Uniportal video-assisted thoracoscopic bronchovascular, tracheal and carinal sleeve resections

Abstract

Locally advanced lung tumours often require complex surgical techniques to achieve an oncological and safe procedure. Sleeve resections when operating on endobronchial lesions or hilar tumours should be attempted whenever possible rather than performing a pneumonectomy. These procedures result in improved survival, better quality of life, a reduced loss of lung function and an improved operative mortality compared with pneumonectomy. Although the most common approach is an open thoracotomy, these complex surgical techniques can be performed in a thoracoscopic way with the skills and the experience gained from major video-assisted thoracoscopic procedures (VATS). However, despite the multiple advantages of VATS compared with thoracotomy, such as decreased postoperative pain and better recovery, this minimally invasive approach is still not widely adopted for advanced stages of lung cancer and complex resections. Concerns about performing an adequate oncological resection and safe reconstruction VATS are the main reasons for the low adoption of these minimally invasive approaches. Like other thoracoscopic techniques, VATS sleeve procedures also have a steep learning curve, and should therefore be performed either by or with skilled and experienced VATS surgeons to ensure safety and avoid complications. In this article, we describe the technique of thoracoscopic sleeve procedures through a single-incision (uniportal) approach for bronchial, bronchovascular, tracheal and carinal reconstruction, and review the literature reporting sleeve resections by VATS.

Nonintubated uniportal VATS pulmonary anatomical resections

“…lobectomies, bilobectomies, pneumonectomies) have been safely performed using a uniportal video-assisted thoracic surgery (VATS) approach since 2011 through general anesthesia and mechanical ventilation (4)(5)(6). The rationale for changing this safe anesthetic management should be performing these procedures under spontaneous breathing in order to decrease surgical invasiveness while preserving safety parameters.…”

For which thoracic operation is U-VATS superior?

“…Obviously, if the tumor is large (more than 5 cm in diameter) or fragile due to necrotic changes, the surgeon need not be particular about the U-VATS approach. On the other hand, Dr. Gonzaletz et al have described the use of U-VATS for bronchovascular and carinal sleeve resection for advanced lung cancer (15). U-VATS is considered to be suitable for treating small tumors and early stage lung cancer, and it might also be useful for treating advanced malignant tumors.…”

Uniportal thoracoscopic surgery: from medical thoracoscopy to non-intubated uniportal video-assisted major pulmonary resections

“…With experience, skilled uniportal VATS surgeons can perform the most complex cases in the same manner as surgeons using a double or triple port approach (47,48). Previous experience in VATS is necessary to perform these advanced cases with success.…”