Clinical application of single incision thoracoscopic surgery: early experience of 264 cases

Abstract

BackgroundSingle incision thoracoscopic surgery (SITS) is recognized as a difficult procedure and surgeons hesitate to perform this technique. We describe our experience of SITS and determine whether SITS can be a routine approach in minimally invasive surgery.MethodsFrom May 2011 to April 2013, a single operator attempted SITS for 264 cases. Their medical records were retrospectively reviewed with regard to age, sex, diagnosis, operation time, hospital stay, need of additional incision, morbidity, and early outcome.ResultsA number of thoracic diseases and procedures were attempted with SITS including primary (n = 172) or secondary (n = 22) spontaneous pneumothorax, biopsy for lung (n = 29), pleura (n = 3), and mediastinal lymph node (n = 3), mediastinal mass excision (n = 11), empyema decortication (n = 11), lobectomy (n = 6), pulmonary metastasectomy (n = 3), pericardial window formation (n = 3), and hematoma evacuation (n = 1). Of these, 237 cases underwent SITS successfully. However, additional incision was needed in 10.2% (n = 27). Reasons for conversions were as follows: extensive pleural adhesion (n = 14), difficulty in endoscopic stapling (n = 11), bleeding (n = 1), and intolerance of one lung ventilation (n = 1). Conversion rate of empyema was 54.5%, which was the most difficult for SITS. In contrast, the conversion rate of PSP was 4.7%, which means PSP was the most applicable for SITS. Postoperative complications included air leak (≥3 days) (n = 1), wound problem (n = 4), delayed pleural effusion (n = 1), and postoperative bleeding (n = 1).ConclusionsSITS can be a routine approach from simple to more complicated diseases. However, we still have difficulties in cases with extensive pleural adhesion or location of lesion with difficult accessibility for endoscopic stapling.

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

“…Although uVATS has been increasingly adapted for the management of recurrent uncomplicated pleural effusions, preoperative staging in lung cancer, treatment of primitive spontaneous pneumothorax, palmar hyperhidrosis and even for complex anatomic lung resections (19,20), surprisingly little is published about its use in empyema. An early publication by Song et al, reported that a uniportal approach in empyema was difficult and resulted in a 50% conversion rate to cVATS or thoracotomy (21). Subsequent studies showed lower conversion rates of around 10% (22).…”

Uniportal thoracoscopic decortication for pleural empyema and the role of ultrasonographic preoperative staging†

“…In a small series (11 patients), Song et al reported a high conversion rate (55%) due to the difficulties encountered in removing the thickened visceral pleura. For this reason, they used more frequently a three portal conventional VATS approach for removal of fibrous peel [19]. Marra et al [20] developed an original 'hybrid' technique of single access thoracoscopy using a classical video-mediastinoscope to debride the cavity and disrupt all pleural septation.…”

Modular 3-cm uniportal video-assisted thoracoscopic left upper lobectomy with systemic lymphadenectomy

“…The location of the incision in uniportal cVATS is important as it affects the complexity of the surgery (7,8). Our surgical incision was made at the fifth intercostal space on the midaxillary line, and was based on our previous experience.…”