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Treatment outcomes of anatomical lung resection in single-port VATS (SPVATS) for stage I lung cancer
Kyoji Hirai.
Nippon Medical School Chiba Hokusou Hospital, Chiba, Japan.

OBJECTIVE: We have already reported the beneficial effects of SPVATS for the patients with stage I lung cancer. (Eur J Cardiothorac Surg 2015). So far today, the anatomical lung resection in SPVATS has been performed in 84 patients. We examine the effectiveness of SPVATS and elucidate its technical knack.
METHODS: In the SPVATS, an approximately 4-cm small incision was placed at the fourth or fifth intercostal space from the anterior to posterior axillary line.
RESULTS: A total 84 patients underwent anatomical lung resections, of whom 80 underwent lobectomy while 4 underwent segmentectomy. The ratio of gender (M/F) was 51/33, and the median age was 68.5±9.5 years. The mean Fev1.0 and maximum size of tumor was 1.85±0.31 L and 2.8±0.3 cm, respectively The median operation time, blood loss was 175±35 min. and 85±25 ml, respectively. The median drainage duration and postoperative hospital stay were 1.6±0.7 and 7.5±1.9 days, respectively and the mean number of dissected lymphnodes was 14.8±3.5. The mean maximum of CPK showed 360±29 IU/ml. The mean of NRS on postopearative day 7 and 30 was 2.7±0.4 and 1.6±0.5, respectively. The number of days that were used with analgestic agents within a month after surgery was 8.3±1.2. Two patients (2.4%) were required conversion to open thoracotomy.
CONCLUSIONS: Anatomical lung resection in SPVATS should be considered as a treatment option for stage I lung cancer. The knack of SPVATS is presented as follows: 1) To perform a safer operation, the operator should manipulate the forceps to raise the vascular sheath above the scissors, avoiding the tips touching. This creates a more 3 dimensional view, prevents chances of damage and provides an easier line of sight. 2) To dissect vessels and bronchus to the peripheral side is needed more sufficient than usual. 3) To master the ligation treatment including transfixing suture to the vessels via the single access at the fourth or fifth intercostal space. In SPVATS the handling of forceps and scissors and the acquirement of the vessel ligation technique are difficult for surgeon at first, however I believe that practiced surgeons can master this operative procedure.

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