From Thoracotomy Straight To U-vats: Is It Worth Skipping A Step?
Marcello Carlo Ambrogi, Diana Bacchin, Stylianos Korasidis, Elisa Sicolo, Vittorio Aprile, 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 other techniques. Most surgeons start performing u-VATS after a multi-portal VATS training; instead, we adopted u-VATS for major lung resections almost without practice in other VATS lobectomy techniques. Methods: Since March 2018 to November 2020, 93 patients underwent u-VATS for major lung resections in our Center. Our analysis focuses on intra- and postoperative outcomes to assess u-VATS technical feasibility after developing large background experience in open major lung resections, performed by antero-lateral thoracotomy. Results: Patients were 53 males and 40 females, mean age: 67.4 years. We performed 81 lobectomies and 12 segmentectomies. Mean operation time was 160 minutes. Operative times analysis showed a significative decrease (ρs: -0.440, p: 0.017) for the first 8 months (30 patients), then it revealed a slight increase (ρs: 0.241, p: 0.092). The growing oncological complexity of surgical cases (namely, primitive tumor dimensions, ρs: 0.134, p: 0.355, and hilar/mediastinal lymphadenopathies, ρs: 0.033, p: 0.822) may be involved in this outcome. No intraoperative complications occurred. Conversion rate was 4.6%, due to presence of hilar lymphadenopathy or adherences. A mean of 5 nodal stations and 12.6 lymph-nodes were removed, with an increasing trend over the time (respectively, ρs: 0.112, p: 0.297 and ρs: 0.215, p: 0.045). Mean drainage period and hospital stay were respectively 4.3 days and 6.8 days. We didnít encounter any severe postoperative morbidity, except for one patient who died for acute myocardial infarction in 30th postoperative day, after discharge; no more deaths occurred within 90 days from surgery. Conclusions: Our surgical and oncological outcomes are consistent with those of literature. We noted that our previous large experience with antero-lateral thoracotomy facilitated since the beginning the passage to u-VATS, maybe even more than multi-portal VATS do, thanks to similar operative view and surgical approach to the hilum. Hence, we may suggest that u-VATS technique is affordable for any surgeon already skilled in major pulmonary resections by antero-lateral thoracotomy.
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