Uniportal Video-assisted Thoracoscopic Surgery Research Articles

Approach to mediastinal masses: a comparison of open surgery and uniportal video-assisted thoracoscopic surgery techniques

Aims: This study aimed to compare perioperative and postoperative outcomes in patients who underwent uniportal video-assisted thoracoscopic surgery (U-VATS) and open surgery for mediastinal mass resection. Methods: A total of 62 patients who underwent mediastinal mass resection in the Thoracic Surgery Clinic were included. The patients were separated into the open surgery group (n=30) and the U-VATS group (n=32). The groups were compared in terms of perioperative and postoperative outcomes including operative time, blood loss, chest tube removal time, drainage volume, pain, and hospital stay. Results: The distributions of age and gender were similar between the groups. Median operation time (120 vs. 180 minutes, P < 0.001), median intraoperative blood loss (50 vs. 100 mL, P < 0.001), median time of chest drain removal (4 vs. 6 days, P < 0.001) and median postoperative drainage volumes were lower in the U-VATS group than the open surgery group. The U-VATS group exhibited a lower VAS score, return time to daily activity (1 vs. 4 days, P < 0.001) and length of hospital stay (4 vs. 6 days, P < 0.001). A postoperative myasthenic crisis was not observed in all cases. One thymoma patient in the open surgery group had a recurrence, but not in the U-VATS group. Conclusion: The U-VATS approach had better intraoperative safety and lower postoperative outcomes than open surgery. U-VATS, which has the potential to enhance postoperative recovery and quality of life, may be a safe and effective treatment option for patients with mediastinal mass resection.

Perioperative outcomes of uniportal versus three-port video-assisted thoracoscopic surgery in lung cancer patients aged ≥ 75 years old: a cohort study

BackgroundIncreasing attention has been raised on the surgical option for lung cancer patients aged ≥75 years, however, few studies have focused on whether uniportal video-assisted thoracoscopic surgery (VATS) is safe and feasible for these patients. This study aimed to evaluate short-term results of uniportal versus three-port VATS for the treatment of lung cancer patients aged ≥75 years.MethodsWe retrospectively evaluated 582 lung cancer patients (≥75 years) who underwent uniportal or three-port VATS from August 2007 to August 2021 based on the Western China Lung Cancer Database. The baseline and perioperative outcomes between uniportal and three-port VATS were compared in the whole cohort (WC) and the patients undergoing lobectomy (lobectomy cohort, LC) respectively. Propensity score matching (PSM) was used to minimize confounding bias between the uniportal and three-port cohorts in WC and LC.ResultsIntraoperative blood loss was significantly less in the uniportal than three-port LC (50 mL vs. 83 mL, P = 0.007) before PSM and relatively less in the uniportal than three-port LC (50 mL vs. 83 mL, P = 0.05) after PSM. Significantly more lymph nodes harvested (13 vs. 9, P = 0.007) were found in the uniportal than three-port LC after PSM. In addition, in WC and LC, there were no significant differences between uniportal and three-port cohorts in terms of operation time, the rate of conversion to thoracotomy during surgery, nodal treatments (dissection or sampling or not), the overall number of lymph node stations dissected, postoperative complications, volume and duration of postoperative thoracic drainage, hospital stay after operation and hospitalization expenses before and after PSM (P > 0.05).ConclusionsThere were no significant differences in short-term outcomes between uniportal and three-port VATS for lung cancer patients (≥75 years), except relatively less intraoperative blood loss (P < 0.05 before PSM and P = 0.05 after PSM) and significantly more lymph nodes harvested (P < 0.05 after PSM) were found in uniportal LC. It is reasonable to indicate that uniportal VATS is a safe, feasible and effective operation procedure for lung cancer patients aged ≥75 years.

Uniportal video-assisted thoracic surgery Ivor-Lewis oesophagectomy with circular stapling anastomosis.

Amongst all minimally invasive oesophagectomies, uniportal video-assisted thoracic surgery (VATS) Ivor-Lewis remains the most challenging procedure due to the skills required for performing the intrathoracic anastomosis. We present an easy and safe circular stapling latero-terminal anastomosis for performing uniportal VATS Ivor-Lewis. The patient had an uneventful post-operative recovery and was disease-free 9 months after surgery.

A giant mediastinal coelomic cyst resected by uni-portal VATS

médiastinal Coelomic cysts are rare cysts of mesothelial origin. They represent 4 to 11% of all mediastinal tumors. It affects both men and women. The diagnosis is often made in adulthood. They are often asymptomatic We repport the rare case of mesothelial cyst of mediastinum. A 38-year-old woman with no medical history, she was reffered to our department after chest X-ray showed a giant anterior madiastinum. The lesion was resected by VATS, which revealed a médiastinal cystic that extends from the top of the anterior mediastinum to the diaphragm. On histological section, the cystic wall is seat of a significant inflammatory, lined by a flattened epithelial lining of mesothelial type, conclusive to mediastinal pleural mesothelial cyst. The prognosis is excellent in the short and long term.

Are the Efficacy and Safety of Chest Tubes in Uniportal Video-Assisted Thoracic Surgery Related to the Level of Intercostal Space Insertion or to the Drain Type? A Prospective Multicenter Study.

The aim of this study is to evaluate if the efficacy and safety of chest tube placement are influenced by the level of intercostal space insertion (uniportal VATS vs. biportal VATS) or by the type of drain employed (standard vs. smart coaxial drain). Data on patients who underwent either uniportal or biportal VATS upper lobectomies with lymphadenectomy were prospectively collected in three European centers. The uniportal VATS group with a 28 Fr standard chest tube (U-VATS standard) was compared with the uniportal VATS group with a 28 Fr smart drain (U-VATS smart), and U-VATS smart was also compared with biportal VATS with a 28 Fr smart drain inserted in the VIII intercostal space (Bi-VATS smart). When comparing the U-VATS standard group with the U-VATS smart, a higher fluid output was recorded in the U-VATS smart (p: 0.004) in the III post-operative day (p.o.) and overall (p: 0.027), with a lower 90-day re-admission in the U-VATS smart (p: 0.04). The Bi-VATS smart group compared to U-VATS smart showed a higher fluid output in the I p.o. (p < 0.001), with no difference in total fluid amount or hospitalization. The Bi-VATS smart recorded a lower incidence (p < 0.001) of residual pleural space or effusion (p: 0.004) at chest X-rays prior to drain removal but a higher level of pain and chronic intercostal neuralgia (p: 0.03). Chest tube insertion through the same incision space in uniportal VATS seems to be safe and effective. Smart drains can improve the fluid output in uniportal VATS, as if the drainage were inserted in a lower space (i.e., biportal VATS), but with less discomfort.

Outcomes of mobilization in the first hour following uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax.

Although primary spontaneous pneumothorax is a common disease in young adults, each thoracic surgery department performs different procedures for its management. The optimal time of postoperative mobilization is not yet standardized in lung surgery. This study included male patients with a primary spontaneous pneumothorax who underwent wedge resection of the upper lobe of the lungs via uniportal video-assisted thoracoscopic surgery. Patients were encouraged to stand up within the first postoperative hour. Mobilization was defined as standing and walking at least 100 m from the bed. If orthostatic hypotension occurred, mobilization was postponed for 30 min. Immediately after surgery, intravenous fluids were discontinued, and patients were instructed to drink water. The analgesic treatment needs, length of hospitalization, drainage, and discharge times were recorded. A total of 43 patients were operated on by the same surgeon. All operations were ended with uniportal video-assisted thoracoscopic surgery. Wedge resection is most commonly indicated for recurrent ipsilateral pneumothorax. Patients walked 345 (range: 150-510) m on the department corridor following bed rest. Paracetamol (2 g) and dexketoprofen (100 mg) were intravenously administered as postoperative analgesia to 76.7% of patients. Narcotic drugs were not needed. Mobilization was recommended in the first hour following uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax.

First Uniportal VATS Sleeve Lobectomy Case in Turkey

Introduction: In recent years, VATS (Video-assisted thoracic surgery) has become the gold standard approach in the surgical treatment of early-stage Non-small Cell Lung Cancer. In August 2022, we presented the first case of Uniportal VATS right bronchial sleeve upper lobectomy for right main bronchial invasion, which was successfully managed following oncologic principles and reported in our country. Case: A patient who had been in remission for five years with a diagnosis of laryngeal carcinoma complained of cough. Computed thoracic tomography showed hilar peribronchial thickening and an endobronchial lesion extending from the right upper lobe bronchus to the main bronchus, almost completely obstructing the upper lobe bronchus. Bronchoscopic biopsy was reported as squamous cell carcinoma.The thorax was entered through an approximately 3 cm incision in the right fifth intercostal space. Firstly, the right upper lobe pulmonary arteries and superior pulmonary vein were dissected and cut. The main bronchus was divided until the intermediate bronchus. With the help of endoscissor, the main and intermediate bronchus were incised with appropriate surgical margins, and the lobectomy material was removed.The mediastinal pleura was opened, and lymph nodes 7, 9, 10 were dissected. Before anastomosis, the azygos vein was turned and fixed to the chest wall with a tying suture, and the azygos vein was removed from the anastomosis line, and appropriate exposure was provided. One suture was passed through the lateral cartilage from the inside out, and the needle was fixed to the posterior pleura. Membranous and cartilage parts were continuously anastomosed with double-needle 3/0 prolene suture at 2-3 mm intervals. Pathological evaluation was reported as squamous cell carcinoma, hilar 1/11 lymph node metastasis, and negative surgical margin. Conclusion: Adhering to oncologic principles, sleeve resections, which are difficult even with the currently known open techniques, can be performed effectively and safely with uniportal VATS in experienced centers

Effect of Anatomical Pulmonary Segmentectomy and Lobectomy under Uniportal Video-Assisted Thoracoscopic Surgery on Cardiopulmonary Function and Serum Tumor Markers in Patients with Early-Stage Non-Small Cell Lung Cancer.

In patients with early non-small cell lung cancer (NSCLC), single-port thoracoscopic anatomical segmentectomy is the primary therapeutic approach. However, the recovery of lung function is slow after operation. Conversely, anatomical segmental pneumonectomy, which excises a smaller volume of lung tissue, may facilitate more rapid functional recovery. This study aims to elucidate the comparative efficacy of these two surgical interventions by analyzing postoperative changes in cardiopulmonary function parameters and serum tumor markers. A retrospective analysis was conducted on 120 patients with NSCLC between October 2020 and October 2023. The cohort was classified into two groups based on the surgical intervention: the pulmonary segmentectomy group (n = 57), which underwent uniportal video-assisted thoracoscopic anatomical pulmonary segmentectomy, and the lobectomy group (n = 63), which received uniportal video-assisted thoracoscopic anatomical lobectomy. Surgical parameters and perioperative stress indicators were recorded for both groups of patients. Additionally, cardiopulmonary function indicators and serum biomarker levels of the patients before and 3 months after operation were compared. The operation time of the segmentectomy group was longer than that of the lobectomy group, the intraoperative blood loss was higher, and the postoperative hospital stay, chest drainage volume and drainage tube indwelling time were shorter (p < 0.001). After treatment, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC and maximal voluntary ventilation (MVV) in the segmentectomy group were higher than those in the lobectomy group (p < 0.001). After treatment, stroke volume (SV) and left ventricular ejection fraction (LVEF) in the segmentectomy group were higher than those in the lobectomy group (p < 0.001). There were no significant differences in carbohydrate antigen 50 (CA50), carcinoembryonic antigen (CEA) and cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) levels between the two groups after treatment (p > 0.05). The levels of Epinephrine (E), Noradrenaline (NE) and Cortisol (Cor) in the segmentectomy group were lower than those in the lobectomy group at one day after operation (p < 0.001). Compared to uniportal video-assisted thoracoscopic anatomical lobectomy, anatomical pulmonary segmentectomy for the treatment of NSCLC is more effective in reducing surgical-induced damage to cardiopulmonary function and can lower perioperative oxidative stress response. However, both surgical approaches exhibit minimal impact on serum tumor marker levels.

Uniportal thoracoscopic mediastinal lymphadenectomy using appropriate surgical steps.

Although lymphadenectomies play an important role in the surgical treatment of patients with non-small cell lung cancer (NSCLC), the quality of lymphadenectomies via a uniportal approach has only been evaluated in a few studies. We describe the surgical steps for a mediastinal lymphadenectomy via uniportal video-assisted thoracoscopic surgery (uVATS) and compare the quality of mediastinal lymphadenectomies using uVATS versus multiportal video-assisted thoracoscopic surgery (mVATS). Between April 2017 and January 2023, we analyzed data from 304 patients with NSCLC who underwent (bi-)lobectomy with nodal dissection (ND)2a-1 or greater lymphadenectomy via uVATS or mVATS. We compared patient characteristics and perioperative results, including the number of harvested lymph nodes (LNs), between the two approaches. In addition, the factors associated with N-upstage were identified. No significant differences in the total number of harvested LNs were detected between the two approaches. Significantly more LN#2R/4R zone LNs were harvested in the uVATS group compared with the number harvested in the mVATS group [uVATS group: 8.5, interquartile range (IQR), 5-12.3; mVATS group: 7, IQR, 5-9, P=0.0177], while no significant differences in total nodes or nodes harvested in other zones were detected. Multivariable analysis revealed that pathologic invasion size [odds ratio: 1.0200, 95% confidence interval (CI): 1.0100-1.0400, P=0.0050], but not approach (uVATS, odds ratio: 0.6240, 95% CI: 0.3160-1.2300, P=0.1750), significantly contributed to N factor upstages. The use of appropriate surgical steps enabled us to achieve similar quality lymphadenectomies via mVATS or uVATS.

Uniportal VATS right upper sleeve bilobectomy with artery suspension

Uniportal VATS right upper sleeve bilobectomy with artery suspension

Uniportal VATS right bilobectomy with bronchial and arterial reconstruction

Uniportal VATS right bilobectomy with bronchial and arterial reconstruction

Uniportal VATS right sleeve bilobectomy and carinal reconstruction

Uniportal VATS right sleeve bilobectomy and carinal reconstruction

Videomediastinoscopy followed by left lung-sparing sleeve bronchoplasty using uniportal VATS.

Videomediastinoscopy followed by left lung-sparing sleeve bronchoplasty using uniportal VATS.

Uniportal VATS right upper sleeve lobectomy and carinal reconstruction

Uniportal VATS right upper sleeve lobectomy and carinal reconstruction

Uniportal VATS right lower sleeve bilobectomy for a 13-year-old boy

Uniportal VATS right lower sleeve bilobectomy for a 13-year-old boy

Uniportal VATS right main bronchus resection and double carinal reconstruction

Uniportal VATS right main bronchus resection and double carinal reconstruction

Non-intubated uniportal VATS right upper sleeve lobectomy &amp; carinal reconstruction

Non-intubated uniportal VATS right upper sleeve lobectomy &amp; carinal reconstruction

Uniportal VATS carinal reconstruction

Uniportal VATS carinal reconstruction

Uniportal VATS tracheal segment resection

Uniportal VATS tracheal segment resection

Uniportal VATS left lower lobe and lingual segment sleeve resection

Uniportal VATS left lower lobe and lingual segment sleeve resection