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The single port thoracoscopic surgery using anchoring suture of lung parenchyme to chest wall instead of using grasping instrument
Hyo Yeong Ahn1, Do Hyung Kim1, Bongsoo Son1, Yeong Dae Kim2, Hoseok I2, Jeong Su Cho2.
1Pusan National University Yangsan Hospital, Yangsan-si, Gyeongnam, Korea, Republic of, 2Pusan National University Hospital, Busan, Korea, Republic of.

OBJECTIVE: Since single port thoracoscopic surgery has been developed, there is still difficulty in manipulation of lung by three thoracoscopic instruments (grasping instrument-thoracoscope-staple) through single incision which would cause postoperative paresthesia and wound dehiscence. In our hospital, to decrease limitation of movement of thoracoscopic instruments, the authors used anchoring suture to tag lung parenchyma to the chest wall instead of grasping instrument.
METHODS: From September 2012 to December 2012, 25 patients underwent single port thoracoscopic surgery for lung biopsy of nodule or interstitial lung disease and pneumothorax.
Under lateral decubitus position, 2-cm single incision was made at an effective area to manipulate and placed by a wound protector (Fig. 1A). After detecting lung lesion to be resected under a guidance of 5-mm straight viewing thoracoscope, penetrated prolene 1-0 through chest wall was used (Fig. 1B) to tag around lung lesion (Fig. 1C) and anchored to the chest wall. As pulling anchoring suture, the staple was introduced to be settled (Fig. 1D) and fired (Fig.1E).
RESULTS: Performing single port thoracoscopic surgery using just two thoracoscopic instruments (thoracoscope-staple) was an easy way for a surgeon to manipulate the lung without any difficulty. The median hospital stay was 4.5 days (range, 0.5 to 1 days) and the median day of chest tube placement was 1.5 days (range, 1 to 2 days). The mean postoperative pain measured by Wong-Baker Scale was 0.48 ± 0.65 and the wound dehiscence was not found.
CONCLUSIONS: The single port thoracoscopic surgery using anchoring suture of lung parenchyme to chest wall instead of using grasping instrument would be one of effective surgical techniques to overcome the obstacles of handling thoracoscopic instruments through small incision and secure a clear surgical view.


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