Single-Incision Thoracoscopic Surgery for Spontaneous Pneumothorax Using Multi-Degrees of Freedom Forceps

Abstract

Purpose: The objective of this study was to assess the perioperative results of a single-incision approach using multi-DOF forceps for spontaneous pneumothorax, in comparison with the traditional 3-port approach. Methods: Between May 2012 and June 2013, 44 patients with spontaneous pneumothorax underwent SITS, and their clinical characteristics and perioperative results were evaluated. We then compared those who had undergone SITS (SITS group) with those who had undergone traditional 3-port surgery before the study period (3-port group). Results: The two groups were similar in terms of mean patient age and pneumothorax laterality (p = 0.81, 0.38), but the proportion of male patients was higher in the 3-port group than in the SITS group (p = 0.0026). Operation time in the SITS group (52.4 min) was longer than in the 3-port group (35.9 min, p <0.0001). The duration of postoperative drainage and hospital stay did not differ significantly between the groups (p = 0.19, 0.075). Although 14 of the 56 SITS patients (25%) showed mild adhesion in the pleural cavity, none required conversion to a 3-port approach. The bullous region in two or three lobes was resected in 23 patients (41%). Conclusions: SITS using multi-DOF forceps is a useful approach for treatment of spontaneous pneumothorax in selected patients.

Initial Experience of Single-Incision Thoracoscopic Surgery for 100 Patients with Primary Spontaneous Pneumothorax

“…Since then, some authors have reported SITS for PSP, and the adequacy of the technique has been discussed. [3][4][5][6][7][8][9] We have also established an original SITS procedure with a single incision 2.0 cm in length and have been using it in PSP patients since 2009. We herein describe the clinical characteristics and surgical results for the first 100 patients who underwent SITS for PSP.…”

Uniportal thoracoscopic surgical management using a suture traction for primary pneumothorax

“…To facilitate the procedure, many authors have proposed the use of an articulated endograsper and a single-incision laparoscopic surgery device. 7–9 This is a dedicated wound protector having multiple channels, which facilitates maintaining a fixed position of the camera and working instruments, and reduces the risk of collisions between instruments during uniportal VATS. However, the single-incision laparoscopic surgery device has a higher cost than the standard wound protectors, and a relatively long skin incision is needed because the port should accommodate a minimum of three instruments.…”

“…Gentle extrathoracic manipulation of the suture lifts the lesion and creates an angle that facilitates stapler wedge resection. Compared to previous methods, 7–13 our strategy does not need special devices; only a 0 suture and a sponge, widely available. Yet, as the suture traction is not accommodated within a uniportal incision, it does not interfere with the movement of other surgical devices inside or outside the thoracic cavity, facilitating handling and resection of the lesion.…”

“…During uniportal VATS, the camera and endoscopic instruments are inserted into the thoracic cavity through the same incision, which may increase the risk of collision between surgical instruments and limit their manipulation. To facilitate this procedure, several techniques have been proposed, 7–13 often requiring special tools or cumbersome surgical maneuvers, which limits their wide adoption into clinical practice. We describe a new strategy to facilitate the management of PSP during uniportal VATS, and to test its validity, we compared the outcomes of our modified technique with those of conventional 3-port VATS.…”

A 3.5-cm Single-Incision VATS Anatomical Segmentectomy for Lung Cancer

“…Our institute performs uniportal thoracoscopic surgery for pneumothorax due to a fundamental belief of "reduced-port surgery." 4) This report describes a successful case of uniportal VATS anatomic segmentectomy through a 3.5-cm incision.…”