Objective To investigate the feasibility and safety of uniportal video-assisted thoracic surgery (VATS) for primary lung cancer. Methods We retrospectively analyzed the clinical data of 95 primary lung cancer patients in our hospital between January 2014 and January 2015. The patients were divided into an observation group (45 patients) and a control group (50 patients). Standard thoracoscopy lobectomy was used in the control group. Uniportal thoracoscopy lobectomy was used in the trial group. The parameters of the two groups were observed. Results The surgeries of the two groups were successfully completed. There was no statistical difference in operative time, intraoperative transit rate, blood loss, number of lymph node dissection, thoracic drainage and pathology Ⅰ, Ⅱ period (P>0.05). Postoperative drainage tube time, postoperative hospital stay, postoperative pain in the observation group were better than those in the control group (P<0.05). But postoperative drainage time in the observation group was longer than that in the control group (P<0.05). Also, the total hospital costs, especially on the use of expensive consumables, during surgery in the observation group was higher. And there was a higher risk of delayed incision healing or airway injury (P<0.05) in the observation group. One death in the control group during perioperative period occurred. Conclusion Uniportal VATS operation applied in radical operation for lung cancer is safe and feasible. It accelerates postoperative turnover, reduces postoperative pain. But there is a higher risk for airway injury or delayed wound healing, and an increase in use of medical consumptive stuff.
ObjectiveTo summarize the clinical experience and investigate the safety and reliability of uniportal procedure for the correction of pectus excavatum (PE). MethodsFrom November 2010 to November 2015, 203 PE patients (164 males, 39 femalzs average age of 5.7±3.0 years, ranging from 2 to 19 years) underwent the correction operation with only single 2 cm incision on right lateral chest. There were 188 patients under 12 years of age and 15 patients above 12 years. According to Park classification, 176 patients were symmetric and 27 were asymmetric. ResultsAll operations were performed successfully. The average operating time was 16.1±5.2 min with a range of 4-65 min and the average postoperative hospital stay was 6.4±1.3 d, ranging from 4-14 d. A single incision was made on the right chest and only one bar was inserted in the patients. Postoperative follow-up was 1-56 months (mean, 27.6 months). There was no complication occurred such as bar turnover, displacement and redepressed sternum. Totally, 84 patients received bar removal procedure. ConclusionIn terms of operation time and surgical trauma, uniportal procedure for PE is superior to Nuss procedure. And there is no significant difference in the safety and effectiveness between two procedures. Uniportal procedure is especially suitable for the treatment of PE children under 12 years of age.
Objective To investigate the effect of modular disscection of mediastinal lymphadenectomy in uniportal video-assisted thoracoscopic surgery (uniportal-VATS) for lung cancer radical resection and assess its safety and feasibility. Methods Data of 311 patients (171 males and 140 females, a mean age of 59.4±5.1 years) with non-small cell lung cancer (NSCLC) who received modular dissection of mediastinal lymphadenectomy in uniportal-VATS or three portal VATS (3P-VATS group) during March to December 2015 were retrospectively analyzed. There were 208 patients (110 males and 98 females, a mean age of 59.2±5.3 years) in the uniportal-VATS group and 103 patients (61 males and 42 femals, a mean age of 59.7±5.1 years) in the 3P-VATS group. The effects of lymph nodes (LNs) dissection and postoperative clinical data were compared between the two groups, especially for N2 LNs dissection. Results There were no perioperative death in two groups. The overall number of dissected stations and LNs in the uniportal-VATS group (7.3±1.0, 17.5±3.0) were similar with those in the 3P-VATS group (7.2±1.0, 17.7±2.7, P=0.208, P=0.596). The dissected stations (uniportal-VATS: 4.3±0.7, 3P-VATS: 4.3±0.6) and number (uniportal-VATS: 8.6±1.1, 3P-VATS: 8.5±1.1) of N2 LNs were both similar between the two groups (P=0.850, P=0.587). The chest tube duration and postoperative hospital stay of uniportal-VATS group (4.4±1.3 d and 9.2±0.9 d) were much shorter than those of 3P-VATS group (5.0±1.3 d and 9.8±2.0 d, both P<0.001). No significant difference was found in morbidity rate between the two groups (P>0.05). Conclusion Modular dissection of mediastinal lymphadenectomy could meet the requirment of radical resection and it is a safe and valid method which could be used during uniportal-VATS for radical resection of lung cancer.
Objective To investigate the optimal procedure and short-term efficacy of uniportal video-assisted thoracic surgery (U-VATS) lobectomy for lung cancer. Methods The clinical data of 61 patients who underwent lobectomy using U-VATS by the same surgeon between April 2016 and February 2017 were retrospectively analyzed. There were 50 patients (40 males and 10 females, aged 61.4±6.6 years) with conventional procedure. And there were 60 patients (45 males and 15 females, aged 59.2±9.7 years) utilizing multiportal thoracoscopic surgery (M-VATS) during this period. Results The baseline characteristics in both groups such as age, gender, body mass index, comorbidity and tumor size were comparable (P>0.05). There was no postoperative mortality or conversion to thoracotomy in the study. The parameters such as operative time, blood loss, harvested lymph nodes, duration of chest tube drainage, and length of postoperative hospital stay were similar in both groups (P>0.05). However, there was a statistical difference in pain score at 12 h after surgery in favor of the U-VATS approach (3.2vs.4.3, P=0.04). Moreover, subgroup analysis indicated that the operation time using single-direction U-VATS was noticeably shorter than that in both conventional U-VATS and M-VATS (76.4 minvs.125.8 minvs.105.6 min, P<0.05). However, further analysis was not performed because of small sample. Conclusion The short-term efficacy of U-VATS lobectomy for lung cancer is noninferior to M-VATS, meanwhile, single-direction U-VATS lobectomy is feasible followed by shortened operative time.
Objective To investigate the advantage of the concept of wide exposure in uniportal video-assisted thoracoscopic surgery (uniportal-VATS) for radical resection of lung cancer and assess its safety and feasibility. Methods Clinical data of 255 patients (110 males and 145 females, a mean age of 54.3±7.9 years) with non-small cell lung cancer (NSCLC) who received wide exposure in uniportal-VATS or three portal VATS (3P-VATS) during August 2017 to March 2018 were retrospectively analyzed. There were 153 patients (67 males and 86 females, a mean age of 56.1±8.5 years) in the uniportal-VATS group and 102 patients (43 males and 59 femals, a mean age of 54.4±7.4 years) in the 3P-VATS group. The clinical effects were compared between the two groups. Results There was no statistical difference in the operation time between the uniportal-VATS and 3P-VATS (135.0±45.6 min vs. 142.0±39.5 min, P>0.05). The overall number of dissected stations (6.9±1.0) and LNs (14.5±3.0) in the uniportal-VATS group were similar with those in the 3P-VATS group (7.1±1.0, 15.1±1.7). The dissected stations of N2 LNs (uniportal-VATS: 4.1±1.7, 3P-VATS: 3.9±0.8) and number of dissected N2 LNs (uniportal-VATS: 8.0±0.9, 3P-VATS: 7.8±1.1) were both similar between the two groups. The duration of postoperative tube drainage and postoperative hospital stay of uniportal-VATS group (3.5±1.8 d and 7.2±0.9 d) were much shorter than those of 3P-VATS group (4.0±1.3 d and 8.8±2.0 d). No significant difference was found in incidence of postoperative complication between the two groups except that the incidence of subcutaneous emphysema in the uniportal-VATS group was much lower. There was no perioperative death in the two groups. Conclusion The concept of wide exposure in uniportal-VATS can meet the requirment of radical resection and it is a safe and valid method which can be used for radical resection of lung cancer.
ObjectiveTo analyze the safety and feasibility of the adhesion dissection in transaxillary uniportal thoracoscopy for palmar hyperhidrosis.MethodsData of 168 patients, including 77 males and 91 females with an average age of 14 - 41 (24.3±5.4) years, who received transaxillary uniportal video-assisted thoracoscopic surgery (VATS) for palmar hyperhidrosis from January 2015 to July 2018 were retrospectively analyzed. Severe adhesion was found in 4 patients and mild adhesion was found in 12 patients. Artificial pneumothorax was used to help dissect adhesion. Preoperative CT scan could help locate the rib according to the relative position to azygos vein or aotic arch.ResultsAll of 168 patients were successfully completed with transaxillary uniportal VATS. Then chest tubes were put in the 4 severe adhesion patients. The tube was removed from one patient after 11 days because of air leak, and from the other three patients on the next day. The other 164 patients with or without adhesion were discharged from hospital on the operation day or the next day.ConclusionAdhesion dissection in transaxillary uniportal VATS for palmar hyperhidrosis is safe and feasibile.
ObjectiveTo investigate the clinical feasibility and safety of uniportal video-assisted thoracoscopic surgery (VATS) without chest tube in enhanced recovery thoracic surgery.MethodThe clinical data of patients with pulmonary bulla, pulmonary nodules and mediastinal tumors who underwent uniportal VATS in Department of Thoracic Surgery in the Affiliated Hospital of Inner Mongolia Medical University between January 2015 to May 2018 were retrospectively analyzed. A total of 78 patients did not receive closed thoracic drainage tube (a tube-free group), including 30 males and 48 females aged 32.5±8.3 years, 92 patients closed thoracic drainage tube after operation (a control group), including 38 males and 54 females aged 31.4±13.6 years. The surgery-related indicators, postoperative complications and visual analogue score (VAS) were compared between the two groups.ResultsThe time of early ambulation and hospital stay after operation in the tube-free group (1.0±0.3 d, 3.3±0.7 d) were significantly shorter than those in the control group (1.8±0.6 d, 5.2±0.8 d) (P=0.000, P=0.000). The VAS pain scores on the first, second and third day after operation in the tube-free group (4.5±1.8, 3.6±2.4, 2.5±1.4) were also significantly lower than those in the control group (6.8±2.2, 5.7±2.9, 3.9±1.2) (P=0.000, P=0.000, P=0.000). Operation time and intraoperative blood loss in the tube-free group (55.3±12.2 min, 21.5±5.1 mL) and the control group (57.1±6.5 min, 22.2±3.5 mL) were not statistically different (P=0.220, P=0.146). There was no pulmonary infection in both groups, and the wound healing rate was 100.0%. There was no significant difference in pneumothorax, pleural effusion, arrhythmia and re-insertion of chest drain between the tube-free group (5 patients, 8 patients, 1 patient, 3 patients) and the control group (1 patient, 4 patients, 2 patients, 1 patient, P=0.145, P=0.134, P=0.885, P=0.499).ConclusionIn strictly screened patients undergoing uniportal thoracoscopic surgery, no thoracic closed drainage tube can relieve postoperative pain, promote early ambulation activities and enhanced recovery of patients.
Uniportal video-assisted thoracic surgery (UniVATS) is a significant approach of mini-invasive surgery for lung cancer. UniVATS was first used for treatment of lung cancer in 2010. The European consensus and the Chinese consensus were published in 2019 and 2020 respectively. The latest Chinese consensus included the definition of UniVATS, indications for lung cancer treatment, safety and feasibility, surgical skills, learning curve, short-term and long-term results, providing suggestions for the standardization of uniportal video-assisted thoracic surgery, which are essential to improve the quality of surgery and reduce the incidence of related complications. The Chinese consensus also summarized the current status of subxiphoid UniVATS and non-intubated UniVATS for lung cancer. Considering the technical difficulties and challenges, the application of both technologies in clinical treatment has certain limitation. This article aims to give an interpretation of the results of the Chinese consensus and the similarities and to compare the differences with the European consensus, and to provide a reference for the majority of thoracic surgery colleagues.
Objective To analyze the perioperative outcomes of uniportal thoracoscopic lobectomy compared with three-port thoracoscopic lobectomy. Methods Data were extracted from the Western China Lung Cancer Database, a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University. Perioperative outcomes of the patients who underwent uniportal or three-port thoracoscopic lobectomy for lung cancer during January 2014 through April 2021 were analyzed by using propensity score matching. Altogether 5 817 lung cancer patients were enrolled who underwent thoracoscopic lobectomy (uniportal: 530 patients; three-port: 5 287 patients). After matching, 529 patients of uniportal and 1 583 patients of three-port were included. There were 529 patients with 320 males and 209 females at median age of 58 (51, 65) years in the uniportal group and 1 583 patients with 915 males and 668 females at median age of 58 (51, 65) years in the three-port group. Results Uniportal thoracoscopic lobectomy was associated with less intraoperative blood loss (20 mL vs. 30 mL, P<0.001), longer operative time (115 min vs. 105 min, P<0.001) than three-port thoracoscopic lobectomy. No significant difference was found between the two groups regarding the number of lymph node dissected, rate of conversion to thoracotomy, incidence of postoperative complication, postoperative pain score within 3 postoperative days, length of hospital stay, or hospitalization expenses. Conclusion Uniportal video-assisted thoracoscopic lobectomy is safe and effective, and the overall perioperative outcomes are comparable between uniportal and three-port strategies, although the two groups show differences in intraoperative blood loss.
Objective To explore the short-term surgical outcomes of the modified surgical procedure for uniportal thoracoscopic right middle lobectomy (RML). Methods In this modified approach, the incision was created at sixth or seventh intercostal space inferior to the subscapular angle. The surgeon stood on the opposite side of the operating table. The surgery was performed by serial division of the anterior oblique fissure, the vein, bronchus, artery, and horizontal fissure following the single-direction strategy. As for patients with malignant lesions, hilar and mediastinal lymph node dissection was performed. Clinical characteristics and early surgical outcomes were collected and analyzed. Results Fifty two patients were included in this study in the Department of Thoracic Surgery, West China Hospital, Sichuan University between January 2021 and June 2023. There were 20 males and 32 females at an average age of 48.0±10.5 years. No conversion or perioperative mortality was occurred. Mean surgical time was 68.1±16.8 min, mean blood loss was 16.5±4.9 mL, median chest tube duration was 2 (2-22) d and median postoperative hospital stay was 3 (3-24) d. There was no intraoperative or postoperative complication but one patient developed postoperative prolonged air leak (>5 d). Mean postoperative visual-analog scale on postoperative day 1, day 2 and day 3 was 1.5±0.8, 1.7±0.4, 0.8±0.7, respectively. Conclusion Trans-posterior-approach uniportal thoracoscopic single-direction RML is a safe, feasible, and effective procedure, which provides an appropriate direction and angle for dissection and stapling, solving the challenge of conventional uniportal RML lobectomy.