A New Traceless Technique for Cosmetic Closure of Minimally Invasive Incision and Chest Tube Fixation After Uniportal Video-Assisted Thoracoscopic Surgery

Abstract

BackgroundWith uniportal video-assisted thoracoscopic surgery (VATS) becoming mainstream, how to make the incision cosmetic has attracted much attention. This study aimed to introduce a new traceless method for cosmetic closure of the incision and a special procedure for chest tube fixation after uniportal VATS and to evaluate the feasibility, effectiveness, and safety of this new technique.MethodsIn this retrospective study, a total of 258 consecutive patients who underwent uniportal VATS were included. Among them, 127 patients were treated with a conventional method, and 131 patients were treated with a new method.ResultsPatients in the new method group had a significantly less incidence of subcutaneous emphysema after the chest tube was removed. The incidence of pneumothorax after the chest tube was removed and fat liquefaction of chest incision was not significantly different between the two groups. No differences in the incidence of pneumothorax after chest tube removal and fat liquefaction of postsurgical incision were found between the two groups. Additionally, there was also no significant difference in follow-up items.ConclusionsTaken together, our results showed that this new method for minimally invasive incision closure and chest tube fixation after uniportal VATS was as feasible, effective, and safe as the conventional one but more cosmetic.

Ameliorated chest drain wound closure in patients undergoing uniportal thoracoscopic pulmonary resection

“…Different layers of continuous barbed sutures with removal-free stitches have been demonstrated in previous studies, supporting their feasibility and variety in uniportal VATS settings (4,7,8). Only a few studies have compared the clinical outcomes of the modified and conventional CWC methods in patients undergoing uniportal VATS (6,7). Similarly, our surgical team has developed different CWC methods for uniportal VATS over the past six years.…”

“…Superiority in post-removal complications and better scar conditions were shown in their modified method, but it requires multiple steps that are more time-consuming than the conventional method ( 18 ). In 2022, Chen et al retrospectively enrolled 258 patients who underwent uniportal VATS and compared their modified full-layer barbed suture technique with the conventional interrupted method ( 7 ). Only the incidence of subcutaneous emphysema after tube removal was significantly reduced with their modified technique ( 7 ), and the evaluation of wound healing or scar conditions was lacking in their study.…”

“…In 2022, Chen et al retrospectively enrolled 258 patients who underwent uniportal VATS and compared their modified full-layer barbed suture technique with the conventional interrupted method ( 7 ). Only the incidence of subcutaneous emphysema after tube removal was significantly reduced with their modified technique ( 7 ), and the evaluation of wound healing or scar conditions was lacking in their study. The relevant literature is summarized in Table 3 .…”

“…Direct tube insertion issues in uniportal VATS can be prevented, and no wound-related complaints have been reported; however, the stitches still need to be removed (5). Subsequently, several similar modified chest tube wound closure methods were proposed (4,6,7,(16)(17)(18)(19). The removal of stitches with a firm wound closing effect due to its innovative suture material, which is the absorbable barbed thread, was first introduced by Kim et al for VATS incisions in 2017 (19); later in 2018, they showed non-inferiority in complication rates compared to the conventional method (16).…”

“…In recent years, modified CWC methods for uniportal VATS have been introduced in terms of suture techniques and materials to improve wound closure and reduce scarring (4)(5)(6)(7)(8). Different layers of continuous barbed sutures with removal-free stitches have been demonstrated in previous studies, supporting their feasibility and variety in uniportal VATS settings (4,7,8). Only a few studies have compared the clinical outcomes of the modified and conventional CWC methods in patients undergoing uniportal VATS (6,7).…”