The concept of broad exposure facilitates uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection

Abstract

Background Systematic lymph node dissection is an important part of radical resection for lung cancer. Insufficient incision of the mediastinal pleura results in a tapered or tunnel-like operation surface, which increases the difficulty of uniportal video-assisted thoracoscopic mediastinal lymph node dissection. The objective of this study was to report our concept of broad exposure and investigate the efficacy and safety of this concept in uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection. Methods We retrospectively analyzed the clinical data of the 204 non-small cell lung cancer patients who underwent uniportal video-assisted thoracoscopic surgery for anatomical lobectomy and systematic lymph node dissection following the concept of broad exposure. SPSS 23.0 software was used for statistical analysis. Results All operations were completed under uniportal video-assisted thoracoscopic surgery following the concept of broad exposure. The median surgery time was 102 (range, 76–285) minutes and the median blood loss was 50 (range, 20–900) milliliters. The median chest tube duration time was 2 (range, 1–6) days, the median postoperative hospital duration time was 5 (range, 4–10) days. The median number of dissected lymph node stations and dissected lymph nodes were 8 (range,6–9) and 15(range,12–19), respectively. The median number of dissected mediastinal lymph nodes stations and dissected mediastinal lymph nodes were 5(range,3–6) and 11(range,10–15), respectively. The up-staging rate of N staging was 6.86%. The postoperative complication rate was 10.29% and there was no perioperative death. Conclusions According to our results, it’s effective and safe to perform uniportal video-assisted thoracoscopic mediastinal lymph nodes dissection following the concept of broad exposure. This new concept not only emphasizes sufficient exposure, but also focuses on protection of important tissues.

Uniportal thoracoscopic mediastinal lymphadenectomy using appropriate surgical steps

“…In this study, the number of harvested LNs and N-upstages were measured. These measurements were based on previous articles ( 15 - 17 ). The optimal indicators for assessing the accuracy of lymphadenectomies are also controversial.…”

Lu’s approach for video-assisted thoracoscopic surgery

“…), thus, reduced the degree of intraoperative space limitation and avoided the operation inconveniences caused by cross-collision between instruments and coaxial operation. Therefore, the LVATS is able to overcome some of the limitations of UVATS, such as mutual interference between instruments and insufficient exposure [ 18 ], reducing the difficulty and surgical risk in UVATS. Intraoperative bleeding is a significant safety concern associated with VATS for a lobectomy.…”

Innovative Techniques in Video-Assisted Thoracoscopic Surgery: Lu’s Approach

“…The UVATS surgical procedure is thoroughly documented in an extensive body of literature. 15 , 16

Figure 4 Coaxial manipulation of instruments during UVATS. ( A ) Dissection at the pulmonary hilum for clear access.

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