From biportal to uniportal video-assisted thoracoscopic anatomical lung resection

Chang, Jia‐Wei; Kam, Kam Hong; Yen, Yi‐Ting; Huang, Wei; Chen, Wei; Tseng, Yau‐Lin; Wu, Ming; Lai, Wu‐Wei; González-Rivas, Diego

doi:10.1097/md.0000000000005097

Cited by 26 publications

(27 citation statements)

References 20 publications

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“…Five patients underwent uniportal anatomic sublobar resections performed by an experienced surgeon in very high volume institutions (12). The diagnose leading to these procedures went from solitary or multiple GGO nodules to solid lesions involving the fissure in patients who did not endure pneumonectomy.…”

Section: Patients and Workupmentioning

confidence: 99%

Uniportal anatomic combined unusual segmentectomies

2017

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Nowadays, sublobar anatomic resections are gaining momentum as a valid alternative for early stage lung cancer. Despite being technically demanding, anatomic segmentectomies can be performed by uniportal video-assisted thoracic surgery (VATS) approach to combine the benefits of minimally invasiveness with the maximum lung sparing. This procedure can be even more complex if a combined resection of multiple segments from different lobes has to be done. Here we report five cases of combined and unusual segmentectomies done by the same experienced surgeon in high volume institutions to show uniportal VATS is a feasible approach for these complex resections and to share an excellent educational resource. palpation. KeywordsThe way of approaching the segments does not differ much from conventional VATS. Because the segmental vessels and bronchi are more distal and lateral, the angles for dissection and insertion of staplers are actually less limited (the more hilar or proximal the dissection, the more difficulty to insert staplers). Segmental vascular branches were proximally ligated with polymer clips (Click'a V ® , Grena) by using a 45° uniportal specific applier and distally divided using energy devices. Bigger vessels and bronchi were divided using staplers. The segmental plane was identified inflating the lung after clamping the segmental bronchus. It should be noted that the more distal the bronchovascular anatomy, the more likely it is to find anatomical variants. It is always recommended to ventilate the lung before cutting the segmental bronchus. The boundary between inflated and non-inflated lung will serve as a good guide to delimit the intersegmental plane. The specimen was extracted with a retrieval bag avoiding rib retraction and lymph node dissection was completed.In the first case (Figure 1), en bloc anatomic segmentomy was performed for a solid tumor that surpassed the fissure involving segments 2, 6 and 10a. Inferior vein is dissected from posterior and V6 is cut. Incomplete fissure is divided anteriorly to expose the artery and A8, A9+10 and A6 segmental branches are identified. Intersegmental plane is delimited by V10a vein. Bronchovascular structures for S6 and then for S2 are cut pulling the bloc cranially. Division between S2 and the remaining upper lobe is made after closing B2 for segmental boundary confirmation.In the second case, we chose to perform a combined anatomic segmentectomy (Figure 2) for a lingular GGO lesion located very close to S3. Superior pulmonary vein is exposed and lingular and S3 branches are identified and transected. Fissure is opened and lingular arteries are cut. Bronchial division between culmen and lingula is dissected and lingular bronchus is cut. B3 can be seen after ligating A3 lateral and medial branches. Intersegmental plane is delimited after insufflation and lobe must be rotated counter clockwise to get the correct stapler angle.In the third case (Figure 3), a small undiagnosed lesion was located in the lateral segment of the middle lobe. This unusua...

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Section: Patients and Workupmentioning

confidence: 99%

Uniportal anatomic combined unusual segmentectomies

2017

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“…After removing duplicates, irrelevant articles, case reports, letters, reviews, comments or meta-analyses, 15 references were identified and assessed further by screening the full texts. After the exclusion of four studies which did not provide the appropriate data, 11 studies (2)(3)(4)(5)7,8,(12)(13)(14)(15)(16) were included for final assessment and were deemed to be suitable for quantitative meta-analysis. The process of article selection is summarized in Figure 1.…”

Section: Selection Processmentioning

confidence: 99%

“…Also, other potential advantages have been reported, including a significant reduction of postoperative pain (2,3), a shorter hospital stays (4,5) as well as improved patient satisfaction (6). Therefore, there was a hypothesis that uniport VATS might be superior to multiport VATS.…”

Section: Introductionmentioning

confidence: 99%

Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1–3N0M0 non-small cell lung cancer: a systematic review and meta-analysis

Yang¹,

Li²,

Yang³

et al. 2018

J. Thorac. Dis.

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Background: Uniport video-assisted thoracoscopic surgery (VATS) has emerged as a less invasive approach for the treatment of non-small cell lung cancer (NSCLC). However, whether uniport VATS has more potential advantages over multiport VATS remains controversial. This meta-analysis aimed to compare the perioperative efficacy of uniport and multiport VATS for T1-3N0M0 NSCLC. .02) and in the overall rate of complications (14.5% vs. 17.5%; P=0.008). There were no significant differences between the two treatment groups with regards to mortality, operative time, the number of dissected lymph nodes or the conversion rate. Conclusions: Uniport VATS might have represent a preferable option for the treatment of T1-3N0M0 NSCLC, due to its superior perioperative efficacy.

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“…The pursuit for mini-invasive keeps promoting the evolution of VATS from traditional multipleport to single-port for most VATS resections, and with the progress of VATS experience, UVATS has become technically feasible to perform lung resections. When compared with traditional multiple-port VATS, UVATS was found to result in equivalent perioperative outcomes and reduced postoperative pain and discomfort [15]. Despite these advancements and the popularization of the UVATS technique, lung resection for PS remains a prohibited area.…”

Section: Introductionmentioning

confidence: 99%

Feasibility investigation of uniportal video-assisted thoracoscopic anatomical lung resection for pulmonary sequestration

Sun

Feng²,

Zhang

et al. 2019

Preprint

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Background Uniportal video-assisted thoracic surgery (UVATS) technique has been increasingly used for many thoracic diseases. Whether UVATS has equivalent or better perioperative outcomes for pulmonary sequestration (PS) patients remains controversial. Our study aimed to evaluate the feasibility of UVATS in anatomical lung resection for pulmonary sequestration.Methods A total of 24 patients with PS including fifteen males and nine females with the mean age of 40.54±14.49 (rang, 18-65) years old, who had received completely UVATS anatomical lung resection for PS in Nanjing Chest Hospital between January 2016 and December 2018 were retrospectively reviewed. Referring clinical data were retrieved from hospital records and analyzed.Results All 24 patients had been treated with the UAVTS approach successfully with no aberrant artery ruptured and no massive hemorrhage occurred, and no patients died during the perioperative period. Overall median surgery time was 102.21 ±28.00 mins (range, 55-150mins), the mean blood loss was 94.17±78.90 ml (range, 10-300ml), the mean days of chest tube maintained were 4.21±2.21 days (range,1-10days), and the mean postoperative hospitalization days was 5.79 ±2.35 days (range,2-11days). All patients were cured, without cough, fever, hemoptysis, and so on, occurring during the average follow-up of 17.42 ±2.00 months (range, 3-35months).Conclusions Our preliminary results revealed that anatomical lung resection by UVATS is a safe and feasible mini-invasive technique for PS patients, which might be associated with less postoperative pain, reduced paresthesia, better cosmetic results, and faster recovery.

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From biportal to uniportal video-assisted thoracoscopic anatomical lung resection

Cited by 26 publications

References 20 publications

Uniportal anatomic combined unusual segmentectomies

Uniportal anatomic combined unusual segmentectomies

Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1–3N0M0 non-small cell lung cancer: a systematic review and meta-analysis

Feasibility investigation of uniportal video-assisted thoracoscopic anatomical lung resection for pulmonary sequestration

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