Single-port video-assisted thoracoscopic lobectomy

González, D.; Paradela, Marina; García, José Ángel Brandariz; Torre, Mercedes dela

doi:10.1510/icvts.2010.256222

Cited by 277 publications

(189 citation statements)

References 6 publications

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“…In 2004, the uniportal or single-port approach was introduced, initially for wedge pulmonary resection (9) and subsequently in 2010 for lobectomy (10). Uniportal VATS is quickly gaining popularity as a surgical approach and has been rapidly adopted across Europe and Asia (11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Uniportal video-assisted thoracoscopic surgery: safety, efficacy and learning curve during the first 250 cases in Quebec, Canada

Drevet¹,

Figueroa²

2016

Ann. Cardiothorac. Surg.

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Background: Video-assisted thoracoscopic surgery (VATS) using a single incision (uniportal) may result in better pain control, earlier mobilization and shorter hospital stays. Here, we review the safety and efficiency of our initial experience with uniportal VATS and evaluate our learning curve. Methods:We conducted a retrospective review of uniportal VATS using a prospectively maintained departmental database and analyzed patients who had undergone a lung anatomic resection separately from patients who underwent other resections. To assess the learning curve, we compared the first 10 months of the study period with the second 10 months. Conclusions: Uniportal VATS was safe and feasible for both standard and complex pulmonary resections.However, when used for pulmonary anatomic resections, uniportal VATS entails a steep learning curve.

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Section: Introductionmentioning

confidence: 99%

Uniportal video-assisted thoracoscopic surgery: safety, efficacy and learning curve during the first 250 cases in Quebec, Canada

Drevet¹,

Figueroa²

2016

Ann. Cardiothorac. Surg.

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“…Median postoperative pain (IQR) on the POD 1 was 4 [3][4][5][6], on the POD 3 was 2 [1][2][3] and on the day of discharge was 1 [0. . Median consumption of the oxycodone (IQR) was 50 mg (40-80 mg).…”

Section: Resultsmentioning

confidence: 99%

Posterior uniportal video-assisted thoracoscopic surgery for anatomical lung resections

2017

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Background: The acceptance of uniportal video-assisted thoracoscopic surgery (uVATS) for anatomical lung resections has been growing in recent years. This study presents the first case-series in the literature with posterior uVATS (puVATS) technique for specific anatomical lung resections. Methods:The first 20 consecutive patients who underwent an anatomical lung resection by a single surgeon, by means of puVATS technique were evaluated in terms of pre-, peri-and post-operative results.A single incision of 3.5-4.5 cm was made posteriorly in the 6 th intercostal space at the so-called 'triangle of auscultation' to perform a resection of either a posterior segment of an upper lobe or a superior segment of a lower lobe for both lungs.Results: There were 5 posterior segmentectomies and 3 apical segmentectomies of the right upper lobe and 6 apical segmentectomies of the left lower lobe. Moreover, there were 6 lobectomies, all except for one as an extension of initially planned "posterior" segmentectomy. There were no intraoperative complications. Median tumor size (IQR) was 1.65 cm (1.1-2.57 cm), while median incision size (IQR) was 3.5 cm (3.5-3.87 cm).Median operative time (IQR) was 160 minutes (142-178 minutes). Median number of removed lymph nodes (IQR) was 19 [15][16][17][18][19][20]. Four patients had postoperative complications: three had bronchitis and one developed heart failure, all of which resolved before patients were discharged. Median length of hospital stay (IQR) was 6 days (5-8 days).Conclusions: puVATS approach for posterior lung segment resections, even for lobectomy if needed, seems to be feasible and safe. Exposure of the bronchovascular structures of the 'posterior segments' is better,and local and mediastinal lymphadenectomy seem to be easier with access directly in front of the incision and the lung, rather than behind it.Keywords: Uniportal video-assisted thoracoscopic surgery (uVATS); posterior approach; anatomical lung resection lobes and posterior segments of both upper lobes, might be more easily accessible in a uniportal fashion from behind, making an incision in the "triangle of auscultation" (5-7).The purpose of this study is to present a case-series of this novel approach for uVATS predominantly used for posterior segmentectomies, and if needed, also for lobectomies. MethodsAn observational retrospective audit study which included the first 20 patients who underwent anatomical resection by a single surgeon utilizing the posterior uVATS (puVATS) method from January 2016-June 2017 was undertaken. Surgical techniqueA single incision of 3.5-4.5 cm was made in the 6 th intercostal space, between the latissimus dorsi and trapezius muscles, in the so-called 'triangle of auscultation' (Figures 1-3) (6). Both surgeon and assistant are positioned on the back of the patient, while scrub nurse approaches from the opposite side. The monitors are located on both sides of the patient. In most of the cases it was not necessary to dissect in the fissure, but to staple it either in the beginning (Figur...

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“…A new frontier will be the performing of uniportal VATS on awake or sedated patients. From 2011 a second milestone in the use of uniportal VATS was done, the first uniportal VATS lobectomy was performed by Gonzales Rivas et al (25).…”

Section: Uniportal Vatsmentioning

confidence: 99%

Uniportal video-assisted thoracoscopic surgery in hemothorax

et al. 2017

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The management of hemothorax (spontaneous or, more often, due to thoracic trauma lesions), follows basic tenets well-respected by cardiothoracic surgeons. In most, a non-operative approach is adequate and safe, with a defined group of patients requiring only tube thoracostomy. Only a minority of patients need a surgical intervention due to retained hemothorax, persistent bleeding or incoming complications, as pleural empyema or entrapped lung. In the early 1990s, the rapid technological developments determined an increase of diagnostic and therapeutical indications for multiport video-assisted thoracoscopic surgery (VATS) as the gold standard therapy for retained and persistent hemothorax, allowing an earlier diagnosis, total clots removal and better tubes placement with less morbidity, reduced post-operative pain and shorter hospital stay. There is no consensus in the literature regarding the timing for draining hemothorax, but best results are obtained when the drainage is performed within the first 5 days after the onset. The traditional multiport approach has evolved in the last years into an uniportal approach that mimics open surgical vantage points utilizing a non-rib-spreading single small incision. Currently, in experienced hands, this technique is used for diagnostic and therapeutic interventions as hemothorax evacuation as like as the more complex procedures, such as lobectomies or bronchial sleeve and vascular reconstructions. visualization, a higher yield of detecting small injuries, less post-operative pain, improved lung function, shorter hospital stay and earlier recovery (2,5,7,8). KeywordsMore recently, the uniportal VATS approach has gained popularity in thoracic surgery, initially for minor procedures (9,10) and then also for major lung resection (11,12). This paper summarised recent advances available in the medical literature focusing especially on the VATS treatment of hemothorax, in particular considering the advantages of uniportal versus multiportal approach. Multiportal VATS strategy: basic conceptsThoracoscopy in the last years has been suggested as the first-line treatment in non-complicated hemothorax, leaving thoracotomy as the rescue option in case of failure or major trauma with bleeding (7). Truly, Joao Martins Castello Branco in 1946 was the first to describe the use of thoracoscopy in thoracic trauma, managing persistent bleeding with electrocoagulation. Since then, many authors described the use of this technique for diagnostic (diaphragmatic lesions) and therapeutic (hemothorax in penetrating chest trauma) options (13,14). However, only in the late 1990s, due to technical advances, its use became worldwide popular and VATS gained a primary position in the care of thoracic trauma patients (7,15). Villavicencio et al. (16) demonstrated that thoracoscopy may be used safely and successfully in assessment of clotted or persistent hemothorax and in empyema drainage; according to their data, 90-95% of patients with posttraumatic hemothorax are treated conservatively o...

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Single-port video-assisted thoracoscopic lobectomy

Cited by 277 publications

References 6 publications

Uniportal video-assisted thoracoscopic surgery: safety, efficacy and learning curve during the first 250 cases in Quebec, Canada

Uniportal video-assisted thoracoscopic surgery: safety, efficacy and learning curve during the first 250 cases in Quebec, Canada

Posterior uniportal video-assisted thoracoscopic surgery for anatomical lung resections

Uniportal video-assisted thoracoscopic surgery in hemothorax

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