From Thoracotomy To Uniportal Video-assisted Thoracic Surgery: Promises And Pitfalls
Diana Bacchin, Marcello Carlo Ambrogi, Stylianos Korasidis, Vittorio Aprile, Elisa Sicolo, Paolo Dini, Marco Lucchi
Division of Thoracic Surgery, University of Pisa, Pisa, Italy, Pisa, Italy
BACKGROUND: Uniportal video-assisted thoracic surgery (u-VATS) is an increasingly used technique, associated to low postoperative pain, early recovery after surgery and oncological results similar to open, traditional thoracoscopic and robotic surgery. Many studies on this technique have already been performed, most of surgeons starting u-VATS after getting through multi-portal VATS training. We chose to start our u-VATS lobectomy experience with almost no previous practice with other VATS lobectomy techniques and while still waiting for dedicated surgical instrumentation. METHODS: Since March 2018 to November 2019, 66 patients (33 males and 33 females, mean age: 66.4 years) underwent u-VATS for major lung resection in our Center. We evaluated intra- and perioperative outcomes to assess the learning curve with Spearman Rank-Order Correlation. Oncological features have also been analyzed. RESULTS: We performed 58 lobectomies and 8 segmentectomies, for both oncological and benign pathologies. We didnít find any particular technical difficulties, thanks to the u-VATS thoracotomy-like vision. The mean operation time was 161.1 minutes. Only one case was converted to thoracotomy for difficulties in the arterial dissection due to hilar lymphadenopathy. No intraoperative complications occurred. A mean of 5 nodal stations (range 1-8) and 12.7 lymph nodes (range 3-32) were removed. Resection margins were negative in all cases. Mean drainage period and hospital stay were respectively 3.9 days (range 1-18) and 6.4 days (range 3-20). Postoperative morbidity is reported in Table 1. Only one patient died for acute myocardial infarction in 30th postoperative day, after discharge; no more deaths occurred within 90 days from surgery. As our experience increased, we noticed a slight decrease of operative times (p= 0.683, ρs= -0.056), an increase of number of lymph nodes removed (p= 0.143, ρs= 0.182) and a significant improvement in the number of nodal stations dissected (p=0.014, ρs= 0.301). CONCLUSIONS: Despite we started performing u-VATS after low practice on multi-portal VATS major lung resections, our perioperative and oncological outcomes are consistent with literature. Probably that can be related to our previous large experience with antero-lateral thoracotomy, which facilitates the passage to u-VATS maybe even more than multi-portal VATS approaches. Further experience with dedicated u-VATS instruments will probably confirm or improve these results. TABLE 1: Postoperative complications. *Common Terminology Criteria for Adverse Events (CTCAE) Version 4.03.
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