Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax: clinical and economic analysis in comparison to the traditional approach

Salati, Michele; Brunelli, Alessandro; Xiumé, Francesco; Refai, Majed; Sciarra, Valeria; Soccetti, A; Sabbatini, Armando

doi:10.1510/icvts.2007.165712

Cited by 104 publications

(92 citation statements)

References 15 publications

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“…In contrast, new uniportal approaches may be associated with significantly fewer and less untoward [22][23][24] and eventually may offer economic advantages. 25) Regarding relapse association with previously supposed "risky bearings," we were surprised to find no published indication for any specific postoperative cautious advice to be given to PNTX patients.…”

Section: Discussionmentioning

confidence: 97%

Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct

Steger

Sostheim

Leistner

et al. 2018

ATCS

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Purpose: Spontaneous pneumothorax (PNTX) is a common disease frequently operated at specialized thoracic surgery units. Videothoracoscopic surgery (VATS) has become the standard for treatment and recurrence prevention. While there is broad consensus regarding indications and techniques of PNTX surgery, postoperative risks and consecutive patient behavioral advice have not been sufficiently elucidated. Methods: Single-center cohort analysis of 641 patients operated for primary PNTX by VATS over 10 years. Putatively recurrence-prone lifestyle activities (smoking status, flying habits, and scuba diving) and actual occurrence of recurrences were correlated. Results: Follow-up rate was 46% (279/607 patients). Mean time interval between primary operation and follow-up was 61 (range: 5-177) months. In 10 patients (3.6%), a PNTX recurrence was observed. Regarding postoperative risk behavior reported at follow-up, 28% of patients were active smokers (15 ± 7 cigarettes/day), 59% traveled by plane repeatedly, and only two patients did scuba diving (0.7%). Low body-mass-index was associated with an increase in PNTX recurrence, whereas smoking, flying, and scuba diving could not be identified as risk factors. Conclusion: In our study, none of the supposed "classic" lifestyle-associated risk factors for PNTX recurrence after VATS proved to be a significant threat. Postoperative patient behavior might not be constrained by overcautious medical advice.

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Section: Discussionmentioning

confidence: 97%

Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct

Steger

Sostheim

Leistner

et al. 2018

ATCS

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“…Recently, uniportal VATS has been applied with minimally invasive concepts in various pulmonary diseases to establish its diagnostic and treatment role in VATS fields (3)(4)(5). Thus, several studies already have been described the feasibility of uniportal VATS for PSP over the multi-port VATS with its less invasiveness (6)(7)(8). However, a few reports have been introduced for wound management to achieve better cosmetic wound healing and for placement of the chest tube in uniportal VATS.…”

Section: Introductionmentioning

confidence: 99%

“…single port VATS can be equivocally performed without increasing morbidities or recurrences (7,8,(12)(13)(14). Thus, uniportal VATS for PSP is increasingly carried out as an alternative modality to the multi-port conventional VATS.…”

mentioning

confidence: 99%

Barbed suture material technique for wound closure and concomitant tube placement in uniportal VATS for pneumothorax

Kim¹

2017

J. Thorac. Dis.

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Background: Uniportal video-assisted thoracoscopic surgery (VATS) is an alternative modality for treatment of primary spontaneous pneumothorax (PSP) with its less invasiveness and acceptable surgical outcomes. However, a few reports have been introduced for wound management to achieve better cosmetic wound healing and for placement of the chest tube in uniportal VATS. Thus, we aimed to evaluate the feasibility of our novel method for wound closure and concomitant tube placement using continuous barbed suture material in uniportal VATS for PSP.Methods: Between July 2012 and December 2015, consecutive 31 patients (22 males) underwent uniportal VATS to treat PSP. Bilateral approaches were performed in four patients, thus total 35 cases were enrolled. We divided them into two groups with one group of 17 (48.5%) cases (group A), using barbed absorbable wound closure device for knotless continuous wound closure and subsequent chest tube anchoring, and the other group of 18 (51.4%) cases (group B), using conventional suture anchoring after skin closure using absorbable suture device. Postoperative surgical outcomes were compared to assess the feasibility of this technique.Results: Demographic data demonstrate no significant difference in both groups. There was no significant difference in length of hospital stay (3.7±1.2 vs. 4.1±1.2 days, P=0.267) and in median chest tube indwelling time (2.4±0.9 vs. 3.1±1.2 days, P=0.066), respectively. Operation time in group A was shorter than in group B but there was no significant difference (41.7±11.8 vs. 45.6±16.0 minutes, P=0.415). There was neither conversion to two or three port VATS in all cases. In group A, all chest tubes were removed with concomitant sealing the tube removal site by pulling the thread. Residual knots do not exist that stitch out procedure is not required. There was no wound complication in both groups during the median follow-up period of 18 months.Conclusions: Knotless, barbed suture material technique for continuous wound closure with concomitant chest tube placement achieved equivocal outcomes in comparison to the conventional suture anchoring method. We suggest this simple technique for wound closure and easy tube removal with cosmetic wound healing in uniportal VATS for PSP.

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“…Compared with thoractomy, VATS has advantages, such as less postoperative pain, faster recovery, fewer complications and shorter hospital stays (1,2).…”

Section: Introductionmentioning

confidence: 99%

Left upper lobectomy and systematic lymph nodes dissection in enlarged pulmonary hilar lymph nodes in primary lung cancer patient by uniportal video-assisted thoracic surgery

et al. 2016

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Uniportal video-assisted thoracic surgery (VATS) anatomical pulmonary resection, with only one small incision for surgery instruments and camera insertion, requires higher operative skills, especially in the cases of the enlarged pulmonary hilar lymph nodes. With improved technology and increased experiences in VATS lobectomy, uniportal VATS lobectomy has been applied in major medical centers recently. A 67-year-old male patient with left upper peripheral lung cancer and enlarged hilar lymph nodes underwent unipotal VATS lobectomy and systemic mediastinal lymph node dissection. The patient recovered uneventfully. (Figure 1). Preoperative pathological examination of the lung lesion obtained by CT-guided percutaneous transthoracic needle biopsy indicated a poorly differentiated squamous cell carcinoma. The patient had coronary heart disease and the coronary artery DSA indicated 50% stenosis in left anterior descending (LAD). Left upper pulmonary lobectomy was performed. The operation took 171 minutes. During the operation, the estimated blood loss was 100 mL.On postoperative day (POD) 1, the amount of fluid drainage was 350 mL, and chest X-ray showed satisfied left lung inflation (Figure 2). The chest tube was removed on POD 4. The patient was discharged on POD 6 without complications. The tumor size was 4 cm in diameter, and the postoperative pathology confirmed lymph metastasis in station 5 ,11 and 13. Four cycles of adjuvant chemotherapy and radiotherapy were followed. Operative techniquesOperative position, insicion and instruments: the uniportal insicion were performed between the anterior axillary line and posterior axillary line over the fourth intercostal space about 4 cm in length ( Figure 3A). No rib spreader was used. A disposable, plastic wound retractor was used to stretch and protect the incision ( Figure 1B). A 30-degree, 10-mm high definition camera thoracoscope was placed at the posterior part of the incision during operation time for a panoramic view. To relieve the camera-man's hand tiredness, the thoracoscope bounded by a tape was fixed to the surgical drape ( Figure 3B). Both the surgeon and the camera-man stood in front of the patient and shared the same vision. VATS uses the same instruments as the conventional 3-port VATS dose (Figure 4). During dissection, we held a curving suction (Panther Healthcare, China) in left hand and an electrocautery hook or an ultra-sonic scalpel in the right hand.Operative key points and procedure ( Figure 5) (I) Mobilization of pulmonary vessels. The patient's interlobar fissure was complete. First we dissected the pulmonary artery in the interlobar fissure with ultrasonic scalpel or electrocautery hook and stapled the lingular atrey with a vascular (white cartridge, 45-mm-long) endostapler (EndoGIA, Covidien, USA). Then we dissected the interlobar lymph nodes (station 11). After the dissection of inter lobar fissure, the mediastinal pleura of the upper and anterior hilum was separated to isolate the anterior and apical segmental pulmonary arteries...

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Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax: clinical and economic analysis in comparison to the traditional approach

Cited by 104 publications

References 15 publications

Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct

Recurrence of Spontaneous Pneumothorax Is Not Associated with Allegedly Risk-Prone Lifestyle Conduct

Barbed suture material technique for wound closure and concomitant tube placement in uniportal VATS for pneumothorax

Left upper lobectomy and systematic lymph nodes dissection in enlarged pulmonary hilar lymph nodes in primary lung cancer patient by uniportal video-assisted thoracic surgery

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