine, Germany, has a shaft cross-section of 6.9 × 5.9 mm and a 25° view angle. It contains an eccentric intraendoscopic working channel with a diameter of 4.1 mm. A transthoracic retropleural approach was used. The anatomical structures were dissected and the anterior thoracic epidural space was decompressed. The planned steps of the operation were performed on all cadavers. The transthoracic retropleural approach allowed the target region to be accessed easily. The anatomical structures could be identified and dissected. The anterior thoracic epidural space could be decompressed sufficiently. Using the uniportal full-endoscopic operation technique with a transthoracic retropleural approach, the anterior thoracic epidural space can be adequately reached. This is a minimally invasive method with the known advantages of an endoscopic technique under continuous irrigation. The retropleural approach allows direct access. The instruments are available for clinical use and have been established for years in other operations on the entire spine. Clin. Anat. 31:716-723, 2018. © 2018 Wiley Periodicals, Inc.