Uniportal Video-assisted Thoracoscopy Research Articles

Differential diagnosis of mediastinal cysts: a case series.

Mediastinal cysts are common mediastinal lesions in which diagnostic and therapeutic choices are not always unambiguously presented. Usually, these cysts are asymptomatic and detected by coincidence. The question remains whether, if symptoms are present, the cyst is responsible and whether it should be treated. Unfortunately, there is a lack of standardised guidelines concerning diagnostic, therapeutic management and follow-up. In this case series we reported five patients with mediastinal cysts. All patients received a thoracic CT during the initial diagnostic assessment. Four out of five patients were symptomatic and were surgically treated during a uniportal video-assisted thoracoscopy. One patient was asymptomatic and receives a biennial follow-up. Most often, histopathological examination confirmed the already presumed type of non-neoplastic mediastinal cyst based on anatomical location and tissue characteristics (one thymic cyst, one bronchogenic cyst and two pericardial cysts). Except for one patient, all surgically treated patients experienced improvement in symptoms. Regarding diagnosis and treatment of this entity, a systematic approach in accordance with the most recent literature is important. The diagnosis can only be confirmed on histopathological examination, but several imaging techniques, with contrast-enhanced CT as the first-choice technique, could guide the differential diagnosis. In large, symptomatic cysts or present potential malignant features, surgical removal is indicated. This case series encourages further substantial research concerning the selection and timing of therapy.

Exploring uniportal video-assisted thoracoscopy in pediatric oncology: early insights and surgical results

Exploring uniportal video-assisted thoracoscopy in pediatric oncology: early insights and surgical results

Uniportal video-assisted thoracoscopy in pediatrics-initial experience.

It has become apparent that the endoscopic surgeries are rapidly developing, and they have become an essential part of every specialty of surgery. Single port thoracoscopic surgery is developing, enhancing the advantages of muti-portal video-assisted thoracoscopic surgery (VATS). Although becoming a well-recognised approach for adult patients, extremely limited literature exists concerning uniportal VATS among pediatric cases. This study aims to present our initial experience with this approach in a single tertiary hospital and extrapolate its feasibility and safety in this specific context. Perioperative parameters and surgical outcomes for all pediatric patients who underwent an intercostal or subxiphoid uniportal VATS surgery in our department in 2 years retrospectively reviewed. The median length of follow-up was 8 months. Sixty-eight pediatric patients underwent different uniportal VATS operation for different types of pathology. The median age was (3.5 years). Median operating time was 116 minutes. Three cases converted to open. The mortality rate was zero. The median length of stay was 5 days. Three patients presented complications. Three patients lost from follow-up. Despite literature data heterogeneity, these results provide support to the feasibility and applicability of uniportal VATS in the pediatric population. Further studies are required to explore the benefit of uniportal over multi-portal VATS (including chest wall deformities, cosmesis and quality of life).

Easy Intra-Operative Localization of Pulmonary Nodules during Uniportal Video-Assisted Thoracoscopy: Experience with Hydrogel Plugs at Our Institution.

Background: The diffusion of lung cancer screening programs has increased the detection of both solid and ground-glass opacity (GGO) sub-centimetric lesions, leading to the necessity for histological diagnoses. A percutaneous CT-guided biopsy may be challenging, thus making surgical excision a valid diagnostic alternative. CT-guided hydrogel plug deployment (BioSentry®) was recently proposed to simplify intraoperative nodule localization. Here, we report our initial experience. Methods: We evaluated 62 patients with single, small, peripheral, non-subpleural pulmonary GGO that was suspicious for cancer. All lesions were preoperatively marked, using CT-guidance, with a hydrogel plug (BioSentry®). Then, a uniportal video-assisted thoracoscopy (uniVATS) wedge resection was performed. If cancer was confirmed at the frozen section, a major lung resection was then performed. The study’s end points were the rates of intraoperative localization and of successful resection. Results: The hydrogel plug was correctly placed in 54 of the 62 cases, leading to an effective resection of the target lesion. In the remaining eight cases, the plug was displaced, and so the identification of pleural erosions due to the previous percutaneous procedure guided the resection. The uniVATS resection success rate was 98.3%. Conclusions: CT-guided hydrogel plug placement allowed for the successful detection of lung GGOs and resection with the uniVATS approach. This device allowed us to obtain lung cancer diagnoses and successfully treat 85.4% of cases.

Postpneumonectomy Empyema Following SARS-CoV-2 Infection in a Patient with Metastatic Lung Cancer

Abstract We present a case of a male patient who underwent right-sided pneumonectomy due to central low-grade squamous cell carcinoma of the right lung, chemo-, radio-, and immunotherapy. However, the disease progressed. In addition the patient got SARSCoV-2 pneumonia in the left lung, followed by postpneumonectomy empyema. Right-sided uniportal video-assisted thoracoscopy, debridement, and definitive drainage of the pleural cavity were performed.

Early Postoperative Results of Patients Undergoing Uniportal Video-Assisted Thoracoscopic Lobectomy and Their Assessment with The Systemic Inflammation Scoring System

Background & Aim: Uniportal video-assisted thoracoscopic surgery (u-VATS) is a minimally invasive approach that allows thoracic operations to be performed through a single small incision of approximately 4 cm. The Systemic Inflammation Score (SIS) is a scoring system that can be measured easily and inexpensively in routine clinical practice and consists of three laboratory parameters, which are serum albumin level, lymphocyte count, and monocyte count. Scoring systems can provide low-cost and easily attainable objective information that can assist surgeons in evaluating patients. The aim of this study was to examine the early postoperative results of patients who underwent u-VATS lobectomy and to evaluate the relationship of these results with the systemic inflammation scoring system. Methods: Age, gender, smoking habits, preoperative lymphocyte and monocyte counts, preoperative albumin values, comorbidities, operative times, length of hospital stay, chest tube removal time, duration of air leak, amount of drainage, and postoperative complications of patients who underwent u-VATS lobectomy operation in our clinic between March 2018 and March 2020 were retrospectively analyzed. Patients were classified by the SIS based on preoperative serum albumin (ALB) level and lymphocyte-to-monocyte ratio (LMR) as follows: SIS=0, ALB ?4.0 g/dL and LMR ?3.4; SIS=1, ALB <4.0 g/dL or LMR <3.4; and SIS=2, ALB <4.0 g/dL and LMR <3.4. Results: The number of patients who underwent u-VATS lobectomy was 42. There were 12 patients in the SIS 0 group, 19 patients in the SIS 1 group, and 11 patients in the SIS 2 group. The amount of postoperative drainage (p=0.000), chest tube removal time (p=0.006), and length of hospital stay (p=0.000) were correlated with systemic inflammatory scores of patients. The rate of developing postoperative complications was found to increase to almost a statistically significant level as the systemic inflammatory scores of patients increased (p=0.084). There was no significant difference between the SIS groups in terms of other parameters. Conclusion: Patients who underwent u-VATS lobectomy and had a high preoperative systemic inflammation score had higher amounts of postoperative drainage, longer duration of chest tube and length of hospital stay. The SIS scoring system is a simple, effective risk stratification method that can be routinely used for patients undergoing u-VATS lobectomy. Keywords: Uniportal Video-Assisted Thoracoscopy, Lobectomy, Systemic Inflammation Scoring System, Thoracic Surgery

Monitoring excimer laser-guided cardiac lead extractions by uniportal video-assisted thoracoscopy: A single center experience.

Though laser guided extractions of cardiac implantable electronic devices leads have become a routine procedure, the severe complications are associated with a high mortality. Here, we report our single center experience using uniportal video-assisted thoracoscopy for laser lead extraction and compare it to stand-alone laser lead extraction. The intraoperative data and postoperative clinical outcomes of patients undergoing laser lead extraction with concomitant thoracoscopy (N = 28) or without (N = 43) in our institution were analyzed retrospectively. Neither the median x-ray time (612.0 s for the thoracoscopy group vs. 495.5 s for the non-thoracoscopy group, p = 0.962), length of the operation (112.5 vs. 100.0 min, p = 0.676) or the median length of hospital stay (9.0 vs. 10.0 days, p = 0.990) differed significantly. The mean intensive care unit stay was longer for patients in the non-thoracoscopy group (0.8 vs. 2.5 days, p = 0.005). The 30-day-mortality in the thoracoscopy group was zero, whereas five patients died in the non-thoracoscopy group. Furthermore, four patients in the non-thoracoscopy group had encountered haemothorax, while none were observed in the thoracoscopy group (p = 0.148). The adoption of uniportal video-assisted thoracoscopy during laser-guided lead extraction of cardiac implantable electronic devices can be considered safe and does not lengthen the operating time or hospital stay. It might be useful in the detection of severe complications and, in experienced hands, possibly allow direct bleeding control.

Non-intubated uniportal video-assisted thoracoscopy for sleeve lobectomy in a patient with severe chronic obstructive pulmonary disease: a case report

: Patients with compromised lung function undergoing uniportal video-assisted thoracoscopic surgeries (VATS) are at high risk for postoperative pulmonary complications. Ventilation technique for these patients should attempt to minimize the potential lung injury as well as to obtain a satisfactory surgical field and provide adequate intraoperative oxygenation. Non-intubated thoracic surgery has been reported to be associated with less ventilatory impairment compared to general anesthesia with double lumen tube intubation. However, this technique in complex surgeries such as sleeve lobectomy is not standardized yet. We described a 71-year-old male with severe chronic obstructive pulmonary disease (COPD) and primary carcinoma obstructing the right upper lobe. Uniportal VATS right upper sleeve lobectomy was performed under non-intubated anesthesia. A cross-field bronchial suction catheter was inserted through the open end of the right main bronchus to provide left lung oxygen delivery during the anastomosis maneuvers. Satisfactory operative conditions as well as adequate oxygenation was achieved using this technique. No signs of pulmonary complications or any other discomfort was observed during the patient’s hospital stay. Thus, we suggest that non-intubated anesthesia could be a safe or even better option in the case of a patient with reduced lung function for complex uniportal VATS surgeries like sleeve lobectomy.

Uniportal video-assisted thoracoscopy is a safe approach in patients with empyema requiring surgery.

BackgroundEmpyema is a well-known complication of pneumonia, with high morbidity and mortality rates. This warrants direct treatment either with antibiotics and chest tube drainage or surgery. With less invasive surgical approaches such as uniportal video-assisted thoracoscopic surgery (uVATS), surgical intervention gets a more prominent role early on in the treatment of empyema. The aim of this study was to compare uVATS with the complete VATS (cVATS) approach in empyema, with respect to postoperative complications, hospital length of stay and mortality.MethodsAll cases of empyema that were treated surgically in our hospital between 2006 and 2019 were included in a retrospective database. The preferential surgical approach changed from cVATS from 2006 to 2015, towards uVATS from 2016 and on, based on the experience of the surgical team. The database included pre- and postoperative data, as well as peropartive characteristics.ResultsOne hundred and thirty-seven patients were treated with cVATS and 49 with uVATS. Apart from a slightly reduced kidney function in the uVATS group (57.3±6.3 vs. 71.4±17.2 mL/min/1.73 m2, P≤0.001), there were no significant baseline differences in patient characteristics. The duration of uVATS was comparable to cVATS (70±17 vs. 56±23 min, P=0.240), and with low per- and postoperative complications. The postoperative hospital stay was equal in both groups (19±13 vs. 20±15 days, P=0.320). There were no statistically significant differences in postoperative complications or death.ConclusionsUniportal VATS is a feasible and safe technique for the use in patients with empyema requiring surgery. Even if decortication in stage III empyema is required this can be performed by uniportal VATS.

The application value of computed tomography in combination with intraoperative noninvasive percutaneous ultrasonic localisation of subpleural pulmonary nodules/ground-glass opacity in uniportal video-assisted thoracoscopy.

IntroductionThis study investigates the application value of preoperative noninvasive computed tomography (CT) localisation, combined with intraoperative percutaneous ultrasonic localisation, in the precise positioning and excision of subpleural pulmonary nodules/ground-glass opacity in uniportal video-assisted thoracoscopic surgery (U-VATS).AimTo derive the precise positioning and excision of subpleural pulmonary nodules by CT combined with intraoperative percutaneous ultrasonic localisation and to avoid the complications caused by preoperative CT-guided puncture localisation, reduce physiological and psychological stress such as anxiety, CT radiation dose, and treatment cost, and to improve the treatment satisfaction of patients.Material and methodsA total of 54 patients with subpleural pulmonary nodules/ground-glass opacity (SPN/GGO), who were treated in our hospital from June 2017 to January 2020, were enrolled in this study. The patients were randomly divided into a treatment group (n = 23), and the nodules were scanned by high-resolution CT and marked at the shortest distance on the surface of the body prior to surgery. These pulmonary nodules were relocated by ultrasound at the original CT positioning points in the same body position following the administration of general anaesthesia. Then, the hookwire puncture location was performed under real-time guidance. For the control group (n = 31), the subpleural pulmonary nodules were located by CT-guided puncture and embedding a hookwire prior to surgery. Pulmonary wedge resection was performed by U-VATS in each group. The subpleural nodules were confirmed by the naked eye and rapid pathological diagnosis after surgery. The difference in positioning success rate, positioning time, the incidence of complications, and patient anxiety scores for subpleural pulmonary nodules were compared and analysed between the two groups.ResultsA total of 22 cases of subpleural nodules were successfully located in the treatment group at a success rate of 95.6% (22/23). The average positioning time for CT in combination with ultrasound was 22.0 ±5.9 min. In the control group, 31 cases of subpleural pulmonary nodules were satisfactorily located at a success rate of 100% (31/31). The average positioning time of CT was 24.2 ±5.4 min. The difference in positioning success rate and positioning time was not statistically significant (p = 0.24; p = 0.15) between the two groups. The incidence of complications and SAS anxiety scores in the treatment group were lower compared with the control group. The difference was statistically significant (p = 0.002; p < 0.001).ConclusionsPreoperative CT combined with intraoperative percutaneous real-time noninvasive ultrasonic localisation can accurately locate subpleural pulmonary nodules, with a high degree of safety and good tolerance in patients who are suitable for U-VATS.

Uniportal video-assisted thoracoscopy approach to the management of non-pulmonary diseases of the chest.

The use of uniportal video-assisted thoracoscopy (u-VATS) is becoming a commonly used surgical technique and can be an effective approach for the surgical treatment of many pulmonary and non-pulmonary conditions. This review article summarizes current medical evidence informing the practice of u-VATS for treating non-pulmonary conditions including hyperhidrosis, hemothorax, pleural effusion, and thymic disease.

Airway Management of the Right Anterior Segmentectomy through Uniportal video-assisted thoracoscopic surgery (VATS) after left pneumonectomy by an adapted double-lumen endobronchial tube (DLT): a case report

BackgroundLung resection after previous contralateral pneumonectomy is rare. We present a case of right anterior segmentectomy despite previous left pneumonectomy, demanding special airway management strategy.Case presentationA 48-year-old woman who had left pneumonectomy 2 years ago was scheduled to have the right anterior segmentectomy through uniportal video-assisted thoracoscopy (VATS). A 32-French (Fr) left-sided double-lumen endobronchial tube (DLT) was chosen and adapted. The DLT was intubated into the bronchus intermedius. And the upper lobe can be isolated from the ventilation in the middle and lower lobes when the bronchial cuff’s inflated. The perioperative period was uneventful and the pathological diagnosis was adenocarcinoma.ConclusionLung cancer radical resection was discouraged after previous contralateral pneumonectomy partly due to the challenging ventilation and isolation. With this new DLT adapting and intubation technique showed in this case, the challenging ventilation and isolation that deter the implementation of the operation mentioned above could be solved.

Watching, Reading and Don’t See-Lung surgery: A Case Report

Incorrect preoperative evaluation can lead to some problems in anesthesiologic management, particularly in thoracic anesthesia. We present the case of an old man with a history of adenocarcinoma of the rectum, diagnosed with a solid pulmonary nodule. The thoracic surgery team scheduled an Uniportal Video-Assisted Thoracoscopy (U-VATS) atypical resection of the right lower lobe. Intraoperative airway management was complicated by the unexpected presence of a tracheal diverticulum, a rare pathological issue that can cause many difficulties in airways management Mastery of the bronchoscopy technique by experienced anesthesiologists and their knowledge of alternative choices for pulmonary exclusion, allowed to choose an alternative for the one lung ventilation, without causing any harm to the patient. Correct handling of the bronchoscope is a gold standard tool for modern anesthesiologist. It is also mandatory, from our point of view, to examine diagnostic images with a critical eye, looking for those details that could make the difference on anesthesiologic management of the patients.

Watching, Reading and Don’t See-Lung surgery: A Case Report

Incorrect preoperative evaluation can lead to some problems in anesthesiologic management, particularly in thoracic anesthesia. We present the case of an old man with a history of adenocarcinoma of the rectum, diagnosed with a solid pulmonary nodule. The thoracic surgery team scheduled an Uniportal Video-Assisted Thoracoscopy (U-VATS) atypical resection of the right lower lobe. Intraoperative airway management was complicated by the unexpected presence of a tracheal diverticulum, a rare pathological issue that can cause many difficulties in airways management Mastery of the bronchoscopy technique by experienced anesthesiologists and their knowledge of alternative choices for pulmonary exclusion, allowed to choose an alternative for the one lung ventilation, without causing any harm to the patient. Correct handling of the bronchoscope is a gold standard tool for modern anesthesiologist. It is also mandatory, from our point of view, to examine diagnostic images with a critical eye, looking for those details that could make the difference on anesthesiologic management of the patients.

Challenges Faced in the Learning Curve of Uniportal Video-Assisted Thoracoscopy

Challenges Faced in the Learning Curve of Uniportal Video-Assisted Thoracoscopy

Uniportal video-assisted thoracoscopy major lung resections after neoadjuvant chemotherapy.

The combination of neoadjuvant chemotherapy and surgery in lung cancer therapy is well established. The role of uniportal video assisted thoracoscopy (VATS) is still not described in literature. This study presents the preliminary short-term results of uniportal VATS after neoadjuvant therapy in our series. The prospectively collected data of 154 patients after uniportal VATS anatomical lung resection (18 patients after neoadjuvant chemotherapy and 136 surgeries alone) were retrospectively reviewed. The perioperative results and follow-up of patients after neoadjuvant therapy were analyzed and compared to those after surgery alone. The mean age of population was 67.51±10.63 years. The mean operative time was overlapping in both groups: 248.97±118.17 min in surgery group and 287.17±94.13 min in chemotherapy + surgery group (P=0.190), with no difference in terms of types of anatomical lung resections performed and number of lymph nodes retrieved. The intraoperative mortality was null in both groups. The incidence of all complications was the same in both groups and no correlations was found with any possible risk factor evaluated (age, gender, comorbidities, type of resection, histology, etc.). Among minor complications, the incidence of parenchymal fistula was significantly higher in the 18 patients underwent chemotherapy (22.2% vs. 5.1% respectively, P=0.013). The overall survival of the series was 93% at 1 year follow-up and 88% at 5-year. The 1- and 2-year survival in only surgery group was 94% and 89% respectively vs. 85% and 85% in Chemotherapy + surgery, without any significant difference (P=0.324). According to our experience, uniportal VATS after neoadjuvant therapy is feasible and quite safe. The oncological results and postoperative complications are comparable to those of other techniques. Uniportal VATS can be performed even for complicated cases in experienced centers.

Lymph node upstaging for non-small cell lung cancer after uniportal video-assisted thoracoscopy.

Radical lymph node dissection (LND) plays a major role in the treatment of non-small cell lung cancer (NSCLC). This study presents the analysis of the results after uniportal video-assisted thoracoscopy (VATS) lymphadenectomy during anatomical lung resections for NSCLC, focusing on pathological nodal upstaging. Any possible risk factor affecting nodal upstaging was also investigated. The prospectively collected clinical data of 136 patients undergone uniportal VATS anatomical lung resections, from June 2012 to September 2017, were reviewed. In particular, all details inherent the clinical and pathological node stage and any possible risk factor affecting nodal upstaging were analyzed. The patient population consisted of 90 males and 46 females; their mean age was 67.42±10.64 years. The mean number of lymph nodes retrieved during uniportal VATS lymphadenectomy was 20.14±10.73 (7.27±5.90 and 12.60±7.96 in N1 and N2 stations, respectively). The incidence of nodal upstaging was 13.3% (18 cases). In particular there was a N0-1 upstaging in 10 cases (7.4%), a N1-2 upstaging in 3 (2.2%) and a N0-2 in 4 (3%). The ROC analysis showed that the resection of 18 lymph nodes was the best predictor of a general upstaging with an AUC-ROC of 0.595, while the resection of 7 hilar lymph nodes was the best predictor of N1 upstaging (AUC-ROC: 0.554) and 11 mediastinal nodes was the best predictor of N2 upstaging (AUC-ROC: 0.671). The number of positive lymph nodes of stations 5-6 (OR: 2.035, 95% CI: 1.082-3.826, P=0.027) and stations 2-3-4 (OR: 6.198, 95% CI: 1.580-24.321, P=0.009) were confirmed to be the only independent risk factors for N2 upstaging by multivariate analysis. According to our experience, uniportal VATS allows a safe and effective radical lymphadenectomy, with a satisfactory pathological nodal upstaging, comparable to other minimally invasive techniques.

Learning curve and established phase for uniportal VATS lobectomies: the Papworth experience.

Uniportal video-assisted thoracoscopy (VATS) has increasingly gained importance in the thoracic surgery scenario. The use of this technique can reduce postoperative pain and length of stay and gives the surgeon the same operative perspective as open surgery. We retrospectively analysed the data of 73 patients who underwent uniportal VATS lobectomies from November 2014 to December 2015 in our institution. We divided the patients in two groups (group 1: first 30 patients vs. group 2: established phase, 43 patients) to compare and evaluate the data regarding the learning curve. To explore evolution of learning curve, data were plotted to calculate Spearman's Rank-Order Correlation. R (version 3.2.3) was used for statistical analysis. The median age was 69.9 (group 1) and 68.8 (group 2) years. Mean operative time was 84.9±33.0 (group 1) and 84.8±31.5 (group 2) minutes. The conversion rate was 13.3% in group 1 vs. 9.3% in group 2, showing a significant learning reduction (rho=0.590). Overall morbidity rate was 15.1%. The most common complication consisted in prolonged air leak. Interpolation line of complications showed a significant decrease due to learning curve (rho=0.676). The median length of stay was 4 days in group 1 vs. 3 days in group 2. The 30-day mortality was 3.3% in group 1 and 0% in group 2. The comparison between the groups showed that the median length of stay, operative time, conversion rate and 30-day mortality statistically significantly improved in the established phase. Also, complications like prolonged air leak were decreasing in the established phase. In conclusion, the uniportal VATS lobectomy technique can be performed safely from experienced surgeons without major complications and with an acceptable mortality rate.

Uniportal video assisted thoracoscopic lobectomy: going directly from open surgery to a single port approach.

Uniportal video-assisted thoracoscopy (VATS) has gaining a special place in the thoracic surgery scenario; nowadays even major pulmonary resections can be performed through this approach. We hereby review our initial experience with uniportal VAT lobectomy, performed passing directly from the open approach to a single port approach. We attempted 26 lobectomies through VATS with a single incision of about 5 cm and 22 of them were completed: eight left lower lobectomies, six right upper lobectomies, five left upper lobectomies and three right lower lobectomies. At pathological staging all but four patients were stage I; three patients were T2N1M0 and one had a micrometastasis in a lymph node of station 7 (T1N2M0-Stage IIIA) and they all underwent adjuvant chemotherapy. No perioperative mortality was observed. One patient had a myocardial infarction in the first postoperative day requiring placement of four stents and another one required thoracentesis after drainage removal. The mean time for drainage removal was 3 days and the length of hospitalization was 4.2±1.1. Pain as measured by the visual analogical scale (VAS) scale was graded as 4.9, 2.6 and 0.5 during the first postoperative day, at discharge and after 1 month respectively.