Uniportal Thoracoscopic Segmentectomy Research Articles

Comparison of early patient-reported outcomes between uniportal thoracoscopic segmentectomy and wedge resection for peripheral small-sized non-small-cell lung cancer

BackgroundAnalysis of patient-reported outcomes (PROs) offers valuable insights into distinguishing the effects of closely related medical procedures from the patient’s perspective. In this study we compared symptom burden in patients undergoing uniportal thoracoscopic segmentectomy and wedge resection for peripheral small-sized non-small cell lung cancer (NSCLC).MethodsThis study included patients with peripheral NSCLC from an ongoing longitudinal prospective cohort study (CN-PRO-Lung 3) who underwent segmentectomy or wedge resection with tumor diameter ≤ 2 cm and consolidation tumor ratio (CTR) ≤ 0.5. PROs data were collected using the Perioperative Symptom Assessment for Lung Surgery questionnaire pre-operatively, daily post-surgery up to the fourth hospitalization day, and weekly post-discharge up to the fourth week. Propensity score matching and a generalized estimation equation model were employed to compare symptom severity. In addition, short-term clinical outcomes were compared.ResultsIn total, data of 286 patients (82.4%) undergoing segmentectomy and 61 patients (17.6%) undergoing wedge resection were extracted from the cohort. No statistically significant differences were found in the proportion of moderate-to-severe symptoms and mean scores for pain, cough, shortness of breath, disturbed sleep, fatigue, drowsiness, and distress during the 4-day postoperative hospitalization or the 4-week post-discharge period before or after matching (all p > 0.05). Compared with segmentectomy, wedge resection showed better short-term clinical outcomes, including shorter operative time (p = 0.001), less intraoperative bleeding (p = 0.046), and lower total hospital costs (p = 0.002).ConclusionsThe study findings indicate that uniportal thoracoscopic segmentectomy and wedge resection exert similar early postoperative symptom burden in patients with peripheral NSCLC (tumor diameter ≤ 2 cm and CTR ≤ 0.5).Clinical trial registrationNot applicable.

Early chest drain removal on the day of uniportal thoracoscopic segmentectomy.

Although early removal of postoperative chest drains can facilitate recovery, it can be difficult to achieve in segmentectomy due to the management of air leakage in intersegmental planes. This study prospectively examined the feasibility of drain removal on the same day of uniportal thoracoscopic segmentectomy. Twenty patients who underwent uniportal thoracoscopic segmentectomy between July 2021 and May 2022 were enrolled in this prospective study. The indications for drain removal on the day of surgery were absence of air leakage in an intraoperative sealing test, radiographic evidence of lung expansion, and continuous absence of air leakage via a drainage bottle for 4 h after the operation. The primary endpoint was rate of the patients who required re-drainage after the postoperative drainage tube was removed on the day of surgery. The secondary end points were postoperative pain evaluated using a numerical rating scale on postoperative days 1, 7, and 28; morbidity; and postoperative hospitalization period. Fifteen patients successfully underwent drain removal on the day of surgery. None required re-drainage. The mean postoperative hospitalization period was 2.3 ± 1.7 days. Overall, 12 of the 15 (80%) patients were discharged on postoperative day 1 or 2. The mean numerical rating scale scores were 1.2 ± 1.6, 0.4 ± 0.7, and 0.4 ± 1.5 on postoperative days 1, 7, and 28, respectively. In uniportal thoracoscopic segmentectomy, drain removal on the day of surgery is feasible and may reduce pain on postoperative day 1.

Learning curve for uniportal thoracoscopic pulmonary segmentectomy: how many procedures are required to acquire expertise?

Minimally invasive surgeries are increasingly being performed. However, few studies have evaluated the learning curve for uniportal thoracoscopic segmentectomies. Therefore, we investigated the learning curve for uniportal thoracoscopic segmentectomy in our department. We retrospectively reviewed the clinical data of consecutive patients who underwent uniportal thoracoscopic segmentectomy at our institution between February 2019 and January 2022. Two senior surgeons [Hitoshi Igai (H.I.) and Natsumi Matsuura (N.M.)] performed all of the surgeries. H.I. introduced uniportal thoracoscopic segmentectomy in our department and supervised N.M. performing this operation. Resident surgeons participated in the operations as assistants. The learning curve for uniportal thoracoscopic segmentectomy was evaluated on the basis of operative time and cumulative sum (CUSUMOT). The entire team, including resident surgeons, completed the learning curve by performing 60 surgeries. The learning curve consisted of three phases: initial learning (60 surgeries), accumulation of competence (16 surgeries), and acquisition of expertise (17 surgeries), respectively. The operative time, blood loss, postoperative drainage, and postoperative hospitalization time significantly improved across the phases. N.M. completed the initial learning curve faster than H.I. (16 and 29 surgeries, respectively). Under supervision by an experienced surgeon, a team successfully completed the learning curve for uniportal thoracoscopic segmentectomy and achieved good perioperative outcomes, which indicates the importance of appropriate supervision for acquiring expertise for this surgery.

Three-port single-intercostal versus uniportal thoracoscopic segmentectomy for the treatment of lung cancer: a propensity score matching analysis

BackgroundThe purpose of this retrospective study was to demonstrate the safety and feasibility of three-port single-intercostal video-assisted thoracoscopic surgery (SIC-VATS) segmentectomy compared to uniportal video-assisted thoracoscopic surgery (UVATS) segmentectomy.MethodsWe included 544 patients diagnosed with cT1N0M0 non-small-cell lung cancer (NSCLC) who underwent thoracoscopic segmentectomy between January 2020 and August 2021, including 147 and 397 patients who underwent three-port SIC-VATS and UVATS, respectively. After incorporating preoperative clinical variables, we compared surgical outcomes and perioperative indicators between the two groups by propensity score matching analysis.ResultsAfter 1:1 propensity score matching, each group comprised 143 patients with no significant differences in baseline demographics and characteristics. There was no significant difference in operative time (p = 0.469), blood loss (p = 0.501), number of dissected lymph nodes (p = 0.228), dwell time of the main chest drain (p = 0.065), hospital stay (p = 0.243), or major complication rate (p = 0.295) between the three-port SIC-VATS and UVATS groups.ConclusionsThe three-port SIC-VATS was as safe and feasible as UVATS for patients who are diagnosed with early-stage NSCLC.

Anatomical variants of pulmonary segments and uni-portal thoracoscopic segmentectomy for lung cancer in a patient with Kartagener syndrome: a case report

Situs inversus totalis (SIT) is an extremely uncommon congenital disease where the major organs of the body are transposed through the sagittal plane. Kartagener syndrome is a complication of SIT with immotility of bronchial cilia, bronchiectasis, and chronic sinusitis. There is no report describing patients with Kartagener syndrome who accept uni-portal segmentectomies for lung cancer in past studies. Here we report a 74-year-old female patient with both Kartagener syndrome and a small early-stage lung cancer lesion located in the apical segment of the left upper lobe (LS1). The pulmonary segment anatomy of the left upper lobe in this case, which had very rare variants, was presented and interpreted in detail. This patient underwent an anatomic segmentectomy to the LS1 and a partial excision to the left middle lobe with bronchiectasis through a single 3 cm length incision. We believe that the case can give surgeons some experience and inspiration.

The learning curve for uniportal video-assisted thoracoscopic anatomical segmentectomy.

The aim of this study is to evaluate the time course and caseload required to achieve proficiency by plotting the learning curve of uniportal thoracoscopic segmentectomy. We retrospectively analyzed the first 238 and 159 cases of uniportal thoracoscopic segmentectomy performed by two surgeons (A and B). The learning curves were assessed using cumulative sum analysis. Perioperative outcomes were evaluated as the learning curve developed. Two subtypes of this surgical approach, simple and complex segmentectomy, were separately analyzed. Based on the learning curve, the inflection points occurred at 64 and 90 cases for surgeon A, 71 and 100 cases for surgeon B. Significantly longer operative time (p = .013), length of stay (p = .002), and drainage duration (p = .039) were observed between phase I and phase II compared to phase III for surgeon A. Operative times (p = .001) were significantly reduced for surgeon B. Furthermore, 26-28 and 52-56 cases were necessary to master the simple and complex segmentectomy, respectively. A total 64-71 cases were required to master uniportal thoracoscopic segmentectomy and 90-100 cases were necessary to achieve proficiency.

Uniportal versus multiportal video-assisted thoracoscopic surgery does not compromise the outcome of segmentectomy.

The goal of this study was to compare the feasibility and safety of uniportal thoracoscopic segmentectomy (UTS) with that of multiportal thoracoscopic segmentectomy (MTS). From January 2014 to December 2015, a total of 1056 patients who underwent thoracoscopic segmentectomy were identified, including 375 and 681 who had simple and complex segmentectomies, respectively. A propensity matched analysis was applied to compare perioperative indicators. Survival outcomes, which included disease-free survival and overall survival, were assessed by Kaplan-Meier estimates and Cox hazards regression analysis. Propensity matching generated 454 paired patients for the UTS and MTS cohorts; the perioperative results were comparable. Survival analysis indicated that the surgical approach (UTS versus MTS) was not an independent risk factor in either disease-free survival (P = 0.247) or overall survival (P = 0.870) of patients with invasive adenocarcinoma. A shorter operative time was observed in patients who had a UTS (P < 0.001) or an MTS (P = 0.011) via a simple segmentectomy compared with those who had a complex segmentectomy. Moreover, 147 and 266 corresponding cases were selected to compare the UTS and MTS in the simple and complex segmentectomy groups, respectively. MTS showed slightly longer operative times (119 vs 108 min; P = 0.007) and drainage duration (P = 0.010) in the simple segmentectomy group. In contrast, UTS was associated with statistically longer operative times (141 vs 133 min; P = 0.016) in the complex segmentectomy group. Although minor differences could be found in the simple and complex segmentectomy groups, respectively, these results were clinically irrelevant. Our study supports UTS as a feasible and safe surgical technique.

Nonintubated Versus Intubated Uniportal Thoracoscopic Segmentectomy for Lung Tumors

Although the use of the uniportal thoracoscopic technique has spread exponentially recently, a comparison of nonintubated and intubated uniportal thoracoscopic segmentectomies for lung tumors has not been reported. We aimed to compare the feasibility, safety, and short-term postoperative outcomes between the 2 methods. From January 2014 to June 2019 we retrospectively reviewed 185 consecutive patients with lung tumors who underwent uniportal thoracoscopic segmentectomy at our institute. A body mass index of ≥25 kg/m2 was considered a contraindication for the nonintubated anesthetic approach. For the remaining cases the anesthetic approach was made at the discretion of each individual anesthesiologist. A propensity-matched analysis incorporating sex and body mass index was used to compare the clinical outcomes of the nonintubated and intubated groups. Fifty patients (27.0%) underwent the procedure with the nonintubated anesthetic approach. The nonintubated group was more likely to be female (P<.001) and with a lower body mass index (P < .001). Other clinical features showed no significant difference. There was no significant difference between the 2 groups in the type of segmentectomy according to the difficulty classification system. After propensity matching 43 matched patients in each group were included. Anesthetic induction duration (12.0 vs 15.3 minutes, P= .014) was shorter in the nonintubated group. No other significant differences in perioperative, postoperative, and anesthetic results were noted between the 2 matched groups. The nonintubated anesthetic approach can be a safe and feasible alternative to intubated uniportal thoracoscopic segmentectomy.

Learning Curve for Uniportal Thoracoscopic Anatomical Pulmonary Segmentectomy.

Background. Video-assisted thoracoscopic segmentectomy has been considered to be an effective management in properly selected patients. Given the substantial technical difficulties, uniportal thoracoscopic segmentectomy is a challenging surgical procedure. The purpose of this study was to investigate the learning curve for uniportal thoracoscopic segmentectomy procedures. Methods. Prospectively collected data were retrospectively analyzed for a series of 124 consecutive patients undergoing uniportal thoracoscopic segmentectomy from August 2016 to September 2018. The learning curve for uniportal thoracoscopic segmentectomy was studied using cumulative sum (CUSUM) combined with risk-adjusted cumulative sum (RA-CUSUM) methods. Results. According to the CUSUM combined with the RA-CUSUM analyses, the learning curve for uniportal thoracoscopic segmentectomy was composed of three well-differentiated phases: cases 1 to 24, cases 25 to 57, and cases 58 to 124. With the procedures proceeded orderly, the operation time tends to progressively decrease. Conclusions. The uniportal thoracoscopic segmentectomy is considered to be a feasible and safe surgical procedure that can be taught to surgeons through a proctored learning curve. The data of the present study indicate that the inflection point for completion the learning curve was reached after a considerable number of 57 cases.

Two-Way: A Novel Method for Identifying the Anatomy During Uniportal Thoracoscopic Segmentectomy

Because the segmental bronchi and vessels are commonly variable and complicated, it is difficult to correctly identify them. Misidentification of the segmental anatomy could result in the failure of segmentectomy and conversion to other surgical procedures such as bisegmentectomy or lobectomy. We describe a novel method to identify the target segmental vessels and bronchi by exposing the adjacent segmental anatomy during uniportal video-assisted thoracoscopic segmentectomy, which could help to reduce the chance of misidentification.

Nonintubated uniportal thoracoscopic segmentectomy for lung cancer

Uniportal thoracoscopic segmentectomy under intubated general anesthesia with one-lung ventilation has recently been introduced for the management of lung cancer patients with small tumors or compromised cardiopulmonary function. However, uniportal thoracoscopic segmentectomy without endotracheal intubation had rarely been performed. Therefore, in this study, we aimed to evaluate the feasibility and safety of this novel technique. From January 2014 to November 2018, 32 lung cancer patients were treated using nonintubated uniportal thoracoscopic segmentectomy under a combination of target-controlled infusion of propofol, nasal high-flow oxygen therapy, intrathoracic intercostal nerve blockade, and vagal nerve blockade. Sixty-two other lung cancer patients who underwent initial planning nonintubated multiportal thoracoscopic segmentectomy during the same period were included as the control group. Preoperative dye localization was required in 18 (56.3%) patients of uniportal group. No patients required conversion to tracheal intubation or thoracotomy. Two patients were converted from the one-port to the two-port approach due to severe adhesions in the pleural cavity. The mean durations of anesthetic induction and surgery were 12.7min and 101.1min, respectively. Postoperative complications were noted in two patients (2/32, 6.3%) of uniportal group: one had subcutaneous emphysema and the other had prolonged air leaks over 3 days. The median durations of postoperative chest drainage and hospital stay were 1 and 3 days in uniportal group, respectively. Nonintubated uniportal thoracoscopic segmentectomy is technically feasible and safe for selected patients. It can be an attractive alternative to intubated thoracoscopic segmentectomy for patients with early lung cancer.

Uniportal thoracoscopic segmentectomy of medial-basal segment (S7) and its variants

Uniportal thoracoscopic segmentectomy of medial-basal segment (S7) and its variants

Feasibility and learning curve of uniportal video-assisted thoracoscopic segmentectomy.

Video-assisted thoracoscopic (VATS) segmentectomy is an acceptable alternative to lobectomy for treating early-stage lung cancer. Uniportal VATS segmentectomy is a challenging surgical procedure that has substantial technical difficulties and complications. In this study, we reviewed our experience of uniportal thoracoscopic segmentectomy and evaluated the feasibility and learning curve of this procedure. Retrospective observational data of 70 patients who underwent uniportal VATS segmentectomy between May 2014 and July 2015 were collected. Perioperative factors, such as demographic characteristics, operation time, blood loss, the number of dissected mediastinal lymph nodes and nodal stations, conversion rate to three-port VATS or thoracotomy, postoperative complications, duration of chest drainage, and postoperative hospital stay, were reviewed. Cumulative summative analysis and one-way ANOVA were used to identify the learning curve of uniportal thoracoscopic segmentectomy. Forty cases were included in the study. The patients were equally divided into four groups according to the sequence of surgery. Twelve patients were men and the mean age was 53.7±8.3 years. The mean operation time was 174.2±51.5 minutes and mean blood loss was 81.9±57.4 mL. There were no differences in demographic characteristics, blood loss, number of removed lymph nodes, chest tube duration, and hospital stay among the groups. However, the operation time in group 4 was significantly shorter than that in groups 1-3 (P=0.012). The learning curve showed that after 33 patients, the operation time was less than the conventional average operation time. There was no conversion to three-port VATS, two-port VATS or open thoracotomy. Three patients had postoperative complications and all of them recovered after treatment. No patient needed reoperation. There was no postoperative 30-day-related death. Uniportal thoracoscopic segmentectomy is a safe and feasible technique for treating small pulmonary lesions, with acceptable morbidity and mortality. This technique can be applied to an operation for segments that are technically difficult and anatomically variant. An experienced surgeon can achieve a relatively stable level after 33 cases.