Standardized surgical technique for uniportal video-assisted thoracoscopic lobectomy

Abstract

Summary Uniportal video-assisted thoracoscopic surgery may be the approach for any thoracic procedure, from minor resections to complex reconstructive surgery. However, anatomical lobectomy represents its most common and clinically proven usage. A wide variety of information about uniportal video-assisted thoracoscopic lobectomies can be found in the literature and multimedia sources. This article focuses on updating the surgical technique and includes important aspects such as the geometric approach, anaesthesia considerations, operating room set-up, tips about the incision, instrumentation management and the operative technique to perform the 5 lobectomies. The following issues are explained for each lobectomy: anatomical considerations, surgical steps and technical advice. Medical illustrations and videos are included to clarify the text with the goal of describing a standard surgical practice.

Uniportal video-assisted thoracoscopic surgery left upper lobectomy in 9 steps

“…In fact, while articulating endograspers retract the parenchymal tissues to mobilize and straighten the vascular and bronchial structures, an articulating endostapler is placed in a way of applying the rule of flexed arms to determine which angulation for the stapler is required in each division of structures. 7 Through the same incision, several instruments, including retractor(s), a dissector or energy device, and a suction device, can be introduced parallel to the videothoracoscope, whereas their mutual position can be changed during the procedure as needed.…”

“…Similar to other minimally invasive procedures, including robotic or conventional VATS procedures, a dedicated team, including a surgeon, an assistant, an anesthesiologist, and nursing staff, should be routinely involved in UniVATS cases to achieve maximal coordination during the operation, and an appropriate preoperative plan should be created for every case. 7,9 UniVATS lobectomy performed according to the internationally approved recommendations should be considered in the armamentarium of the modern thoracic surgeon. 10 Especially during the initial learning curve period, conversion to either multiport VATS or even open thoracotomy should always be considered without any hesitation if it is considered necessary to achieve a safer operation or better oncological results.…”

“…4 Despite many suggested benefits, 5,6 UniVATS lobectomy remains a challenging and demanding procedure to perform and may require a longer learning curve because of its distinct technical characteristics. 2,7,8 In this setting, the geometric configuration of UniVATS, eye-to-hand coordination, and instrument handling are crucial to the successful outcome of the operation, as well as to optimal visualization and surgeon-assistant interaction. 9 This article Uniportal video-assisted thoracoscopic surgery lobectomy can be performed safely and efficiently, especially if it is well planned and coordinated between team members.…”

Uniportal robotic versus thoracoscopic assisted surgery: a propensity score-matched analysis of the initial 100 cases

“…For uVATS, a 3–4 cm incision was placed in the 4 th –5 th intercostal space (ICS) between the anterior and mid-axillary lines. Surgery was performed using a 30º camera and uVATS type instruments (grasper, dissector, stapler and suction) ( 27 ). For uRATS, a 4 cm incision was placed in the 6 th –7 th ICS between the anterior and mid-axillary lines.…”

Editorial: Women in thoracic surgery

“…In particular, nodal staging and surgical/oncological outcomes have been analyzed in the study, underlying the lower postoperative pain and shorter in-hospital stay compared to open surgery. Still, this is a challenging and demanding procedure to perform and the learning curve leads to an increase in the number of intraoperative complications ( 7 ).…”