Comparing Subxiphoid Versus Intercostal Uniportal Video-assisted Thoracoscopic Pulmonary Lobectomy - A United Kingdom Centre Experience
Jacie Jiaqi Law1, Karen Chien Lin Soh2, Pranav Kumar Santhosh2, Jeremy Chan3, Giuseppe Aresu4.
1Royal Victoria Hospital, Belfast, United Kingdom, 2University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, United Kingdom, 3Bristol Heart Institute, Bristol, United Kingdom, 4Royal Papworth Hospital, Cambridge, United Kingdom.
Subxiphoid uniportal video-assisted thoracoscopic (SUVAT) lobectomy is a novel approach aimed to enhance recovery by reducing incisional pain after traditional intercostal uniportal video-assisted thoracoscopic (IUVAT) approach.However, evidence on SVAT remains scattered, especially in Europe and Americas. We aim to share our institutional experience with SUVAT lobectomy in the management of primary lung cancer and compare perioperative outcomes with IUVAT lobectomy to assess its safety and feasibility.
Retrospective analysis of prospectively collected data identified 57 patients and 132 patients undergoing SUVAT and IUVAT lobectomy respectively. Data on patient characteristics and perioperative outcomes are presented as mean ± standard deviation. Comparison of continuous and categorical variables between groups was performed with Pearson’s Chi-suqared test, Fisher’s exact test and Wilcoxon rank sum test. Statistical significance was considered at P < 0.05.
Patient characteristics such as age (69.84±9.69, p=0.39), BMI (26.34±4.42, p=0.07), pulmonary function (FEV1/FVC 62.65±15.24%, p=0.86 and TLCO 75.19±22.13%, p=0.68) and ASA grade were similar between two groups. There was no difference in operating times (209±69 minutes vs 199±54 minutes, p=0.42).Post-operatively, the SUVAT group experienced lower postoperative day 1 drainage volume (96±118ml vs 153±154ml, p<0.001), shorter duration of chest drain use (3±4.6 days vs 5±4.6, p=0.043) and reduced hospital length of stay (5±6.4 vs 6±14.3 days, p=0.04). There was also no difference in R0 resection (p=0.30), reoperation within 30 days (p=0.56) and disease recurrence(p=0.91).
Our experience demonstrates that SUVAT lobectomy for primary lung cancer is safe and promising with similar perioperative outcomes and oncological resection results when compared to IUVAT lobectomy.
"LEGEND" Figure (A) shows the patient positioning and (B) the insertion of a subxiphoid wound retractor in SVAT Lobectomy.(C) demonstrates the dissection of the pulmonary artery and (D) an excellent view of the pulmonary vein.
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