Original article
General thoracic
Uniportal Video-Assisted Thoracoscopic Lobectomy: Two Years of Experience

https://doi.org/10.1016/j.athoracsur.2012.10.070Get rights and content

Background

A video-assisted thoracoscopic approach to lobectomy varies among surgeons. Typically, 3 to 4 incisions are made. Our approach has evolved from a 3-port to a 2-port approach to a single 4- to 5-cm incision with no rib spreading. We report results with single-incision video-assisted thoracic major pulmonary resections during our first 2 years of experience.

Methods

In June 2010, we began performing video-assisted thoracoscopic lobectomies through a uniportal approach (no rib spreading). By July 12, 2012, 102 patients had undergone this single-incision approach.

Results

Of 102 attempted major resections, 97 were successfully completed with a single incision (operations in 3 patients were converted to open surgery and 2 patients needed 1 additional incision). Five uniportal pneumonectomies were not included in the study. We have analyzed early outcomes of successful uniportal lobectomies (92 patients studied). Right upper lobectomy was the most frequent resection (28 cases). Mean surgical time was 154.1 ± 46 minutes (range, 60–310 minutes), mean number of lymph nodes was 14.5 ± 7 (range, 5–38 nodes), and mean number of explored nodal stations was 4.6 ± 1.2 (range, 3–8 stations). The mean tumor size was 2.8 ± 1.5 cm (0–6.5 cm). The median duration of time a chest tube was in place was 2 days and the median length of hospital stay was 3 days. There were complications in 14 patients; no postoperative 30-day mortality was reported.

Conclusions

Single-incision video-assisted thoracoscopic anatomic resection is a feasible and safe procedure with good perioperative results, especially when performed by surgeons experienced with the double-port technique and anterior thoracotomy.

Section snippets

Material and Methods

A retrospective descriptive prevalence study was performed in patients undergoing a single-port approach for major pulmonary resections in the Minimally Invasive Thoracic Surgery Unit and Coruña Hospital (Spain) between June 29, 2010 and July 12, 2012. This study was approved by the review board at Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit, and all patients provided written informed consent before operation. The primary endpoint of this study was to demonstrate the

Results

From June 29, 2010 to July 12, 2012, we attempted 102 major pulmonary resections using the uniportal approach. Most were performed by a single surgeon and an assistant, both with experience in VATS, specifically in the double-port technique for major pulmonary resections and the single-port technique for minor procedures. The demographic and preoperative patient characteristics are described in Table 1.

The anatomic pulmonary resections included right upper lobectomy in 28 patients (combined

Comment

VATS lobectomy for lung cancer was initially described in 1992 [3, 4]. Most authors describe the VATS approach to lobectomy using 3 to 4 incisions [5], but the operation can be performed using only 1 incision with similar outcomes [6]. Since June 2010, and after performing 95 cases using the 2-port approach, we began performing VATS lobectomies with a single incision [7].

The first reports of single-port procedures were described in abdominal operations [8]. Currently, those abdominal procedures

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