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A uniportal thoracoscopic major pulmonary resections
Mitsuhiro Kamiyoshihara, Takashi Ibe, Natsuko Kawatani, Hitoshi Igai.
Maebashi Red Cross Hospital, Maebashi, Japan.

OBJECTIVE: The preferred thoracoscopic approach to lung resection varies among surgeons. Typically, three or four incisions are required. We have a fundamental commitment to “reduced-port surgery”, and our approach has evolved from a three-incision method to use of a single incision 3-3.5 cm in length. Herein, we report our early experience (2 years) with uniportal thoracoscopic major pulmonary resections.
METHODS: We analyzed the outcomes of successful uniportal thoracoscopic lobectomies and anatomical segmentectomies with special reference to the methodologies employed, and whether conventional instruments were used. However, we prefer the following techniques: the shaft-on-shaft approach, the pulley method, one-hand encircling, one-hand exposure, extra vessel exposure, and “move-the -ground”.
RESULTS: Of 14 attempted uniportal approaches to major lung resections (primary lung cancer in 11 patients and metastatic cancer in 3), 11 were successfully completed (in 3 patients, the operations were converted to three-port approaches. The procedures included eight lobectomies (right lower in five cases, left lower in one, right upper in one, and right middle in one) and three segmentectomies (one each in the right S6 region, the left basal, and the left lingular). The median surgical time was 180 min; the median duration of chest tube residence 2 days; and the median hospital stay 4 days. No major complication developed and no hospital death was recorded.
CONCLUSIONS: Uniportal thoracoscopic anatomical resection is feasible, safe, and affords good perioperative results. However, the selection criteria for the approach will limit the use thereof.

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