Experiences of novel cotton device for uniportal video-assisted thoracoscopic surgery: CS Two-Way HandleTM

Abstract

In Japan, cotton is commonly used in thoracic surgery for the gentle handling of organs as well as obtaining a good surgical field. While uniportal video-assisted thoracoscopic surgery is being recognized as a major surgical approach, use of cotton is not noted in this technique. Uniportal video-assisted thoracoscopic surgery needs curved instruments because they are effective in preventing the interference of instruments. Thus, we developed a novel curved cotton instrument, known as the "CS Two-Way Handle TM ", for uniportal video-assisted thoracoscopic surgery. The CS Two-Way Handle TM can be used not only as a cotton bar but also as a suction aid. Moreover, surgical smoke can be suctioned with the insertion of cotton.This instrument was introduced in our institution in September 2019, along with some other prototypes.When anatomical lung resection using uniportal video-assisted thoracoscopic surgery was first introduced, there were some instances of conversion to conventional multiportal video-assisted thoracoscopic surgery.However, after the CS Two-Way Handle TM introduction, the procedure has become easy to perform and the need for conversion to conventional methods has reduced. The main uses of the CS Two-Way Handle TM are: (I) exposure of the surgical view, (II) lymph node dissection, (III) bleeding control, (IV) suction, and (V) evacuation of surgical smoke. We present our experiences using the CS Two-Way Handle TM in uniportal video-assisted thoracoscopic surgery.

The impact of novel instrumentation in promoting uniportal video-assisted thoracoscopic surgery

“…In the United States, VATS typically entails multiple ports into the chest wall. However, it has been shown that approximately 50% of patients develop clinically significant post-operative chest wall pain and paresthesias ( 3 ). In addition, VATS has historically required the use of straight instruments which may make dissection difficult in tight anatomical spaces.…”

“…In addition, VATS has historically required the use of straight instruments which may make dissection difficult in tight anatomical spaces. To address some of these drawbacks of VATS, Homma et al describe their approach to uniport VATS with an innovative curved cotton instrument known as the “CS Two-Way Handle™” ( 3 ). Homma et al report the multiple uses and features of this novel instrument that allows for the feasibility of performing uniportal VATS safely ( 3 ).…”

“…To address some of these drawbacks of VATS, Homma et al describe their approach to uniport VATS with an innovative curved cotton instrument known as the “CS Two-Way Handle™” ( 3 ). Homma et al report the multiple uses and features of this novel instrument that allows for the feasibility of performing uniportal VATS safely ( 3 ). As conventional VATS in the United States is performed via a multiport VATS approach, Homma et al ’s demonstration of safe and effective uniportal VATS in Japan is an excellent opportunity to improve surgical methods and technique on a global scale ( 1 - 3 ).…”

“…Homma et al succinctly describe their novel instrument, the CS Two-Way Handle™, while clearly demonstrating its use in real-time intra-operatively ( 3 ). The CS Two-Way Handle™ features the use of a cotton tip, Naruke Thoraco-Cotton™, that allows for gentle traction and mobilization of delicate tissues when inserted into their special metal rod, Naruke Cotton Finger™.…”

“…The CS Two-Way Handle™ features the use of a cotton tip, Naruke Thoraco-Cotton™, that allows for gentle traction and mobilization of delicate tissues when inserted into their special metal rod, Naruke Cotton Finger™. The CS Two-Way Handle™ addresses some limitations by classical “cotton-tipped” instruments in that it is uniquely curved ( 3 ). It has been known that curved instruments in laparoscopic surgery help improve the ergonomic position to establish an appropriate triangulation ( 4 ).…”