CV42. Uniportal VATS Parenchymal-Sparing Resection and Reconstruction of the Right Secondary Carina for Mucoepidermoid Carcinoma

Objective To compare the short-term efficacy of robot-assisted and uniportal video-assisted thoracoscopic surgery (U-VATS) for right upper lobectomy in treating non-small cell lung cancer (NSCLC). Methods 99 early-stage NSCLC patients from Nanxishan Hospital of Guangxi Zhuang Autonomous Region who underwent surgery between July 2022 and December 2024, were selected and grouped based on the surgical approach: patients undergoing da Vinci robot-assisted right upper lobectomy (da Vinci group) and patients undergoing U-VATS right upper lobectomy (U-VATS group). Clinical data were compared between the two groups, including baseline data, efficacy, surgical indicators, postoperative complications, and survival curves. Results There were no statistically significant differences in baseline data between the two groups ( P > 0.05). The efficacy between the two groups showed no statistical significance ( P > 0.05); however, the R0 was higher in the da Vinci robot group at 86.00% compared to 73.47% in the U-VATS group. There were no statistically significant differences in terms of surgical time, intraoperative blood loss, chest tube drainage, duration of drainage tube placement, and length of postoperative hospital stay between the two groups ( P > 0.05). The da Vinci robot group had a higher number of lymph node dissections than the U-VATS group ( P < 0.05). The incidence of postoperative complications showed no statistically significant difference between the two groups ( P > 0.05). There were no cases of loss to follow-up among the 99 patients. The survival rate was 89.80% in the U-VATS group and 96.00% in the da Vinci robot group, with no statistical significance ( P > 0.05). Conclusion Compared to U-VATS, da Vinci robot-assisted right upper lobectomy for early-stage NSCLC patients demonstrates similar safety and operability, with a significantly higher number of lymph node dissections. There were no significant differences in surgical time, intraoperative blood loss, postoperative chest tube drainage, duration of drainage tube placement, length of postoperative hospital stay, and incidence of postoperative lung infections between the two approaches.

Uniportal video-assisted thoracoscopic surgery (U-VATS) is emerging as a promising approach for the treatment of pulmonary aspergilloma (PA). Nevertheless, it remains technically challenging and is associated with significant morbidity and a considerable risk of conversion to thoracotomy. This study aimed to evaluate the feasibility and safety of U-VATS in patients with PA and to identify prognostic factors that influence postoperative morbidity and conversion rates. We retrospectively reviewed the medical records of 51 patients who underwent U-VATS resection for PA between 2017 and 2020. Patients were classified as having either simple or complex aspergilloma. Clinical, radiological and surgical variables were analysed to determine their impact on outcomes. Of the 51 patients, 31 were male, with a median age of 43.5 years. simple PA was present in 9 patients and complex PA (CPA) in 42. Tuberculosis was the most common underlying condition and was significantly associated with complex aspergilloma (P = 0.015). Haemoptysis was the most frequent symptom, and the upper lobes were the predominant sites of involvement. Lobectomy was performed in 74.5% of cases, and 29.4% required conversion to thoracotomy. Post-operative complications occurred in 19.6% of patients, predominantly in those with CPA. Multivariable analysis identified haemoptysis, tuberculosis, CPA, lobectomy and complete pleural adhesions as significant predictors of postoperative morbidity. Haemoptysis, tuberculosis, upper lobe location, complex CPA and pleural adhesions were independent predictors of conversion. Haemoptysis, tuberculosis, CPA and complete pleural adhesions are key prognostic factors associated with increased morbidity and higher rates of conversion in patients undergoing U-VATS for PA.

Background Chest tube placement is a routine but critical component of uniportal video-assisted thoracoscopic surgery (VATS). The routine method places the chest tube directly through the working incision, which may exacerbate acute postoperative pain. Multiple modified placement strategies have been proposed, yet evidence evaluating their comparative effectiveness on pain outcomes remains limited. This study examined the association between a newly proposed modified same-intercostal chest tube placement and acute postoperative pain following uniportal VATS lobectomy. Methods This retrospective cohort study included adult patients undergoing elective uniportal VATS lobectomy at a tertiary medical center in Beijing, China, from June 2021 to June 2023. Among 1,701 screened patients, 1,082 met inclusion criteria. The exposure was tunneled same-intercostal chest tube placement, which creates a short subcutaneous and intramuscular tunnel along the superior border of the lower rib without traversing the rib or accessing an adjacent intercostal space. The primary outcomes were moderate-to-severe pain at rest within the first 24 hours. Propensity score overlap weighting was applied to achieve baseline covariate balance. Weighted logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Pragmatic care-adjusted sensitivity analyses incorporated both baseline covariates and postoperative covariates. Results The modified technique was associated with a lower rate of moderate-to-severe pain (16.8% vs. 27.1%). In weighted multivariable logistic regression analyses, modified technique was associated with 48% lower odds of acute postoperative pain (adjusted odds ratio [aOR] = 0.52, 95% CI = 0.35-0.79, p = 0.002) and a 38% lower adjusted risk (risk ratio [RR] = 0.62, 95% CI: 0.43-0.81, p < 0.001). Conclusions The modified tunneled chest tube placement technique may meaningfully improve acute postoperative pain after uniportal VATS.

To investigate the risk factors for vascular oozing or bleeding after vessel transection with automatic staplers during uniportal video-assisted thoracoscopic surgery (VATS). Among 157 consecutive uniportal anatomical lung resections performed between December 2018 and December 2023, 117 cases involving vascular stapling were retrospectively reviewed. A five-grade blood leakage scale (Grades 0-4) was used to assess both proximal and distal vessel stumps. Among 446 transected vessels, Grade 2 blood leakage occurred in 39 sites (8.7%) and Grade 3 in seven sites (1.6%). No Grade 4 bleeding or secondary injuries were observed. Multivariate analysis revealed body height ≤ 160cm (odds ratio [OR] 4.7, p = 0.004) and left upper lobe vessels (OR 11.9, p = 0.002) as independent risk factors for Grade ≥ 2 blood leakage. Detailed vessel-level analysis further revealed that the proximal stump of the first branch of the left upper lobe most frequently required hemostatic intervention (11 sites; 24%). This study is the first to report that short stature and left upper lobe vessels are risk factors for Grade ≥ 2 blood leakage during uniportal VATS. Although Grade 2 bleeding is not critical, it may serve as a precursor to Grade 3 or more severe bleeding. Therefore, surgical procedures should be performed with careful consideration of these potential risks.

We report two cases of successful oesophageal diverticulectomy through uniportal video-assisted thoracoscopic surgery (VATS). In both cases, a chest computed tomography showed huge mid-oesophageal diverticulum. Gastrointestinal endoscopy confirmed a diverticulum on the right wall. Surgical treatment through uniportal VATS was planned and performed successfully. We recommend that uniportal VATS could be a feasible method for oesophageal diverticulectomy.

Resection of giant anterior mediastinal masses (AMMs) has traditionally required median sternotomy as the limited operative space and visibility of conventional video-assisted thoracoscopic surgery (VATS) pose significant technical challenges. In this study, we describe a percutaneous suspension technique using a Tian-Ping sternal lifter, to facilitate uniportal VATS for the complete resection of a giant teratoma. A 28-year-old Chinese female presented with a three-month history of intermittent chest pain and cough. Computed tomography (CT) revealed a 17.0 × 9.0 cm AMM with heterogeneous density, and positron emission tomography/computed tomography (PET/CT) demonstrated increased metabolic activity. Complete tumor resection was achieved via a uniportal subxiphoid VATS approach, with operative exposure enhanced by a Tian-Ping sternal lifter that expanded the retrosternal working space. The patient had an uneventful recovery and was discharged nine days after surgery. Histopathology confirmed a mature cystic teratoma. At 18-month follow-up, the patient remained asymptomatic with no recurrence or procedure-related complications. This single-case report illustrates the feasibility of a percutaneous suspension technique using a Tian-Ping sternal lifter to assist uniportal subxiphoid VATS resection of large AMMs, offering a minimally invasive, sternum-sparing option for selected patients.

Abstract Background Non-intubated uniportal video-assisted thoracic surgery (NI-UVATS) has been introduced to further minimize invasiveness in lung resection. However, its feasibility and safety in complex procedures such as sleeve lobectomy remain underexplored. This study aimed to compare perioperative and early oncological outcomes between non-intubated and intubated UVATS for sleeve lobectomy. Methods We conducted a retrospective cohort study at a single center from March 2019 to July 2021, including patients undergoing UVATS sleeve lobectomy. Patients received either non-intubated spontaneous ventilation or intubated general anesthesia with a double-lumen tube. Perioperative outcomes, including operative time, blood loss, complications, and pathological results, were compared between groups. Results A total of 65 patients were analyzed (18 NI-UVATS, 47 I-UVATS). Baseline characteristics were similar, except for a slightly higher baseline PaCO2 (41.29 ± 3.16 vs. 39.15 ± 3.40 mmHg, p = 0.025) and lower serum albumin (36.22 ± 3.87 vs. 39.09 ± 3.57 g/L, p = 0.006) in the NI group. There were no conversions to intubation or thoracotomy in the NI group (0/18). Operative time (118.3 ± 19.2 vs. 107.3 ± 34.7 min, p = 0.180), estimated blood loss (median 50 mL in both, p = 0.310), and lymph node yield (13.2 ± 5.9 vs. 14.3 ± 8.5, p = 0.632) were comparable. Overall postoperative complication rates were similar (27.8% vs. 25.5%, p = 0.289), with prolonged air leak being the most common. No anastomotic complications or 90-day mortality occurred in either cohort. All surgical resections achieved an R0 margin. Conclusions In this cohort, NI-UVATS sleeve lobectomy was associated with comparable perioperative and pathological outcomes to the intubated approach in selected patients. This technique offers a less invasive anesthetic alternative without compromising surgical quality, supporting its consideration within enhanced recovery pathways for thoracic surgery.

Comparative study of robotic-assisted and uniportal video-assisted thoracic surgery: Insights from the introduction of Versius CMR surgical robot-Propensity score-matched analysis.

Historically, stage T4 non-small cell lung cancer (NSCLC) with direct spinal invasion was considered a definitive surgical contraindication due to the perceived inability to achieve negative margins without catastrophic morbidity. This paradigm has shifted through the advancement of specialized surgical techniques, which facilitate radical en-bloc resection in highly selected candidates by adhering to the en-bloc concept. This concept mandates the retrieval of the tumor and invaded vertebral segments as a single, contiguous unit to prevent intralesional transgression and local recurrence. Achieving microscopic negative margins (R0) stands as the most critical prognostic factor, as radical resection offers a significantly improved potential for long-term survival. Technical success requires a meticulously planned multidisciplinary approach encompassing varied surgical corridors-ranging from combined anterior-posterior windows to single-stage posterior-only approaches-tailored to the tumor's anatomical level. Furthermore, preoperative hemostatic optimization using dual-energy computed tomography (DECT) for vascular assessment and transarterial embolization (TAE) has become indispensable for managing the hypervascularity of the invaded vertebral bone. This review synthesizes these evolving strategies, illustrated by a case of a 74-year-old male with stage T4 NSCLC where an R0 resection was achieved through a two-stage approach integrating uniportal video-assisted thoracoscopic surgery (VATS). Ultimately, en-bloc management provides a feasible and potential surgical strategy toward long-term survival for localized, spine-invasive lung cancer within a multidisciplinary treatment framework.

Giant bullous lung disease presents unique challenges in thoracic surgery due to the large size of bullae and compromised respiratory function. This case report highlights the successful use of awake uniportal video-assisted thoracoscopic surgery (A-UVATS) in a high-risk patient with severe chronic obstructive pulmonary disease and a giant multiseptated bulla occupying the entire left lower lobe. Instead of traditional general anaesthesia, regional techniques, including thoracic paravertebral block and dexmedetomidine sedation, were employed to ensure safety and comfort. The procedure resulted in significant clinical improvement, with minimal complications, aside from a transient air leak. Post-operative recovery was uneventful, and lung re-expansion was confirmed via imaging. This case highlights the feasibility and safety of A-UVATS bullectomy in carefully selected patients, offering improved recovery and reduced perioperative risks. More research is needed to develop standardised protocols and evaluate long-term outcomes of awake thoracic surgical approaches.

Uniportal video-assisted thoracoscopic surgery (uVATS) provides excellent postoperative outcomes but limits instrument triangulation, making vascular stapling particularly challenging. We developed a simple "pulley technique" using a loop ligature device to create gentle, multidirectional, and dynamically adjustable traction during pulmonary vessel division. This technique involves passing a vessel tape around the target vessel through a loop ligature device and externalizing the tape to allow controlled retraction. The system stabilizes the vessel, improves the angle for stapler insertion, and minimizes the risk of overstretching. Compared with conventional traction methods, the pulley mechanism reduces instrument collision and provides more predictable tension distribution. The technique was successfully applied in multiple lobectomies and segmentectomies without vascular injury or conversion. Its simplicity, reproducibility, and low cost make it a valuable adjunct for improving safety and efficiency in uVATS.

Background/Objectives: This study aimed to assess the safety and efficacy of lung surgery for the treatment of early-stage non-small cell lung cancer (NSCLC) in octogenarians, with a specific focus on the Uniportal-VATS approach, evaluating surgical outcomes and short-term oncological results within a precision medicine perspective. Methods: This retrospective, single-center study included octogenarian patients who underwent surgical treatment for early-stage NSCLC between January 2018 and March 2024. Among 1329 patients treated during the study period, 136 octogenarians were carefully evaluated by a multidisciplinary board and selected for surgical management. Results: The mean age was 82.41 ± 2.72 years, with a prevalence of men (63.2%). In 107 (78.7%) cases, lung resection was performed using the Uniportal-video-assisted thoracic surgery (U-VATS) approach. Overall, 71 lobectomies (52.2%) and 65 segmentectomies or wedge resections (47.8%) were performed, balancing oncological radicality with comorbidities. Only minor complications occurred, such as atelectasis (2.9%), atrial fibrillation (4.4%), pneumonia (1.5%), or air-leakage (2.2%). Factors significantly associated with postoperative complications included open approach (p = 0.014), lobectomy as the extent of resection (p = 0.008), and chronic obstructive pulmonary disease (COPD) (p = 0.010). On multivariable analysis, lobectomy remained the only independent predictor for postoperative complications (OR: 5.95, 95% CI [1.24-28.62], p = 0.026). In-hospital and 90-day mortality were null. The median length of hospital stay in octogenarians was 6 days and was significantly shorter in the Uniportal-VATS group compared with the open surgery one (p < 0.001). All patients were discharged home independently. One- and three-year overall survival rates were 88% and 71%, respectively. No risk factor was associated with mortality in our series. Conclusions: Lung surgery, particularly the Uniportal-VATS approach, appears to be a safe and effective treatment option for octogenarian patients with early-stage NSCLC, provided that patient selection is carefully based on individual clinical characteristics within a multidisciplinary framework based on individualized risk stratification. When feasible, sublobar resection should be preferred in order to minimize postoperative complications.

Bronchial sleeve resection is a lung-sparing procedure that avoids pneumonectomy and reduces postoperative mortality, but it remains technically demanding. The rise of minimally invasive approaches such as video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) adds further complexity, increasing the need for realistic and high-fidelity training. The purpose of this study is to develop high fidelity dry lab for minimally invasive bronchial sleeve resection and reconstruction. A modular chest wall training device was created to support various minimally invasive approaches. The module includes 25 configurable 30 mm ports with detachable 8 mm rubber plugs, allowing simulation of multiportal and uniportal VATS, as well as RATS. A 3-dimensional precise bronchial model derived from computed tomography data was used to simulate right upper lobe sleeve resection. The training model was evaluated with a 5-point Likert scale (surgical exposure, manipulation, and usefulness as training) after four board-certified thoracic surgeons performed simulations with both approaches. The training was successfully conducted using both thoracoscopic and robotic approaches and could be repeated with no issues in port interference or stability. The evaluation by the four thoracic surgeons was generally acceptable (VATS: median score [range] on a 5-point Likert scale: surgical exposure 3.5 [2-5], manipulation 2.5 [2-5], usefulness as training 4.0 [4-5]. Robotic-assisted surgery: surgical exposure 4.5 [4-5], manipulation 4.0 [4-5], usefulness as training 5.0 [4-5]). This training system helps thoracic surgeons prepare for the growing demand for this type of procedure and ultimately improve surgical outcomes.

Thymic epithelial tumors (TETs), comprising thymoma and thymic carcinoma, are rare mediastinal neoplasms that pose significant diagnostic and therapeutic challenges due to their complex anatomy and frequent association with paraneoplastic syndromes like myasthenia gravis (MG). This narrative review synthesizes recent advances in the multidisciplinary management of TETs, providing clinicians with a contemporary, tumor-specific overview. We conducted systematic literature searches across PubMed, Scopus, and Web of Science for publications from January 2018 to June 2024, focusing on high-impact studies (impact factor >3) with sample sizes >10 patients. Key terms included "thymoma", "thymic carcinoma", "minimally invasive thymectomy", "targeted therapy", and "immunotherapy". Content screening prioritized TETs-specific evidence. Innovations in computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/CT (PET/CT) have enhanced TETs characterization, though differentiation of thymic hyperplasia remains challenging. Surgical management has shifted toward minimally invasive techniques [uniportal video-assisted thoracoscopic surgery (VATS), subxiphoid approach] and robotic surgery, reducing morbidity while maintaining oncological outcomes. For giant or invasive TETs, extended open techniques like clamshell incision remain indispensable. Systemic therapy advances include KIT/PIK3CA-targeted agents (imatinib, everolimus) showing modest efficacy, while programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) inhibitors demonstrate 20-30% response rates in thymic carcinoma but are associated with a >50% risk of severe immune-related adverse events (irAEs). Platinum-based chemotherapy [cisplatin, doxorubicin, cyclophosphamide (CAP) regimen] remains standard for advanced disease. Multidisciplinary team (MDT) integration is fundamental, particularly for managing MG perioperatively. TETs management is evolving rapidly through technological and biological advances. Future progress hinges on: (I) validating artificial intelligence (AI)-driven imaging classifiers; (II) conducting randomized controlled trials (RCTs) comparing surgical approaches; (III) elucidating immunotherapy toxicity mechanisms; and (IV) developing predictive composite biomarkers integrating genomic, immunological, and clinical parameters to enable precision medicine while mitigating fatal toxicities.

Micro-incision uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in an adolescent: a technical case report

Short-term outcomes of multi-arm uniportal robotic thoracic surgery versus uniportal video-assisted thoracoscopic surgery for non-small cell lung cancer.

BackgroundTubeless anesthesia for non-intubated uniportal video-assisted thoracoscopic surgery (NI-UniVATS) has been widely used in various thoracic surgical procedures. However, most patients selected for this procedure have a normal body mass index (BMI), and the impact of this surgery on patients with high BMI (H-BMI) remains unclear. The study aims to evaluate the perioperative course of NI-UniVATS in H-BMI patients.MethodsA retrospective analysis was conducted on data from patients who underwent tubeless anesthesia for NI-UniVATS at The Affiliated Hospital of Hebei University between June 2023 and June 2025. A total of 414 eligible patients were included, with 38 in the H-BMI group (BMI ≥28 kg/m2) and 376 in the non-high BMI (NH-BMI) group (BMI <28 kg/m2). The intraoperative management and postoperative outcomes of the two groups were comprehensively compared.ResultsThe clinical characteristics of the two groups were comparable, including age (P=0.78), gender (P=0.81), and surgical type (P=0.84). The number of intraoperative anesthetic adjustments was significantly higher in the H-BMI group than in the NH-BMI group (1.39±1.36 vs. 0.29±0.57, P=1×10−5). Intraoperative complications such as coughing (2.63%, P=0.31), hypercapnia (5.26%, P=0.15), and airway management due to laryngeal mask displacement (2.63%, P=0.31) occurred only in the H‑BMI group. No significant differences were observed between the two groups in mediastinal movement (34.21% vs. 15.78%, P=0.06), hypoxemia (10.52% vs. 2.63%, P=0.16), or intraoperative bleeding (5.26% vs. 7.89%, P=0.64). There were no statistically significant differences between the H-BMI group and the NH-BMI group in terms of operation time (122.05±55.55 vs. 110.92±47.45 min, P=0.41), intraoperative blood loss (10.63±10.98 vs. 13.95±17.67 mL, P=0.14), extubation (12.18±18.2 vs. 9.0±7.02 min, P=0.50), and post-anesthetic care unit recovery (32.18±12.07 vs. 34.11±19.43 min, P=0.74). Regarding postoperative pulmonary complications, in the H-BMI group, there were 4 cases (10.86%) of pleural effusion, 3 cases (7.89%) of atelectasis, and 2 cases (5.26%) of pneumothorax; in the NH-BMI group, the corresponding numbers were 2 cases (5.26%), 2 cases (5.26%), and 3 cases (7.89%). There were no statistically significant differences in chest drainage (500.26±553.80 vs. 521.32±523.40 mL, P=0.70), chest tube duration (3.68±2.37 vs. 3.74±2.79 days, P=0.95), postoperative discharge (4.87±2.52 vs. 4.45±2.69 days, P=0.31), and total costs (expressed in US dollars) (5,605.84±1,421.34 vs. 5,350.37±1,511.90, P=0.23) between the two groups.ConclusionsCompared with NH-BMI patients, H-BMI patients undergoing NI-UniVATS have similar intraoperative conditions and postoperative outcomes, but require more intraoperative anesthetic adjustments.

Uniportal video-assisted thoracoscopic surgery (uVATS) is an established minimally invasive approach for lung cancer. Uniportal robotic-assisted thoracoscopic surgery (uRATS) is a recent innovation integrating robotic technology with single-incision access. Comparative data between these techniques remain scarce. We retrospectively analyzed patients who underwent anatomic pulmonary resection via uVATS or uRATS at Chang Gung Memorial Hospital between July 2023 and July 2025. Propensity score matching (1:1) was applied using key baseline variables. Perioperative outcomes and cost-effectiveness were assessed. A total of 356 patients (251 uVATS, 105 uRATS) were included; 98 matched pairs were analyzed. Operative time was longer with uRATS (median 179.50 vs. 117.00min, p < 0.001). uRATS was associated with shorter hospital stay (2.70 vs. 3.00 days, p < 0.001), reduced chest drainage duration (1.45vs. 2.00 days, p < 0.001), and lower postoperative day 1 pain scores (p = 0.04). Median N1 and N2 lymph node counts were similar in uRATS and uVATS. Postoperative complication rates did not differ significantly between groups (2.04% vs. 9.18%, p = 0.06). Cost analyses quantified the incremental costs associated with short-term recovery benefits of uRATS. uRATS was associated with modest, short-term differences in selected early postoperative recovery parameters compared with uVATS, accompanied by longer operative time and higher cost. Oncologic surrogate outcomes were comparable between groups, while definitive conclusions regarding long-term oncologic and economic benefits require confirmation in larger, multicenter studies with extended follow-up.

This study aimed to compare perioperative outcomes, lymphadenectomy quality, postoperative recovery, pulmonary function, and short-term oncologic results between robotic-assisted thoracoscopic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (U-VATS) for early-stage non-small cell lung cancer (NSCLC). This retrospective cohort study included 231 consecutive patients with stage I-IIA NSCLC who underwent curative-intent anatomic lobectomy at our institution between January and December 2023. Based on the surgical approach, patients were assigned to either the RATS group (n = 105) or the U-VATS group (n = 126). All procedures were performed by the same experienced surgical team using standardized perioperative protocols. Clinical characteristics, intraoperative and postoperative parameters, pulmonary function, and 12-month oncologic outcomes were collected for comparative evaluation. RATS resulted in shorter operative time, reduced blood loss, and increased lymph node and mediastinal station retrieval compared with U-VATS. Postoperative pain, drainage volume, length of hospital stay, and complication rates were comparable between groups. Patients undergoing RATS demonstrated significantly higher global health and functional scores, along with lower symptom scores, during the first 6 months after surgery (p < 0.05). Pulmonary function recovery, 1-year disease-free survival (DFS), and overall survival (OS) did not differ significantly between the two approaches. However, hospitalization costs were higher for the RATS group (p < 0.001). Both RATS and U-VATS are safe and effective minimally invasive approaches for anatomic lobectomy in early-stage NSCLC. RATS offers advantages in operative precision, lymph node dissection, and short-term quality of life without compromising safety or early oncologic outcomes, although it is associated with increased cost.