The Efficacy Of Thoracoscopic Pulmonary Segmentectomy Performed Viaa Uniportal Approach
Hitoshi Igai, Mitsuhiro Kamiyoshihara, Ryohei Yoshikawa, Fumi Ohsawa, Tomohiro Yazawa, Natsumi Matsuura
Japanese Red Cross Maebashi Hospital, Maebashi, Japan
BACKGROUND: We introduced uniportal, thoracoscopic, major pulmonary resection (which is less invasive than minithoracotomy or use of a multiportal approach) in February 2012. This approach has been applied to both lobectomy and segmentectomy, although the latter operation is associated with certain technical difficulties including division of the peripheral pulmonary vessel branches and/or the intersegmental plane. Here, we investigated the efficacy of thoracoscopic pulmonary segmentectomy performed via a uniportal approach, compared to minithoracotomy and use of a multiportal approach. METHODS: Between April 2006 and October 2019, 140 patients underwent pulmonary segmentectomy and were divided into two groups; those for whom a uniportal (n=14) and other (multiportal or minithoracotomy, n=126) approaches were employed. We compared their demographics and perioperative outcomes. The uniportal approach featured creation of a 4-cm incision in the fourth or fifth intercostal space of the anterior axillary line; the multiportal approach featured creation of three or four ports; minithoracotomy proceeded via a 5-8-cm incision in the fifth intercostal space of the mid-axillary line. RESULTS: The groups did not differ in terms of mean age, the sex ratio, the resected lobe, or underlying disease (p=0.11, 1, 0.81, 0.1 respectively). None of blood loss (uniport: 49 g; other: 42 g, p=0.72), morbidity (uniport: 4.5%; other: 13%, p=0.48), or re-admission rate within 30 days of discharge (uniport: 0%; other: 4.2%, p=1.00) differed between the groups. However, the uniportal approach was superior in terms of operative time (uniport: 146 min.; other: 184 min., p=0.0016), duration of postoperative drainage (uniport: 1.4 days; other: 2.6 days, p=0.0068), and postoperative hospitalization time (uniport: 3.4 days; other: 6.4 days, p=0.0012). The rate of conversion to thoracotomy did not differ significantly between the two groups (uniport: 4.5%; other: 1.7%, p=0.4). There was no death within 30 days after surgery in either group. Intentional segmentectomy was performed on 36 patients who lacked local and distant recurrences (observation period: 625 days). CONCLUSIONS: The uniportal approach is more effective for pulmonary segmentectomy patients than is minithoracotomy or a multiportal approach. The former approach delivered better or equivalent perioperative outcomes.
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