Complete port-accessed lobectomy by the muscle-sparing method

Doki, Yoshinori; Ichiki, Katsuyuki; Tsuda, Motoharu; Toge, Masayoshi; Misaki, Takuro; Usuda, K; Sugiyama, Shigeki

doi:10.1016/s0003-4975(03)01157-3

Cited by 10 publications

(7 citation statements)

References 5 publications

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“…Our hospital began using complete VATS lobectomy without a mini-thoracotomy in 2002 (3). Since then, most patients requiring lobectomy at our hospital have undergone complete VATS.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of neuropathic pain after thoracic surgery

Homma¹,

Doki²,

Yamamoto³

et al. 2018

J. Thorac. Dis.

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“…Our hospital began using complete VATS lobectomy without a mini-thoracotomy in 2002 (3). Since then, most patients requiring lobectomy at our hospital have undergone complete VATS.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of neuropathic pain after thoracic surgery

Homma¹,

Doki²,

Yamamoto³

et al. 2018

J. Thorac. Dis.

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“…Several approaches to minimize postoperative pain in VATS have been reported recently, such as complete portaccessed lobectomy by the muscle-sparing method [11], the transcervical approach with one intercostal 5-mm thoracoscopic camera port [12], single-port video-assisted thoracoscopic lobectomy [13], the microthoracoscopic oneport method [14], and uniportal VATS using a singleincision laparoscopic surgery port [15]. However, these procedures are not widely used because of their technical difficulties.…”

Section: Discussionmentioning

confidence: 99%

Needlescopic video-assisted wedge resection combined with the subcostal trans-diaphragmatic approach for undetermined peripheral pulmonary nodules

et al. 2013

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Background Reduced mortality from lung cancer by computed tomography (CT) screening facilitates the use of video-assisted thoracic surgery (VATS) lung wedge resection to obtain a definite diagnosis and to treat tiny nodules. The authors evaluated their initial experience using novel needlescopic VATS wedge resection combined with the subcostal trans-diaphragmatic (SCTD) approach for managing undetermined peripheral pulmonary nodules. Methods Between 2009 and 2012, 35 patients who had 36 operations underwent needlescopic VATS wedge pulmonary resection with the SCTD approach. Preoperative percutaneous CT-guided marking of the nodule was performed. Two 3-mm miniports were placed in the thorax for the thoracoscopic camera and minigrasper. Just anterior to the 10th rib, a 2-cm subcostal incision was made, and a 12-or 15-mm port was placed trans-diaphragmatically into the chest cavity. Wedge resection of the lung was performed with endostaplers introduced through a subcostal port. Results The median tumor size was 1.1 cm. Localization of the tumor was widely distributed. The mean operation time was 51 min, and the mean blood loss was 4.2 mL. No patients required conversion to thoracotomy, and one patient required conversion to conventional VATS. Additional thoracic ports were placed in five patients, and the needlescopic incision was extended to 15 mm in one patient. The median duration of chest drainage was 1 day. Additional analgesia was not required for 22 patients and was used for less than 1 day for three patients, less than 2 days for seven patients, and less than 3 days for seven patients. The pathologic diagnosis of the nodules was malignant for 28 patients and benign for 8 patients. On postoperative day 7 or at admission, 34 patients were free of postoperative neuralgia. Conclusions Needlescopic VATS wedge pulmonary resection combined with the SCTD approach is both safe and feasible and offers the specific advantages of minimal invasiveness and good cosmetic outcomes.Keywords Lung cancer Á Minimally invasive surgery Á Needlescopic surgery Á Subcostal trans-diaphragmatic approach Á Video-assisted thoracic surgery Á Wedge pulmonary resection Video-assisted thoracic surgery (VATS) wedge resection has been widely performed for many different lung diseases, including pneumothorax, as well as for undetermined pulmonary nodules. Clear advantages of VATS over open wedge lung cancer resection have been found in terms of both acute clinical outcomes and hospital costs [1]. Furthermore, the National Lung Screening Trial showed that lung screening with the use of low-dose computed tomography (CT) reduces mortality from lung cancer [2] and appears to facilitate the use of VATS lung wedge resection to obtain a definite diagnosis and treat tiny nodules.The Danish Lung Cancer Study Group also reported that CT screening appears to facilitate the use of VATS in 84 % of lung cancer operations, and in their study, all benign Electronic supplementary material The online version of this article

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“…19 Kido et al, 20 and Hutter et al 21 ; lobectomy with VATS assistance: Detterbeck and Egan, 17 Doki et al, 22 and Yilmaz et al 23 *Estimated number of procedures performed, based on publications and personal knowledge. The need for visualization and instrumentation that allows one to work ''around the corner'' is perhaps even greater; much of the upper mediastinum is accessible quite directly from above.…”

Section: Gazing Up From Belowmentioning

confidence: 99%

Looking in from above and up from below New Vistas in Thoracic Surgery

Detterbeck

Kim

Zieliński

2012

Innovations�(Phila)

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T horacic surgery has undergone many changes. Lung resection was not performed to any significant degree until less than 100 years ago. Initially, surgery for complications of tuberculosis predominated. It is often said that tuberculosis allowed the field of thoracic surgery to evolve. However, considering how difficult surgery is for end-stage tuberculosis, even in the modern era, perhaps, it was the appearance of lung cancer, and thus patients with less chronically scarred chest anatomy, that allowed the specialty to develop. Initial resection involved pneumonectomy, but gradually, the anatomy began to be understood better, and lobectomy became the most common operation. More recently, the approach has changed, at least in experienced centers, so that most lobectomies are performed by a minimally invasive video-assisted thoracic surgery approach (VATS). The use of robotic technology, with enhanced articulation of instruments, is beginning to be explored. Although these advances are associated with a learning curve and require validation to define their appropriate place, there is no doubt that thoracic surgery is a dynamic field that continues to evolve. Given this history and current state of affairs, what does the future hold? This article explores potential new developments in thoracic surgery. THE FORCES OF CHANGE What are the forces that are bringing about change? There is no doubt that surgery is invasive. In fact, this is a strength of surgery: to directly approach a problem (altered anatomy) and to fix it. Although advances are likely that will prevent problems from developing, halt their progression, or perhaps minimize the consequences, anatomic problems will likely always require a direct approach. At the same time, the invasive nature of surgery is a limitation. A less invasive approach to an anatomic site is at least conceptually desirable. This includes smaller incisions, VATS, or catheter-based approaches. Of course, it must be demonstrated that such less invasive approaches provide an effective and safe way of addressing the problem at hand. But incisions are associated with pain, and pain is a strong motivator for patients. Therefore, the push toward less invasive approaches is enormous, sometimes even overshadowing the desire for treatment efficacy. Other changes in the world we live in are important. Technology is advancing at a rapid, accelerating pace, providing new opportunities to explore alternative approaches. For example, advances in imaging technology, always a critical aspect for surgical procedures, have been crucial to the development of VATS approaches. On a different level, imaging is changing the very nature of the diseases we encounter; increased computed tomography imaging results in a shift to more early-stage lung cancer, 1 as well as an increased proportion of more slow-growing cancers. 2 Less extensive resection may be appropriate for many such lesions, although the role of such interventions is still being defined. Advances in clinical science, data gathering, and analysi...

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Complete port-accessed lobectomy by the muscle-sparing method

Cited by 10 publications

References 5 publications

Risk factors of neuropathic pain after thoracic surgery

Risk factors of neuropathic pain after thoracic surgery

Needlescopic video-assisted wedge resection combined with the subcostal trans-diaphragmatic approach for undetermined peripheral pulmonary nodules

Looking in from above and up from below New Vistas in Thoracic Surgery

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