Uniportal Thoracoscopic Approach Research Articles

Radicality of mediastinal lymphadenectomy in minimally invasive pulmonary resection: a comparative analysis of uniportal and multiportal thoracoscopic approaches.

Lung cancer is a serious health problem with a high mortality rate. In the context of surgical management, minimally invasive approaches, including uniportal thoracoscopic techniques, offer potential benefits such as faster recovery and increased patient cooperation. The aim of this study was to compare the accessibility of the mediastinal lymph nodes between uniportal and multiportal thoracoscopic approaches and to verify whether the use of the uniportal approach affects the radicality of the lymphadenectomy. A comparative study conducted from January 2015 to July 2022 at the University Hospital Ostrava focused on evaluating the radicality of mediastinal lymphadenectomy between subgroups of patients undergoing surgery using the uniportal thoracoscopic approach and the multiportal thoracoscopic approach. A total of 278 patients were included in the study. There were no significant differences in the number of available lymphatic stations between the subgroups. The mean number of lymph node stations removed was 6.46 in the left hemithorax and 6.50 in the right hemithorax. Thirty-day postoperative morbidity for the entire patient population was 24.5%, with 18.3% having minor complications and 3.6% having major complications. The overall mortality rate in the study population was 2.5%, with a statistically significant difference in mortality between uniportal and multiportal approaches (1.0% vs 6.4%, p=0.020). The uniportal approach demonstrated comparable accessibility and lymph node yield to the multiportal approach. There was also no difference in postoperative morbidity between the two approaches. The study suggests the possibility of lower mortality after uniportal lung resection compared with multiportal lung resection, but this conclusion should be interpreted with caution.

Radicality and safety of mediastinal lymphadenectomy in lung resection: a comparative analysis of uniportal thoracoscopic, multiportal thoracoscopic, and thoracotomy approaches.

Lung cancer poses a significant challenge with high mortality rates. Minimally invasive surgical approaches, including the uniportal thoracoscopic technique, offer potential benefits in terms of recovery and patient compliance. This study focuses on evaluating the radicality of mediastinal lymphadenectomy during uniportal thoracoscopic lung resection, specifically assessing the reachability of established lymphatic stations. A comparative study was conducted at the University Hospital Ostrava from January 2015 to July 2022, focusing on the evaluation of radicality in mediastinal lymphadenectomy across three patient subgroups: uniportal thoracoscopic approach, multiportal thoracoscopic approach, and thoracotomy approach. The study implemented the routine identification and excision of 8 lymph node stations from the respective hemithorax to assess the radicality of lymph node harvesting. A total of 428 patients were enrolled and evaluated. No significant differences were observed in the number of lymph nodes removed between the subgroups. The mean number of lymph nodes removed was 6.50 in the left hemithorax and 6.49 in the right hemithorax. The 30-day postoperative morbidity rate for the entire patient population was 27.3%, with 17.5% experiencing minor complications and 6.5% experiencing major complications. Statistically significant differences were observed in major complications between the uniportal approach and the thoracotomy approach (3.5% vs 12.0%, p = 0.002). The overall mortality rate in the study population was 3%, with a statistically significant difference in mortality between the uniportal and multiportal approaches (1.0% vs 6.4%, p = 0.020). The uniportal approach demonstrated comparable accessibility and lymph node yield to multiportal and thoracotomy techniques. It is equivalent to established methods in terms of postoperative complications, with fewer major complications compared to thoracotomy. While our study indicates a potential for lower mortality following uniportal lung resection in comparison to multiportal lung resection, and demonstrates comparable outcomes to thoracotomy, it is important to approach these findings cautiously and refrain from drawing definitive conclusions.

Lymphadenectomy in the subcarinal zone using a uniportal thoracoscopic approach: a narrative review

Lymphadenectomy in the subcarinal zone using a uniportal thoracoscopic approach: a narrative review

Combined right thoracotomy and left video-assisted thoracoscopic surgery for left tracheal sleeve pneumonectomy: a case report

: Left tracheal sleeve pneumonectomy (LTSP) is a challenging operation and traditional surgical approaches have their downsides. We describe the case of a 38-year-old patient affected by adenoid cystic carcinoma of the left main bronchus and the carina who underwent surgical excision of his tumor through a bilateral approach. En bloc tumor and carinal resection, followed by right main bronchial reimplantation were performed through right thoracotomy; while the left pneumonectomy was completed through a contralateral uniportal thoracoscopic approach. This is the seventh reported case of LTSP performed through a combined open and thoracoscopic approach. Some details, such as the side of the operation to approach first and the method of intraoperative ventilation, vary between reports; however, globally, the reported outcomes seem favorable. The growing number of published cases suggests that such approach should be acknowledged as a reasonable alternative to traditional surgical accesses for LTSP.

Uniportal thoracoscopic right anterior basal (S8) segmentectomy using unidirectional dissection

Anterior basal (S8) segmentectomy is one of the most challenging procedures among the uncommon pulmonary segmentectomies because the surgeon has to identify dominant pulmonary vein branches located deep in the lung parenchyma. Moreover, with the uniportal thoracoscopic approach, the angulation of inserted surgical instruments via a single small incision is extremely limited, which causes technical difficulties. However, adoption of a suitable procedure such as unidirectional dissection enables us to perform this type of minimally invasive surgical procedure. We describe the successful results of a patient undergoing uniportal thoracoscopic S8 segmentectomy of the right lower lobe and explain the nuances of performing it.

Combined right thoracotomy and left video-assisted thoracoscopic surgery for left tracheal sleeve pneumonectomy: a case report

: Left tracheal sleeve pneumonectomy (LTSP) is a challenging operation and traditional surgical approaches have their downsides. We describe the case of a 38-year-old patient affected by adenoid cystic carcinoma of the left main bronchus and the carina who underwent surgical excision of his tumor through a bilateral approach. En bloc tumor and carinal resection, followed by right main bronchial reimplantation were performed through right thoracotomy; while the left pneumonectomy was completed through a contralateral uniportal thoracoscopic approach. This is the seventh reported case of LTSP performed through a combined open and thoracoscopic approach. Some details, such as the side of the operation to approach first and the method of intraoperative ventilation, vary between reports; however, globally, the reported outcomes seem favorable. The growing number of published cases suggests that such approach should be acknowledged as a reasonable alternative to traditional surgical accesses for LTSP.

Removal of an endobronchial lipoma via uniportal thoracoscopic right basal segmentectomy

BackgroundEndobronchial lipoma is a rare benign tumor. The standard treatment is bronchoscopic intervention or surgical resection. Here, we present a case of endobronchial lipoma treated by right basal segmentectomy via a uniportal thoracoscopic approach.Case presentationA 66-year-old female presented with a persistent cough and recurring high-grade fever 4 months in duration. Chest X-ray revealed an abnormal infiltration shadow in the right lower lung field. Chest computed tomography revealed a tumor that occluded the lateral segmental bronchus of the right lower lobe. Surgical resection was planned because we failed to diagnose the tumor via bronchoscopic biopsy. Finally, uniportal, thoracoscopic right basal segmentectomy, which is less invasive than lobectomy and allows preservation of the apical segment of the lower lobe, was successfully performed. The pathological diagnosis was of endobronchial lipoma. The cough and recurrent pneumonia improved after surgery.ConclusionsSegmentectomy via a uniportal thoracoscopic approach could be a novel treatment option for endobronchial lipoma.

Micro-incision thoracoscopic treatment of primary spontaneous pneumothorax: the "loop" technique.

Primary spontaneous pneumothorax has been defined as the disease of the 'young and healthy'. There are multiple possible therapies and in recent years, surgery has evolved towards the use of the uniportal thoracoscopic approach. The objective of our study is to describe and present an innovative approach to access to the thoracic cavity in patients with spontaneous pneumothorax. The surgery was performed using a single access of 20 mm at the level of the 8th intercostal space. For the isolation and suspension of any dystrophic area, we use a 'loop' of non-absorbable braided suture inserted through the IV intercostal space and successive wedge resection using an endoscopic 10 mm mechanical stapler. Using this access, we were able to visualize and dissect the pulmonary ligament and perform complete pleural abrasion. We had no complications. The operative time was 60 min, the chest tube was removed the 2th postoperative day and the patient was discharged the day after. The operation we propose permits the reduction of the dimension of the access to the thoracic cavity. We were able to resect blebs without problems, the recovery was excellent and no complications related to the procedure were reported.

Uniportal Video-Assisted Thoracoscopic Surgery and Outcomes for Recurrent Primary Spontaneous Pneumothorax: Single-Institution Experience

Introduction: Primary spontaneous pneumothorax is relatively common condition in young adults. Uniportal video-assisted thoracoscopic surgery (uniportal VATS) has been accepted as a less invasive technique for the treatment of primary spontaneous pneumothorax. Strong evidence suggests that Uniportal VATS procedures are technically feasible and safe with excellent outcomes comparable to conventional VATS approach. Objectives: This article aims to discuss our experience with uniportal thoracoscopic approach as a valuable option in patients with recurrent spontaneous pneumothorax. Study Design: A retrospective study analysis between January 2014 and December 2016. Materials and Methods: From January 2014 to December 2016, 22 consecutive patients with unilateral recurrent spontaneous pneumothorax were to undergo uniportal video-assisted thoracic surgery (uniportal VATS). Their chronic residual postoperative pain, hospital stay and recurrence rate were analyzed. Results: Twenty-two patients with unilateral recurrent spontaneous pneumothorax were included; all received uniportal video-assisted thoracic surgery (uniportal VATS) and mechanical pleurodesis. Conclusions: We conclude that uniportal video-assisted thoracic surgery (uniportal VATS) demonstrated benefits to patients with primary spontaneous pneumothorax a safe, effective and also faster recovery, and decreased postoperative pain and short hospital stay.

Commentary on: “uniportal video-assisted thoracoscopic surgery: safety, efficacy and learning curve during the first 250 cases in Quebec, Canada”

The past two decades have seen video-assisted thoracoscopic surgery (VATS) become the preferred approach for the treatment of early stage lung cancer (1,2) (NCCN, ACCP). Traditionally performed through 2–4 small incisions, thoracoscopic resection by a single 3–4 cm incision, or uniportal VATS resections, gaining traction at many centers around the globe. The adoption of anatomic resection by a uniportal thoracoscopic approach is still in a relatively early, phase with champions and critics on both teams (3,4). Proponents of uniportal VATS lobectomy advocate that this approach is associated with decreased pain, paresthesias, and morbidity, when compared to a multiportal thoracoscopic approach, resulting in expedited recovery. Opponents of the uniportal approach intimate concerns of patient safety and a steep learning curve as a result of the technical requirements of having all instrumentation share the same incision, in addition to unresolved questions of oncologic adequacy.

Subxiphoid uniportal thoracoscopic extended thymectomy.

The aim of this article is to present a thoracoscopic technique of extended thymectomy through a subxiphoid incision. Six consecutive patients were successively treated with this approach, which provided a good view of the bilateral pleural cavities. The procedure is safe and technically feasible and yields excellent cosmetic results. We believe that subxiphoid uniportal thoracoscopic approach is a satisfactory procedure for performing extended thymectomy in well selected patients.