Uniportal video-assisted thoracic surgery for pneumothorax and blebs/bullae

Abstract

Abstract:The last British Society of Thoracic Surgeons guidelines of 2010 for the management of primary spontaneous pneumothorax (PSP) stated that, after the first recurrence, the treatment of PSP should be a surgical operation, like a bullectomy accompanying with a procedure for inducing pleural adhesions. Therefore, the surgical approach is considered the best treatment to minimise the risk of recurrence in patients who experienced a PSP. There is substantial evidence in the literature demonstrating that the minimally invasive approach should be preferred to the thoracotomic procedure since it can reduce the postoperative pain and it is associated with a faster recovery of the physical and working activity. The video-assisted thoracic surgery (VATS) approach has been shown to offer greater advantages about patient pain and respiratory function when compared to thoracotomic incisions. A single port or single incision or uniportal approach was developed as an alternative to the standard multi-port VATS. Uniportal technique has shown to be safe and efficient not only for pulmonary resections and biopsies but also for lobectomy.When used for PSP, the bullectomy/blebectomy and pleural abrasion/pleurectomy is performed through the single incision through which the chest drain is then inserted. In this perspective, evidence showed that the minimally invasive approach should be preferred, confirming the advantages in comparison with traditional techniques. blebectomy and pleural abrasion/pleurectomy is performed through the single incision through which the chest drain is then inserted (3). In this perspective, evidence showed that the minimally invasive approach should be preferred, confirming the advantages in comparison with traditional techniques (4).Here we described the theoretical aspects of the uniportal VATS approach for PSP. Surgical techniqueUniportal VATS allows performing all the main surgical steps recommended for treating patients affected by PSP with the same clinical advantages of the traditional three-port VATS. The VATS technique achieves the exploration of the chest cavity and the lung parenchyma to find blebs/bullae, to resect the diseased areas of the lung, and to perform adequate pleurodesis procedures (e.g., mechanical parietal pleural abrasion, talc poudrage, pleurectomy, etc.) (2).Patient decubitus is in the lateral position. Otherwise, from the standard three-port VATS approach, where the lesion represents the peak of an ideal pyramid, and the camera and instruments are placed in correspondence of the other three pinnacles, the uniportal VATS technique implies that the target, the thoracoscope, and the instruments all lie in the same sagittal plane. Although the single incision is the fulcrum where the parallel devices reach the target, arranging themselves in a craniocaudal direction (5), the surgeon should be free to move inside the chest cavity without the boundaries due to an unfavourable geometry (6). A 1.5-2 cm skin incision at the sixth intercostal space along the middle axillary line...

Scar tissue to lung cancer; pathways and treatment

“…It has been observed that different lesions have different gene expressions, the main site could have EGFR positive expression, while metastasis not. Moreover; metastasis in different sites of the body might be a different cancer as it has been observed in previous case reports 12, 13. Usually adenocarcinoma tends to transform to small cell lung cancer either due to tyrosine kinase inhibitors or on its own due to a cascade of inflammatory proteins that are secreted from the tumor 14-16.…”

Minimally invasive approach to pneumothorax: Single port or two ports?

“…[5] An acceptable rate of recurrence, better patient satisfaction, and improved tolerability are shown in the VATS technique. [4] In this method, conventional two-or three-port approaches are preferred. The SP approach has emerged as an alternative to the traditional method.…”

“…The key to success in the uniportal approach is the use of an angled (30º) thoracoscope and staplers with articulation. [4,11,13] Also, the intercostal space is required to be dissected widely so that the extensive mobility of all instruments can be ensured. Therefore, the size of the intercostal opening should be much larger than the skin incision.…”

“…[2] Over the years, an uniportal approach has been developed as an alternative to the standard multi-port approach. [4] However, there is still a limited number of studies on uniportal VATS experience for the treatment of pneumothorax. [5] In this study, we aimed to compare the effectiveness of single-port (SP) and two-port (TP) VATS in patients with pneumothorax.…”

Uniportal, single incision VATS for the skeptics

“…After an historical view, world famous anesthesiologists and thoracic surgeons gave their marvelous contributions to the development of this relatively new "exciting" surgical approach in thoracic surgery (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”