Uniportal versus three-port single-direction thoracoscopic lobectomy: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Shuai , ZHANG Miao , ZHANG Hui ,  LIU Dong , WU Wenbin

Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, P.R.China;

Corresponding author：

LIU Dong, Email: liudongdoc@yeah.net

Keywords：

Single-direction; uniport; video-assisted thoracoscopic surgery (VATS); lobectomy; surgery

DOI：

10.7507/1007-4848.201907029

Video：

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Objective To explore the feasibility and short-term efficacy of uniportal and three-port single-direction video-assisted thoracoscopic surgery (S-VATS) anatomical lobectomy for lung cancer.Methods Clinical data of 60 lung cancer patients, including 40 males and 20 females with an average age of 62.2±9.0 years, who received S-VATS anatomic lobectomy and systematic lymph nodes dissection by the same surgeon in our hospital between July 2016 and January 2019 were retrospectively analyzed. These patients were divided into a uniportal S-VATS group and a three-port S-VATS group according to surgical procedures, with 30 patients in each group. The clinical data of the two groups were compared.Results There was no conversion to thoracotomy, surgical port addition, or mortality in this cohort, with tumor-negative surgical margin. There was no statistical difference in the operation time between the two groups (70.8±16.4 min vs. 73.7±14.3 min, P>0.05). Meanwhile, both groups showed similar intraoperative blood loss, stations and numbers of dissected lymph nodes, incidence of operation-related complications, duration and volume of chest tube drainage, as well as postoperative hospital stay (P>0.05). Besides, pain score of the patients in the uniportal S-VATS group was significantly lower than that of the three-port S-VATS group on postoperative 3-14 d (P<0.05). The mean duration of follow-up was 10 months, and all the patients were survived without tumor recurrence or metastasis.Conclusion The transition from three-port S-VATS to uniportal S-VATS anatomical lobectomy for treatment of lung cancer is feasible. However, further studies are needed to elucidate the optimal resection sequence of pulmonary vessels.

Citation： WANG Shuai, ZHANG Miao, ZHANG Hui, LIU Dong, WU Wenbin. Uniportal versus three-port single-direction thoracoscopic lobectomy: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(6): 663-668. doi: 10.7507/1007-4848.201907029 Copy

1.	Mu JW, Gao SG, Xue Q, et al. A propensity matched comparison of effects between video assisted thoracoscopic single-port, two-port and three-port pulmonary resection on lung cancer. J Thorac Dis, 2016, 8(7): 1469-1476.
2.	王珩, 张淼, 武文斌, 等. 单孔胸腔镜肺叶切除术治疗肺癌的经验与反思. 中华胸心血管外科杂志, 2017, 33(8): 493-498.
3.	刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
4.	刘成武, 郭成林, 林锋, 等. 单向式胸腔镜肺叶或肺段切除术治疗Ⅰ期肺癌的远期疗效. 中华外科杂志, 2015, 53(10): 742-746.
5.	中华医学会胸心血管外科学分会胸腔镜外科学组, 中国医师协会胸外科医师分会微创胸外科专家委员会. 中国胸腔镜肺叶切除临床实践指南. 中华医学杂志, 2018, 98(47): 3832-3841.
6.	中华医学会, 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2018 版). 中华肿瘤杂志, 2018, 40(12): 935-964.
7.	赵田, 张淼, 武文斌, 等. 单向式理念在单孔胸腔镜肺叶切除术中的应用. 中华腔镜外科杂志(电子版), 2018, 11(5): 295-299.
8.	邓康, 许世杰, 钱燕飞, 等. 前锯肌平面阻滞自控镇痛在胸腔镜术后的应用. 中华医学杂志, 2018, 98(8): 570-575.
9.	刘伦旭, 刘雪梅. 用质量控制和技术规范改善胸心血管外科临床结果—2018 新春寄语. 中国胸心血管外科临床杂志, 2018, 25.2): 103-104.
10.	罗清泉, 黄佳, 李函玥. 非小细胞肺癌生物学意义微创治疗的研究: 附 700 例 Da Vinci 机器人辅助肺部手术分析. 中华腔镜外科杂志(电子版), 2017, 10(5): 270-271.
11.	Bertolaccini L, Batirel H, Brunelli A, et al. Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 56(2): 224-229.
12.	Yang X, Li M, Yang X, et al. Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis, 2018, 10(4): 2186-2195.
13.	杨懿, 刘伦旭. 单孔胸腔镜与传统多孔胸腔镜手术治疗肺癌有效性及安全性的系统评价与 Meta 分析. 中国胸心血管外科临床杂志, 2018, 25(3): 222-232.
14.	Sihoe ADL. Uniportal lung cancer surgery: State of the evidence. Ann Thorac Surg, 2019, 107(3): 962-972.
15.	Perna V, Carvajal AF, Torrecilla JA, et al. Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: a randomized study. Eur J Cardiothorac Surg, 2016, 50(3): 411-415.
16.	Tosi D, Nosotti M, Bonitta G, et al. Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database. Interact Cardiovasc Thorac Surg, 2019. doi: 10.1093/icvts/ivz153. [Epub ahead of print].
17.	梅建东, 蒲强, 马林, 等. 胸腔镜肺手术中血管损伤出血及其防控策略. 中华外科杂志, 2017, 55(12): 898-902.
18.	Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
19.	Feng M, Lin M, Shen Y, et al. Uniportal video-assisted thoracic surgery for left upper lobe: single-direction lobectomy with systematic lymphadenectomy. J Thorac Dis, 2016, 8(8): 2281-2283.
20.	刘成武, 蒲强, 马林, 等. 单孔与单向式胸腔镜肺癌切除术的结合—单孔单向式胸腔镜肺癌切除术. 中国胸心血管外科临床杂志, 2017, 24(12): 907-910.
21.	Ma L, Liu C, Mei J, et al. Video-assisted thoracic surgery (VATS) non-grasping en bloc mediastinal lymph node dissection for the left side. J Thorac Dis, 2018, 10(11): 6271-6273.
22.	Ma L, Liu C, Mei J, et al. Video-assisted thoracoscopic surgery non-grasping en bloc mediastinal lymph node dissection for the right side. J Thorac Dis, 2018, 10(7): 4502-4504.
23.	赵田, 张淼, 武文斌, 等. 单孔胸腔镜单向式解剖性右上肺切除术的临床分析. 中华解剖与临床杂志, 2019, 24(2): 176-181.
24.	姜冠潮, 李凤卫, 李晓, 等. 全胸腔镜肺叶切除术中肺动、静脉切断顺序对早期非小细胞肺癌疗效的影响. 中华胸心血管外科杂志, 2014, 30(9): 513-516.
25.	Sumitomo R, Fukui T, Marumo S, et al. Effects of vessel interruption sequence during thoracoscopic lobectomy for non-small cell lung cancer. Gen Thorac Cardiovasc Surg, 2018, 66(8): 464-470.
26.	He HH, He JX, Hao ZX, et al. Association between different sequences of vessel ligation during video-assisted thoracoscopic lobectomy and survival in patients with non-small cell lung cancer. J Thorac Dis, 2019, 11(3): 686-693.
27.	Wei S, Guo C, He J, et al. Effect of vein-first vs. artery-first surgical technique on circulating tumor cells and survival in patients with non-small cell lung cancer: a randomized clinical trial and registry-based propensity score matching analysis. JAMA Surg, 2019, 154(7): e190972.
28.	阎石, 吴楠, 王兴, 等. 右肺上叶肺动脉分支特点. 中国胸心血管外科临床杂志, 2018, 25(7): 567-571.
29.	秦志祥, 李春雨, 邢柏春, 等. 前锯肌间隙阻滞的解剖学观察及其临床意义. 中国临床解剖学杂志, 2017, 35(5): 490-493.
30.	张隆盛, 林旭林, 张欢楷, 等. 前锯肌平面阻滞与胸椎旁神经阻滞用于胸腔镜手术患者术后镇痛效果的比较. 临床麻醉学杂志, 2019, 35(1): 47-51.

1. Mu JW, Gao SG, Xue Q, et al. A propensity matched comparison of effects between video assisted thoracoscopic single-port, two-port and three-port pulmonary resection on lung cancer. J Thorac Dis, 2016, 8(7): 1469-1476.
2. 王珩, 张淼, 武文斌, 等. 单孔胸腔镜肺叶切除术治疗肺癌的经验与反思. 中华胸心血管外科杂志, 2017, 33(8): 493-498.
3. 刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
4. 刘成武, 郭成林, 林锋, 等. 单向式胸腔镜肺叶或肺段切除术治疗Ⅰ期肺癌的远期疗效. 中华外科杂志, 2015, 53(10): 742-746.
5. 中华医学会胸心血管外科学分会胸腔镜外科学组, 中国医师协会胸外科医师分会微创胸外科专家委员会. 中国胸腔镜肺叶切除临床实践指南. 中华医学杂志, 2018, 98(47): 3832-3841.
6. 中华医学会, 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2018 版). 中华肿瘤杂志, 2018, 40(12): 935-964.
7. 赵田, 张淼, 武文斌, 等. 单向式理念在单孔胸腔镜肺叶切除术中的应用. 中华腔镜外科杂志(电子版), 2018, 11(5): 295-299.
8. 邓康, 许世杰, 钱燕飞, 等. 前锯肌平面阻滞自控镇痛在胸腔镜术后的应用. 中华医学杂志, 2018, 98(8): 570-575.
9. 刘伦旭, 刘雪梅. 用质量控制和技术规范改善胸心血管外科临床结果—2018 新春寄语. 中国胸心血管外科临床杂志, 2018, 25.2): 103-104.
10. 罗清泉, 黄佳, 李函玥. 非小细胞肺癌生物学意义微创治疗的研究: 附 700 例 Da Vinci 机器人辅助肺部手术分析. 中华腔镜外科杂志(电子版), 2017, 10(5): 270-271.
11. Bertolaccini L, Batirel H, Brunelli A, et al. Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 56(2): 224-229.
12. Yang X, Li M, Yang X, et al. Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis, 2018, 10(4): 2186-2195.
13. 杨懿, 刘伦旭. 单孔胸腔镜与传统多孔胸腔镜手术治疗肺癌有效性及安全性的系统评价与 Meta 分析. 中国胸心血管外科临床杂志, 2018, 25(3): 222-232.
14. Sihoe ADL. Uniportal lung cancer surgery: State of the evidence. Ann Thorac Surg, 2019, 107(3): 962-972.
15. Perna V, Carvajal AF, Torrecilla JA, et al. Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: a randomized study. Eur J Cardiothorac Surg, 2016, 50(3): 411-415.
16. Tosi D, Nosotti M, Bonitta G, et al. Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database. Interact Cardiovasc Thorac Surg, 2019. doi: 10.1093/icvts/ivz153. [Epub ahead of print].
17. 梅建东, 蒲强, 马林, 等. 胸腔镜肺手术中血管损伤出血及其防控策略. 中华外科杂志, 2017, 55(12): 898-902.
18. Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
19. Feng M, Lin M, Shen Y, et al. Uniportal video-assisted thoracic surgery for left upper lobe: single-direction lobectomy with systematic lymphadenectomy. J Thorac Dis, 2016, 8(8): 2281-2283.
20. 刘成武, 蒲强, 马林, 等. 单孔与单向式胸腔镜肺癌切除术的结合—单孔单向式胸腔镜肺癌切除术. 中国胸心血管外科临床杂志, 2017, 24(12): 907-910.
21. Ma L, Liu C, Mei J, et al. Video-assisted thoracic surgery (VATS) non-grasping en bloc mediastinal lymph node dissection for the left side. J Thorac Dis, 2018, 10(11): 6271-6273.
22. Ma L, Liu C, Mei J, et al. Video-assisted thoracoscopic surgery non-grasping en bloc mediastinal lymph node dissection for the right side. J Thorac Dis, 2018, 10(7): 4502-4504.
23. 赵田, 张淼, 武文斌, 等. 单孔胸腔镜单向式解剖性右上肺切除术的临床分析. 中华解剖与临床杂志, 2019, 24(2): 176-181.
24. 姜冠潮, 李凤卫, 李晓, 等. 全胸腔镜肺叶切除术中肺动、静脉切断顺序对早期非小细胞肺癌疗效的影响. 中华胸心血管外科杂志, 2014, 30(9): 513-516.
25. Sumitomo R, Fukui T, Marumo S, et al. Effects of vessel interruption sequence during thoracoscopic lobectomy for non-small cell lung cancer. Gen Thorac Cardiovasc Surg, 2018, 66(8): 464-470.
26. He HH, He JX, Hao ZX, et al. Association between different sequences of vessel ligation during video-assisted thoracoscopic lobectomy and survival in patients with non-small cell lung cancer. J Thorac Dis, 2019, 11(3): 686-693.
27. Wei S, Guo C, He J, et al. Effect of vein-first vs. artery-first surgical technique on circulating tumor cells and survival in patients with non-small cell lung cancer: a randomized clinical trial and registry-based propensity score matching analysis. JAMA Surg, 2019, 154(7): e190972.
28. 阎石, 吴楠, 王兴, 等. 右肺上叶肺动脉分支特点. 中国胸心血管外科临床杂志, 2018, 25(7): 567-571.
29. 秦志祥, 李春雨, 邢柏春, 等. 前锯肌间隙阻滞的解剖学观察及其临床意义. 中国临床解剖学杂志, 2017, 35(5): 490-493.
30. 张隆盛, 林旭林, 张欢楷, 等. 前锯肌平面阻滞与胸椎旁神经阻滞用于胸腔镜手术患者术后镇痛效果的比较. 临床麻醉学杂志, 2019, 35(1): 47-51.

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Uniportal versus three-port single-direction thoracoscopic lobectomy: A retrospective cohort study

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