Uniportal Thoracoscopic Wedge Resection 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.

Thoracoscopic sublobar resection for congenital bronchial atresia in adults: a report of three cases

BackgroundCongenital bronchial atresia (CBA) is a rare bronchial abnormality. Adult patients with CBA generally do not show any symptoms. Although surgical resection is the first-line treatment, the indication for the surgical intervention is controversial, especially in mildly symptomatic or asymptomatic patients. Recently, thoracoscopic surgery is the commonly preferred approach to treat this condition.Case presentationCase 1: A woman in her 20s suffered from repeating episodes of fever and cough due to left CBA with the interruption of B9 and B10. Uniportal thoracoscopic left lower lobe wedge resection was performed, following which the symptoms disappeared. Case 2: A woman in her 40s presented to the clinic with dyspnea on exertion, and the computed tomography image revealed the absence of B2. Multiportal thoracoscopic right S2 segmentectomy was performed on her, after which the symptoms of dyspnea improved. Case 3: A woman in her 40s visited the hospital with symptoms of intermittent cough, sputum, and slight fever for 7 months. The examinations identified the absence of B6a. Right S6 segmentectomy and S2 wedge resection were carried out by multiportal thoracoscopic approach. The patient is now asymptomatic.ConclusionsBased on our experiences in the three adult CBA surgery cases, the three-dimensional image reconstruction system is very useful for diagnosis and surgical decisions with regard to this disease. Even for CBA patients with subtle symptoms, early surgical treatments may be beneficial from the point of view of minimally invasive interventions, and sublobar resection will be sufficient for treatments and preservation of respiratory function.

A propensity sore-matched study: Applying a modified chest tube drainage strategy in rapid rehabilitation following uni-portal thoracoscopic pulmonary wedge resection.

PurposeThis study aimed to compare the value of a modified chest tube drainage strategy to a traditional drainage strategy in single‐port thoracoscopic pulmonary wedge resection.MethodsFrom January 2019 to July 2021, we collected clinical data on 405 patients who underwent single‐port thoracoscopic pulmonary wedge resection in the No.1 Department of Thoracic Surgery at Fujian Medical University Union Hospital, with 121 (29.9%) cases in the modified drainage strategy group and 284 (70.1%) cases in the traditional drainage strategy group. The propensity score matching method (Match Ratio = 1:1) was used to reduce differences in clinical characteristics between the two groups.ResultsFollowing 1:1 propensity score matching, 120 matched pairs (240 patients) were included in the study. There was no significant difference in general clinical characteristics between the two groups. There was no statistical difference in intraoperative factors except for operative times (71.42 ± 22.98 min vs. 86.80 ± 36.75 min, p < 0.001). In terms of postoperative factors, there were significant differences in postoperative chest tube duration (0.00 ± 0.00 h vs. 32.68 ± 18.51 h, p < 0.001), total drainage volume (143.03 ± 118.33 ml vs. 187.73 ± 140.82 ml, p = 0.008), postoperative hospital stay (2.61 ± 0.70 days vs. 3.27 ± 1.88 days, p < 0.001), number of additional pain relief (0.14 ± 0.40 vs. 0.42 ± 0.74, p < 0.001), facial pain score (2.7 ± 1.8 vs. 3.6 ± 2.7, p = 0.005) and adverse events (p = 0.046). Furthermore, there was a statistical difference between the two groups regarding CTCAE grade‐1 complication, but no statistical difference in CTCAE grade‐2 complication.ConclusionsA modified drainage strategy in single‐port thoracoscopic pulmonary wedge resection is safe and feasible, allowing for less postoperative rehabilitation time, pain relief, reduced postoperative pleural effusion, and reduced clinical workload.

A pilot study of intraoperative intercostal nerve block during uniportal thoracoscopic wedge resection of the lung

BACKGROUND AND AIMS:Uniportal thoracoscopic surgery has been reported to result in alleviating the postoperative pain when compared with traditional video-assisted thoracoscopic surgery (VATS). However, postoperative pain is still the main concerns associated with thoracic surgeries. The objective of this study is to evaluate the postoperative pain of patients undergoing uniportal VATS, especially wedge resection, with the use of intraoperative intercostal nerve block.METHODS:All consecutive patients undergoing the uniportal VATS wedge resection between January 2019 and March 2020 were reviewed retrospectively. Twenty consecutive patients in Group A underwent the uniportal VATS wedge resection without intraoperative intercostal nerve block. The other 20 consecutive patients in Group B underwent the uniportal VATS wedge resection with intraoperative intercostal nerve block. The numeric pain rating scale (NRS) scores were recorded at 1, 12, and 24 h, postoperatively. The number of opioid consumption was also recorded until the time to chest tube removal.RESULTS:There was no difference between groups with regard to sex, age, chest tube duration, length of stay, operative time, laterality time, and diagnosis. There was a significant difference in postoperative NRS scores at 1 h (P = 0.001) and 12 h (P = 0.022) between the groups. The opioid consumption was significantly in Group B lower than those in Group A (P = 0.025).CONCLUSION:The intraoperative intercostal nerve block with bupivacaine provided immediate postoperative pain relief with reducing the postoperative opioid consumption compared in patients who underwent uniportal VATS, especially wedge resection of the lung.

Tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage

BackgroundTo investigate whether tubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage has better short-term outcomes than non-intubated approach with chest tube drainage.MethodsData were collected retrospectively from January 2017 and December 2019. Tubeless group included 55 patients with pulmonary nodules underwent tubeless uniportal thoracoscopic wedge resection, 211 patients underwent non-intubated uniportal thoracoscopic wedge resection with chest tube drainage were included in drainage group. Peri-operative outcomes between two groups were compared.ResultsAfter 1:1 matching, 110 patients remained for analysis, baseline demographic and clinical variables were comparable between the two groups. Mean incision size was 3 cm in both group. Mean operative time was 59.3 min in tubeless group and 52.8 min in drainage group. The detectable mean lowest SpO2 and mean peak EtCO2 during operation was acceptable in both groups. Conversion to intubated ventilation or thoracotomy was not required. No patient failed the air leak test and did not undergo a tubeless procedure. Mean postoperative hospital stay was 1.5 days in tubeless group and 2.5 days in drainage group. Residual pneumothorax or subcutaneous emphysema was not frequent and mild in tubeless group. Side effects were rare and mild, including cough and hemoptysis. No re-intervention or readmission occurred. The postoperative VAS score was significantly lower in tubeless group.ConclusionsTubeless uniportal thoracoscopic wedge resection with modified air leak test and chest tube drainage is feasible and safe for selected patients with peripheral pulmonary nodules, it might reduce post-operation pain and lead to faster recovery.

Contralateral spontaneous rupture of the esophagus following severe emesis after non-intubated pulmonary wedge resection

BackgroundNon-intubated thoracoscopic lung surgery has been reported to be technically feasible and safe. Spontaneous rupture of the esophagus, also known as Boerhaave’s syndrome (BS), is rare after chest surgery.Case presentationA 60-year-old female non-smoker underwent non-intubated uniportal thoracoscopic wedge resection for a pulmonary nodule. Ultrasound-guided serratus anterior plane block was utilized for postoperative analgesia. However, the patient suffered from severe emesis, chest pain and dyspnea 6 h after the surgery. Emergency chest x-ray revealed right-sided hydropneumothorax. BS was diagnosed by chest tube drainage and computed tomography. Besides antibiotics and tube feeding, a naso-leakage drainage tube was inserted into the right thorax for pleural evacuation. Finally, the esophagus was healed 40d after the conservative treatment.ConclusionsPerioperative antiemetic therapy is an indispensable item of fast-track surgery. Moreover, BS should be kept in mind when the patients complain of chest distress following emesis after thoracic surgery.

Uniportal Thoracoscopic Wedge Resection of Lung Nodules: Paravertebral Blocks Are Better Than Intercostal Blocks.

Background. Regional analgesia for tubeless, uniport, thoracoscopic wedge resection of benign peripheral nodules is generally performed by intercostal nerve block (INB). We examined the effectiveness of thoracic paravertebral block (PVB), in comparison to the traditional intercostal blocks, for the procedure. Methods. Between July 2016 and December 2016, 20 consecutive patients with solitary benign peripheral lung nodules underwent tubeless uniport thoracoscopic wedge resection using thoracic PVB (PVB group). The clinical outcomes were compared with those of 20 other consecutive patients who underwent the same procedure under the conventional INB, between January 2016 and July 2016 (INB group). In both groups, the procedures were performed without endotracheal intubation, urinary catheterization, or chest tube drainage. Results. The clinical data of patients in both groups were comparable in terms of demographic and baseline characteristics, operative and anesthetic characteristics, puncture-related complications, and postoperative anesthetic adverse events. No puncture-related complications occurred during the perioperative period in either group. The threshold values for mechanical pain at postoperative hours 4 and 8 were significantly higher in the PVB group than in the INB group. Furthermore, the incidence of nausea or vomiting in the PVB group was significantly less than that in the INB group. None of the patients required reintervention or readmission to our hospital. Conclusions. Tubeless uniportal thoracoscopic wedge resection for solitary benign peripheral lung nodules using thoracic PVB for regional analgesia is a feasible and safe procedure. Moreover, we found that thoracic PVB is less painful than INB.

Thoracoscopic Surgery Without Drainage Tube Placement for Peripheral Lung Nodules

Although drainage tube placement following thoracoscopic pulmonary resection is considered mandatory, the drainless approach after pulmonary resections may be feasible in selected patients. We aimed to determine whether a drainless approach is safe and associated with shorter hospital stay after thoracoscopic surgery for peripheral lung nodules. This single-center, open-label, parallel-group, prospective, randomized, controlled trial enrolled patients with peripheral lung nodules treated via uniportal thoracoscopic wedge resection. After confirming the absence of air leaks and before closing the wound, patients were allocated to receive or not receive drainage using a chest tube, according to a pre-established randomization sequenced provided in sealed envelopes. The primary endpoint was the length of postoperative hospital stay. Of 107 patients who agreed to participate in the study between August 2016 and September 2017, 100 were randomized to the drainage group (n=50) or drainless group (n=50) for intention-to-treat analysis. Patients in the drainless group had shorter postoperative hospital stay (mean, 1.2 vs 2.6 days, P<0.001), shorter surgery duration (mean, 59.0 vs 73.7 minutes, P=0.001), and lower pain on postoperative day 1 (mean, 0.9 vs 1.2 points, P=0.011). In the drainless group, residual pneumothorax was noted in 31 (62%) patients at 6 hours, in 18 (36%) patients at 1 day, and in one (2%) patient at 10-14 days postoperatively. Medical costs were also significantly lower in the drainless group. Uniportal thoracoscopic wedge resection without drainage is feasible and safe for selected patients with peripheral lung nodules.

Nonintubated uniportal thoracoscopic wedge resection for early lung cancer

Minimal invasive surgery is current choice of treatment for lung cancer. Combined nonintubated anesthesia with uniportal thoracoscopic surgery is not well understood. Here, we report the experience of nonintubated uniportal thoracoscopic surgery in the treatment of primary non-small cell lung cancer (NSCLC). From January 2014 to December 2015, we retrospectively reviewed 131 consecutive patients with primary NSCLC who underwent nonintubated uniportal thoracoscopic wedge resection and mediastinal lymph node dissection at a single medical center. Of the 131 patients, 110 (84%) received preoperative computed tomography-guided dye localization. Most of them were diagnosed with early stage invasive adenocarcinoma (N=112, 85.5%; pathological stage IA: 84.7%, N=111), and the mean size of the nodule was small (diameter: 0.85±0.40 cm). All section margins were free of malignancy. In total, 7 of the 131 patients (5.3%) had their treatment converted from uniportal to multi-portal video-assisted thoracoscopic surgery (VATS), and 1 (0.8%) had his treatment converted to endotracheal intubation with general anesthesia. The mean operation time was 91.1±32.6 minutes, and the postoperative complications included pneumonia (0.8%), prolonged air leaks (0.8%), and subcutaneous emphysema (1.5%). Overall, nonintubated uniportal VATS is a feasible, effective and safe procedure for the treatment of early primary lung cancer.

Surgical technique of nonintubated uniportal thoracoscopic wedge resection of a computed tomography-guided tattooed lesion

Surgical technique of nonintubated uniportal thoracoscopic wedge resection of a computed tomography-guided tattooed lesion

Invited Commentary

The paper by Yang and colleagues [1Yang S.-M. Wang M.-L. Hung M.-H. Hsu H.-H. Cheng Y.-J. Chen J.-S. Tubeless uniportal thoracoscopic wedge resection for peripheral lung nodules.Ann Thorac Surg. 2017; 103: 462-469Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar] published in this issue of The Annals focuses on one of the undisputable characteristics of uniportal video-assisted thoracoscopic surgery (VATS)—that is, its propensity to be used in an outpatient setting. Yang and coworkers have demonstrated, with a commendable attention to detail, that patients with peripheral lung nodules requiring a wedge resection for diagnosis or treatment can be approached by uniportal VATS under locoregional anesthesia and without inserting a chest drain. The results presented by the authors are not surprising, and they reflect the current knowledge of this surgical approach. Nevertheless, the real take home message from this manuscript is threefold. First, the protocols to perform nonintubated, awake uniportal VATS surgery are becoming standardized and user-friendly. This aspect may obviate the understandable reservations against “tubeless” and facilitate having the anesthesiologists involved. After all, with an extremely careful selection of patients, “tubeless” may not mean reckless. Second, a uniportal VATS practice can be a distinctive feature of thoracic surgeons participating in multidisciplinary groups. As an example, imagine how lung cancer screening programs would benefit from a thoracic surgical expertise able to resolve diagnostic dilemmas regarding peripheral lung nodules with a simple outpatient procedure. Or, think of those patients with borderline characteristics (i.e., older, marginal cardiorespiratory reserve) who may be offered a reliable—no pain, no drain, no stay—surgical option as an alternative to stereotactic body radiotherapy. Third, results of tubeless uniportal VATS are to be evaluated with an unprecedented depth of analysis with a renewed attention of its methodology. This manuscript by Yang and colleagues paves the way to prospective, randomized trials based on standardized management of selected patients to provide a solid evidence in favor of tubeless uniportal VATS. Without this evidence, additional papers reporting on single institutional experiences on tubeless uniportal VATS are destined to remain a celebration of the fortuitous combination of surgical expertise and favorable institutional attitude towards this approach. Tubeless Uniportal Thoracoscopic Wedge Resection for Peripheral Lung NodulesThe Annals of Thoracic SurgeryVol. 103Issue 2PreviewEndotracheal intubation and chest tube drainage are considered mandatory for thoracoscopic pulmonary resection. The management of peripheral lung nodules by tubeless uniportal thoracoscopic surgical repair has not been reported previously. Full-Text PDF

Tubeless Uniportal Thoracoscopic Wedge Resection for Peripheral Lung Nodules

Endotracheal intubation and chest tube drainage are considered mandatory for thoracoscopic pulmonary resection. The management of peripheral lung nodules by tubeless uniportal thoracoscopic surgical repair has not been reported previously. From October 2015 through January 2016, 30 consecutive patients with peripheral lung nodules underwent uniportal thoracoscopic wedge resection without endotracheal intubation and chest tube drainage (tubeless group). The clinical outcomes were compared with the outcomes in 30 consecutive patients with peripheral lung nodules who underwent uniportal thoracoscopic wedge resection with chest tube drainage from April through October 2015 (chest tube group). The demographic, anesthetic, and operative characteristics of the patients were comparable in both groups. No major adverse events occurred after operation. A small residual pneumothorax was noted in 12 (40.0%) patients at 6 hours and day 1 and in 2 (6.6%) patients on day 14 in the tubeless group. No patient required reintervention or readmission to the hospital. Patients in the tubeless group had lower pain scale scores on postoperative day 1 (mean, 1.0 vs 1.5, p= 0.012) and shorter postoperative hospital stays (mean, 3.1 days vs 4.4 days, p= 0.011) than did those in the chest tube group. Tubeless uniportal thoracoscopic wedge resection is feasible and safe and may be a less invasive alternative for treating selected patients with peripheral lung nodules.