Clinical application of single incision thoracoscopic surgery: early experience of 264 cases

Journal of Cardiothoracic Surgery

Hee Chul Yang¹  Sanghoon Jheon¹  Kwhanmien Kim¹  Sukki Cho¹  Wonsuk Choi¹  Sungwon Yum¹  In-Hag Song¹ 

[1] Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463–707, Seoul, Korea

关键词: Single port surgery;    Pneumothorax;    Uniportal;    Single incision thoracoscopic surgery;    VATS;   

Others  :  811388
DOI  :  10.1186/1749-8090-9-44

 received in 2013-11-25, accepted in 2014-03-04,  发布年份 2014

【 摘 要 】

Background

Single incision thoracoscopic surgery (SITS) is recognized as a difficult procedure and surgeons hesitate to perform this technique. We describe our experience of SITS and determine whether SITS can be a routine approach in minimally invasive surgery.

Methods

From May 2011 to April 2013, a single operator attempted SITS for 264 cases. Their medical records were retrospectively reviewed with regard to age, sex, diagnosis, operation time, hospital stay, need of additional incision, morbidity, and early outcome.

Results

A number of thoracic diseases and procedures were attempted with SITS including primary (n = 172) or secondary (n = 22) spontaneous pneumothorax, biopsy for lung (n = 29), pleura (n = 3), and mediastinal lymph node (n = 3), mediastinal mass excision (n = 11), empyema decortication (n = 11), lobectomy (n = 6), pulmonary metastasectomy (n = 3), pericardial window formation (n = 3), and hematoma evacuation (n = 1). Of these, 237 cases underwent SITS successfully. However, additional incision was needed in 10.2% (n = 27). Reasons for conversions were as follows: extensive pleural adhesion (n = 14), difficulty in endoscopic stapling (n = 11), bleeding (n = 1), and intolerance of one lung ventilation (n = 1). Conversion rate of empyema was 54.5%, which was the most difficult for SITS. In contrast, the conversion rate of PSP was 4.7%, which means PSP was the most applicable for SITS. Postoperative complications included air leak (≥3 days) (n = 1), wound problem (n = 4), delayed pleural effusion (n = 1), and postoperative bleeding (n = 1).

Conclusions

SITS can be a routine approach from simple to more complicated diseases. However, we still have difficulties in cases with extensive pleural adhesion or location of lesion with difficult accessibility for endoscopic stapling.

【 授权许可】

   
2014 Song et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Yan TD, Black D, Bannon PG, McCaughan BC: Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 2009, 27:2553-2562.
• [2]Kim K, Kim HK, Park JS, Chang SW, Choi YS, Kim J, Shim YM: Video-assisted thoracic surgery lobectomy: single institutional experience with 704 cases. Ann Thorac Surg 2010, 89:S2118-S2122.
• [3]McKenna RJ Jr, Houck W, Fuller CB: Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 2006, 81:421-425. discussion 425–6
• [4]Waller DA, Forty J, Morritt GN: Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax. Ann Thorac Surg 1994, 58:372-376. discussion 376–7
• [5]Chen PR, Chen CK, Lin YS, Huang HC, Tsai JS, Chen CY, Fang HY: Single-incision thoracoscopic surgery for primary spontaneous pneumothorax. J Cardiothorac Surg 2011, 6:58. BioMed Central Full Text
• [6]Gonzalez-Rivas D, Paradela M, Fernandez R, Delgado M, Fieira E, Mendez L, Velasco C, de la Torre M: Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Ann Thorac Surg 2013, 95:426-432.
• [7]Jutley RS, Khalil MW, Rocco G: Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: comparison of post-operative pain and residual paraesthesia. Eur J Cardiothorac Surg 2005, 28:43-46.
• [8]Rocco G: Single-Port Video-Assisted Thoracic Surgery (Uniportal) in the Routine General Thoracic Surgical Practice. Oper Tech Thorac Cardiovasc Surg 2009, 14:326-335.
• [9]Rocco G, Martin-Ucar A, Passera E: Uniportal VATS wedge pulmonary resections. Ann Thorac Surg 2004, 77:726-728.
• [10]Yang HC, Cho S, Jheon S: Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery. Surg Endosc 2013, 27:139-145.
• [11]Assouad J, Vignes S, Nakad J, Grunenwald D: Single incision video-assisted thoracic surgery using a laparoscopic port. Ann Thorac Surg 2011, 91:2020-2021. author reply 2021
• [12]Chen CH, Lee SY, Chang H, Liu HC, Chen CH, Huang WC: Technical aspects of single-port thoracoscopic surgery for lobectomy. J Cardiothorac Surg 2012, 7:50. BioMed Central Full Text
• [13]Oka S, Uramoto H, Hanagiri T: Successful extirpation of thoracic pleural lipoma by single-port thoracoscopic surgery. Asian J Surg 2011, 34:140-142.
• [14]Rocco G, Brunelli A, Jutley R, Salati M, Scognamiglio F, La Manna C, La Rocca A, Martucci N: Uniportal VATS for mediastinal nodal diagnosis and staging. Interact Cardiovasc Thorac Surg 2006, 5:430-432.
• [15]Rocco G, Martucci N, La Manna C, Jones DR, De Luca G, La Rocca A, Cuomo A, Accardo R: Ten-year expreience on 644 patients undergoing single-port (uniportal) video-assisted thoracoscopic surgery. Ann Thorac Surg 2013, 2:434-438.
• [16]Chen CH, Chang H, Lee SY, Liu HC, Hung TT, Huang WC: Single-port thoracoscopic surgery can be a first-line approach for elective thoracoscopic surgery. Rev Port Pneumol 2012, 18:278-284.