Clinical application of preferential manual bronchoplasty in single-port video-assisted thoracoscopic upper lobectomy: A retrospective analysis in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QI Kang , LIN Gang , ZHANG Xining , LIU Haibo , HUANG Weiming , LIU Jingwei ,  LI Jian

Department of Thoracic Surgery, Peking University First Hospital, Beijing, 100034, P. R. China;

Corresponding author：

LI Jian, Email: pkuftsl@163.com

Keywords：

Non-small cell lung cancer; upper lobe; single-port video-assisted thoracoscopic lobectomy; bronchoplasty

DOI：

10.7507/1007-4848.202307011

Video：

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Objective To explore the safety and feasibility of preferential manual bronchoplasty in single-port video-assisted thoracoscopic surgery (VATS) upper lobectomy. Methods The clinical data of 457 patients with non-small cell lung cancer who underwent single-port VATS lobectomy in the Department of Thoracic Surgery of Peking University First Hospital from March 2020 to March 2022 were retrospectively analyzed. The patients were divided into a preferential manual bronchoplasty group and a traditional single-port VATS lobectomy group with a 1 : 1 propensity score matching for further research. Results A total of 204 patients were matched, and there were 102 patients in each group. There were 50 males and 52 females aged 62.2±10.1 years in the preferential bronchoplasty group, and 49 males and 53 females aged 61.2±10.7 years in the traditional single-port VATS group. The preferential bronchoplasty group had shorter surgical time (154.4±37.0 min vs. 221.2±68.9 min, P<0.01), less bleeding (66.5±116.9 mL vs. 288.6±754.5 mL, P=0.02), more lymph node dissection (19.8±7.5 vs. 15.2±4.7, P<0.01), and a lower conversion rate to multi-port or open surgery (2.3% vs. 13.8%, P=0.04) in left upper lobe resection. In the right upper lobe resection surgery, there was no statistical difference in postoperative results between two groups. There was no perioperative death or occurrence of bronchopleural fistula in both groups. Conclusion Compared with traditional single-port VATS upper lobectomy, preferential bronchoplasty has similar safety and feasibility. In addition, priority bronchoplasty in left upper lobectomy has the advantages of shorter surgical time, less bleeding, more lymph node dissection, and lower conversion rate to multi-port or open surgery.

Citation： QI Kang, LIN Gang, ZHANG Xining, LIU Haibo, HUANG Weiming, LIU Jingwei, LI Jian. Clinical application of preferential manual bronchoplasty in single-port video-assisted thoracoscopic upper lobectomy: A retrospective analysis in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1422-1428. doi: 10.7507/1007-4848.202307011 Copy

1.	Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
2.	Gonzalez-Rivas D, de la Torre M, Fernandez R, et al. Single-port video-assisted thoracoscopic left upper lobectomy. Interact Cardiovasc Thorac Surg, 2011, 13(5): 539-541.
3.	Gonzalez-Rivas D, Sihoe ADL. Important technical details during uniportal video-assisted thoracoscopic major resections. Thorac Surg Clin, 2017, 27(4): 357-372.
4.	Kim HK, Han KN. Uniportal video-assisted thoracoscopic surgery segmentectomy. Thorac Surg Clin, 2017, 27(4): 387-398.
5.	Gonzalez-Rivas D, Yang Y, Ng C. Advances in uniportal video-assisted thoracoscopic surgery: Pushing the envelope. Thorac Surg Clin, 2016, 26(2): 187-201.
6.	Gonzalez-Rivas D, Yang Y, Stupnik T, et al. Uniportal video-assisted thoracoscopic bronchovascular, tracheal and carinal sleeve resections. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i6-i16.
7.	Halezeroğlu S. Advantages and disadvantages of single incision VATS in major anatomical resection for lung cancer. J Vis Surg, 2017, 3: 115.
8.	Harris CG, James RS, Tian DH, et al. Systematic review and meta-analysis of uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer. Ann Cardiothorac Surg, 2016, 5(2): 76-84.
9.	Grismer JT, Read RC. Evolution of pulmonary resection techniques and review of the bronchus-first method. Ann Thorac Surg, 1995, 60(4): 1133-1137.
10.	Zhang L, Xu H. Video-assisted thoracic surgical right upper lobectomy with bronchus-first and simultaneous vessel stapling technique. Thorac Cardiovasc Surg, 2018, 66(2): s177-s179.
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.	Migliore M, Calvo D, Criscione A, et al. Uniportal video assisted thoracic surgery: Summary of experience, mini-review and perspectives. J Thorac Dis, 2015, 7(9): E378-E380.
13.	Han KN, Kim HK, Lee HJ, et al. Single-port video-assisted thoracoscopic pulmonary segmentectomy: A report on 30 cases. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i42-i47.
14.	Ji C, Xiang Y, Pagliarulo V, et al. A multi-center retrospective study of single-port versus multi-port video-assisted thoracoscopic lobectomy and anatomic segmentectomy. J Thorac Dis, 2017, 9(10): 3711-3718.
15.	Xie D, Wang H, Fei K, et al. Single-port video-assisted thoracic surgery in 1063 cases: A single-institution experience. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i31-i36.
16.	Xu H, Zhang L. The bronchus first and vessels simultaneously stapled technique: A safe and simple method for video-assisted right upper lobe lobectomy. Thorac Cardiovasc Surg, 2019, 67(2): 131-136.
17.	张彬彬, 钱如林, 陈茂林. 支气管优先处理法在胸腔镜肺上叶切除术中的应用. 中国微创外科杂志, 2020, 20(4): 4.
18.	Asamura H, Kondo H, Tsuchiya R. Management of the bronchial stump in pulmonary resections: A review of 533 consecutive recent bronchial closures. Eur J Cardiothorac Surg, 2000, 17(2): 106-110.
19.	Zakkar M, Kanagasabay R, Hunt I. No evidence that manual closure of the bronchial stump has a lower failure rate than mechanical stapler closure following anatomical lung resection. Interact Cardiovasc Thorac Surg, 2014, 18(4): 488-493.
20.	Skrzypczak P, Roszak M, Kasprzyk M, et al. The technique of stump closure has no impact on post-pneumonectomy bronchopleural fistula in the non-small cell lung cancer-a cross-sectional study. J Thorac Dis, 2022, 14(9): 3343-3351.
21.	Guo ZH, Kang MQ, Lin RB, et al. Management of the pulmonary artery during video-assisted thoracoscopic left upper lobectomy. World J Surg, 2014, 38(10): 2645-2651.
22.	Herrera LJ, Schumacher LY, Hartwig MG, et al. Pulmonary open, robotic, and thoracoscopic lobectomy study: Outcomes and risk factors of conversion during minimally invasive lobectomy. J Thorac Cardiovasc Surg, 2022, S0022-5223(22)01236-3.

1. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
2. Gonzalez-Rivas D, de la Torre M, Fernandez R, et al. Single-port video-assisted thoracoscopic left upper lobectomy. Interact Cardiovasc Thorac Surg, 2011, 13(5): 539-541.
3. Gonzalez-Rivas D, Sihoe ADL. Important technical details during uniportal video-assisted thoracoscopic major resections. Thorac Surg Clin, 2017, 27(4): 357-372.
4. Kim HK, Han KN. Uniportal video-assisted thoracoscopic surgery segmentectomy. Thorac Surg Clin, 2017, 27(4): 387-398.
5. Gonzalez-Rivas D, Yang Y, Ng C. Advances in uniportal video-assisted thoracoscopic surgery: Pushing the envelope. Thorac Surg Clin, 2016, 26(2): 187-201.
6. Gonzalez-Rivas D, Yang Y, Stupnik T, et al. Uniportal video-assisted thoracoscopic bronchovascular, tracheal and carinal sleeve resections. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i6-i16.
7. Halezeroğlu S. Advantages and disadvantages of single incision VATS in major anatomical resection for lung cancer. J Vis Surg, 2017, 3: 115.
8. Harris CG, James RS, Tian DH, et al. Systematic review and meta-analysis of uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer. Ann Cardiothorac Surg, 2016, 5(2): 76-84.
9. Grismer JT, Read RC. Evolution of pulmonary resection techniques and review of the bronchus-first method. Ann Thorac Surg, 1995, 60(4): 1133-1137.
10. Zhang L, Xu H. Video-assisted thoracic surgical right upper lobectomy with bronchus-first and simultaneous vessel stapling technique. Thorac Cardiovasc Surg, 2018, 66(2): s177-s179.
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. Migliore M, Calvo D, Criscione A, et al. Uniportal video assisted thoracic surgery: Summary of experience, mini-review and perspectives. J Thorac Dis, 2015, 7(9): E378-E380.
13. Han KN, Kim HK, Lee HJ, et al. Single-port video-assisted thoracoscopic pulmonary segmentectomy: A report on 30 cases. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i42-i47.
14. Ji C, Xiang Y, Pagliarulo V, et al. A multi-center retrospective study of single-port versus multi-port video-assisted thoracoscopic lobectomy and anatomic segmentectomy. J Thorac Dis, 2017, 9(10): 3711-3718.
15. Xie D, Wang H, Fei K, et al. Single-port video-assisted thoracic surgery in 1063 cases: A single-institution experience. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i31-i36.
16. Xu H, Zhang L. The bronchus first and vessels simultaneously stapled technique: A safe and simple method for video-assisted right upper lobe lobectomy. Thorac Cardiovasc Surg, 2019, 67(2): 131-136.
17. 张彬彬, 钱如林, 陈茂林. 支气管优先处理法在胸腔镜肺上叶切除术中的应用. 中国微创外科杂志, 2020, 20(4): 4.
18. Asamura H, Kondo H, Tsuchiya R. Management of the bronchial stump in pulmonary resections: A review of 533 consecutive recent bronchial closures. Eur J Cardiothorac Surg, 2000, 17(2): 106-110.
19. Zakkar M, Kanagasabay R, Hunt I. No evidence that manual closure of the bronchial stump has a lower failure rate than mechanical stapler closure following anatomical lung resection. Interact Cardiovasc Thorac Surg, 2014, 18(4): 488-493.
20. Skrzypczak P, Roszak M, Kasprzyk M, et al. The technique of stump closure has no impact on post-pneumonectomy bronchopleural fistula in the non-small cell lung cancer-a cross-sectional study. J Thorac Dis, 2022, 14(9): 3343-3351.
21. Guo ZH, Kang MQ, Lin RB, et al. Management of the pulmonary artery during video-assisted thoracoscopic left upper lobectomy. World J Surg, 2014, 38(10): 2645-2651.
22. Herrera LJ, Schumacher LY, Hartwig MG, et al. Pulmonary open, robotic, and thoracoscopic lobectomy study: Outcomes and risk factors of conversion during minimally invasive lobectomy. J Thorac Cardiovasc Surg, 2022, S0022-5223(22)01236-3.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical application of preferential manual bronchoplasty in single-port video-assisted thoracoscopic upper lobectomy: A retrospective analysis in a single center

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