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OBJECTIVE: A few publications describing the single incision VATS for wedge resection of lung have been reported. We introduce the single incision VATS technique with aid of spinal needle for wedge resection of lung.
METHODS: Between March 2011 and December 2012, 109 patients were enrolled. A 1.5~2.0 cm hole in anterior or mid-axillary line of the 5th~8th intercostal space was created according to the location of the target lesion. A 5 mm 30° scope and a 5mm grasper were inserted into pleural cavity through the hole without guidance of a trocar. The target lesion was picked up by a grasper and then a spinal needle (20 gauge, 9 cm) bended approximately 90° was inserted into pleural cavity through the most appropriate intercostal space. The target lesion was hooked by the needle and the grasper was taken out of the pleural cavity. A roticulating stapler was inserted into pleural cavity through the hole and wedge resection of lung was performed. Additionally the stapled line was covered with Neoveil® sheet and fibrin glue in the pneumothorax patients.
RESULTS: Patients included 78 men and 31 women with the mean age of 37.5 years (range 15~75). There were 69 patients with spontaneous pneumothorax patients and 40 patients with pulmonary mass or disease (primary lung cancer 13, metastatic lung cancer 3, hamartoma 3, organizing pneumonia 4, granuloma 3, interstitial lung disease 5, tuberculosis 4, sarcoidosis 2, and others 3). The mean operative times were 33 minutes (20~60) in the 69 pneumothorax patients and 41 minutes (20~70) in the other 32 patients. Neither mortality nor major morbidity was observed in all the 109 patients. The median chest drain duration and median hospital stay were 2 days (1~5) and 3 days (2~7) in the pneumothorax patients. There was no recurrence of peumothorax during mean 9 months follow up period in the pneumothorax patients.
CONCLUSIONS: Single incision VATS technique with aid of spinal needle for pulmonary wedge resection is simple and easy to perform and may applicable to both spontaneous pneumothorax and peripheral lung lesions.