Clinical application and learning curve of uniportal thoracoscopy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

KUANG Bijing ¹ , ZHANG Jing ² , NIU Lingli ^1,2 , MA Lin ¹ , LIU Chengwu ¹ , ZHANG Xiaolong ² ,  WANG Wenping ¹

1. Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Thoracic Surgery, Chengdu Shangjin Nanfu Hospital (Shangjin Branch of West China Hospital), Chengdu, 611743, P.R.China;

Corresponding author：

WANG Wenping, Email: drwangwp@163.com

Keywords：

Thoracoscope; uniport; lobectomy; segmentectomy; wedge resection; learning curve

DOI：

10.7507/1007-4848.202102056

Video：

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Objective To analyze the operation outcomes and learning curve of uniportal video-assisted thoracoscopic surgery (VATS).Methods All consecutive patients who underwent uniportal VATS between November 2018 and December 2020 in Shangjin Branch of West China Hospital of Sichuan University were retrospectively enrolled, including 62 males and 86 females with a mean age of 50.1±13.4 years. Operations included lobectomy, segmentectomy, wedge resection, mediastinal mass resection and hemopneumothorax. Accordingly, patients' clinical features in different phases were collected and compared to determine the outcome difference and learning curve for uniportal VATS.Results Median postoperative hospital stay was 5 days, and the overall complication rate was 8.1% (12/148). There was no 30-day death after surgery or readmissions. Median postoperative pain score was 3. Over time, the operation time, incision length and blood loss were optimized in the uniportal VATS lobectomy, the incision length and blood loss increased in the uniportal VATS segmentectomy, and the postoperative hospital stay decreased in the uniportal VATS wedge resection.Conclusion Uniportal VATS is safe and feasible for both standard and complex pulmonary resections. While, no remarkable learning curve for uniportal VATS lobectomy is observed for experienced surgeon.

Citation： KUANG Bijing, ZHANG Jing, NIU Lingli, MA Lin, LIU Chengwu, ZHANG Xiaolong, WANG Wenping. Clinical application and learning curve of uniportal thoracoscopy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(7): 826-829. doi: 10.7507/1007-4848.202102056 Copy

1.	Yim AP. VATS major pulmonary resection revisited--controversies, techniques, and results. Ann Thorac Surg, 2002, 74(2): 615-623.
2.	Meacci E, Nachira D, Zanfrini E, et al. Uniportal VATS approach to sub-lobar anatomic resections: Literature review and personal experience. J Thorac Dis, 2020, 12(6): 3376-3389.
3.	Bedetti B, Solli P, Lawrence D, et al. Single port video-assisted thoracoscopic thymectomy. J Vis Surg, 2016, 2: 149.
4.	Hernandez-Arenas LA, Lin L, Yang Y, et al. Initial experience in uniportal subxiphoid video-assisted thoracoscopic surgery for major lung resections. Eur J Cardiothorac Surg, 2016, 50(6): 1060-1066.
5.	Yang W, Zhang G, Pan S, et al. Comparison of the perioperative efficacy between single-port and two-port video-assisted thoracoscopic surgery anatomical lung resection for non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2019, 11(7): 2763-2773.
6.	Yang X, Li M, Yang X, et al. Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2018, 10(4): 2186-2195.
7.	Wong MKH, Sit AKY, Au TWK. Minimally invasive thoracic surgery: Beyond surgical access. J Thorac Dis, 2018, 10(Suppl 16): S1884-S1891.
8.	Passera E, Rocco G. From full thoracotomy to uniportal video-assisted thoracic surgery: Lessons learned. J Vis Surg, 2017, 3: 36.
9.	Han D, Cao Y, Wu H, et al. Uniportal video-assisted thoracic surgery for the treatment of lung cancer: A consensus report from Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS) and Chinese Association of Thoracic Surgeons (CATS). Transl Lung Cancer Res, 2020, 9(4): 971-987.
10.	熊燃, 徐广文, 吴汉然, 等. 单孔胸腔镜肺叶切除术治疗可切除肺癌的学习曲线研究. 中华外科杂志, 2018, 56(6): 447-451.
11.	Stamenovic D, Messerschmidt A, Jahn T, et al. Initial experience with uniportal video-assisted thoracoscopic surgery for anatomical lung resections: A propensity score study and an observational assessment of the learning curve. Zentralbl Chir, 2018, 143(1): 84-89.
12.	Guido-Guerrero W, Bolaños-Cubillo A, González-Rivas D. Single-port video-assisted thoracic surgery (VATS)-advanced procedures & update. J Thorac Dis, 2018, 10(Suppl 14): S1652-S1661.
13.	伍治强, 唐小军. 单孔胸腔镜手术应用进展. 中国微创外科杂志, 2020, 26(6): 553-556.
14.	施庆彤, 刁亚利, 钱军. 单孔胸腔镜手术联合ERAS理念指导下的呼吸功能锻炼在肺癌围手术期的应用. 中国肺癌杂志, 2020, 23(8): 667-672.
15.	Kutluk AC, Kocaturk CI, Akin H, et al. Which is the best minimal invasive approach for the treatment of spontaneous pneumothorax? Uniport, two, or three ports: A prospective randomized trail. Thorac Cardiovasc Surg, 2018, 66(7): 589-594.
16.	Suda T. Subxiphoid uniportal video-assisted thoracoscopic surgery procedure. Thorac Surg Clin, 2017, 27(4): 381-386.
17.	杨盛荣. 经剑突下胸腔镜手术研究进展. 现代医药卫生, 2020, 36(10): 1519-1521.
18.	Lerut T. Uniportal video-assisted thoracoscopic surgery in esophageal diseases: An introduction. J Vis Surg, 2017, 3: 182.
19.	Dmitrii S, Pavel K. Uniportal video-assisted thoracic surgery esophagectomy. Thorac Surg Clin, 2017, 27(4): 407-415.
20.	Onugha O, Ivey R, McKenna R. Novel techniques and approaches to minimally invasive thoracic surgery. Surg Technol Int, 2017, 30: 231-235.
21.	Suda T. Robotic subxiphoid thymectomy. J Vis Surg, 2016, 2: 118.
22.	胡晓星, 李辉. 单孔胸腔镜肺手术的扶镜体会与思考. 中国胸心血管外科临床杂志, 2018, 25(12): 1096-1099.

1. Yim AP. VATS major pulmonary resection revisited--controversies, techniques, and results. Ann Thorac Surg, 2002, 74(2): 615-623.
2. Meacci E, Nachira D, Zanfrini E, et al. Uniportal VATS approach to sub-lobar anatomic resections: Literature review and personal experience. J Thorac Dis, 2020, 12(6): 3376-3389.
3. Bedetti B, Solli P, Lawrence D, et al. Single port video-assisted thoracoscopic thymectomy. J Vis Surg, 2016, 2: 149.
4. Hernandez-Arenas LA, Lin L, Yang Y, et al. Initial experience in uniportal subxiphoid video-assisted thoracoscopic surgery for major lung resections. Eur J Cardiothorac Surg, 2016, 50(6): 1060-1066.
5. Yang W, Zhang G, Pan S, et al. Comparison of the perioperative efficacy between single-port and two-port video-assisted thoracoscopic surgery anatomical lung resection for non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2019, 11(7): 2763-2773.
6. Yang X, Li M, Yang X, et al. Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: A systematic review and meta-analysis. J Thorac Dis, 2018, 10(4): 2186-2195.
7. Wong MKH, Sit AKY, Au TWK. Minimally invasive thoracic surgery: Beyond surgical access. J Thorac Dis, 2018, 10(Suppl 16): S1884-S1891.
8. Passera E, Rocco G. From full thoracotomy to uniportal video-assisted thoracic surgery: Lessons learned. J Vis Surg, 2017, 3: 36.
9. Han D, Cao Y, Wu H, et al. Uniportal video-assisted thoracic surgery for the treatment of lung cancer: A consensus report from Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS) and Chinese Association of Thoracic Surgeons (CATS). Transl Lung Cancer Res, 2020, 9(4): 971-987.
10. 熊燃, 徐广文, 吴汉然, 等. 单孔胸腔镜肺叶切除术治疗可切除肺癌的学习曲线研究. 中华外科杂志, 2018, 56(6): 447-451.
11. Stamenovic D, Messerschmidt A, Jahn T, et al. Initial experience with uniportal video-assisted thoracoscopic surgery for anatomical lung resections: A propensity score study and an observational assessment of the learning curve. Zentralbl Chir, 2018, 143(1): 84-89.
12. Guido-Guerrero W, Bolaños-Cubillo A, González-Rivas D. Single-port video-assisted thoracic surgery (VATS)-advanced procedures & update. J Thorac Dis, 2018, 10(Suppl 14): S1652-S1661.
13. 伍治强, 唐小军. 单孔胸腔镜手术应用进展. 中国微创外科杂志, 2020, 26(6): 553-556.
14. 施庆彤, 刁亚利, 钱军. 单孔胸腔镜手术联合ERAS理念指导下的呼吸功能锻炼在肺癌围手术期的应用. 中国肺癌杂志, 2020, 23(8): 667-672.
15. Kutluk AC, Kocaturk CI, Akin H, et al. Which is the best minimal invasive approach for the treatment of spontaneous pneumothorax? Uniport, two, or three ports: A prospective randomized trail. Thorac Cardiovasc Surg, 2018, 66(7): 589-594.
16. Suda T. Subxiphoid uniportal video-assisted thoracoscopic surgery procedure. Thorac Surg Clin, 2017, 27(4): 381-386.
17. 杨盛荣. 经剑突下胸腔镜手术研究进展. 现代医药卫生, 2020, 36(10): 1519-1521.
18. Lerut T. Uniportal video-assisted thoracoscopic surgery in esophageal diseases: An introduction. J Vis Surg, 2017, 3: 182.
19. Dmitrii S, Pavel K. Uniportal video-assisted thoracic surgery esophagectomy. Thorac Surg Clin, 2017, 27(4): 407-415.
20. Onugha O, Ivey R, McKenna R. Novel techniques and approaches to minimally invasive thoracic surgery. Surg Technol Int, 2017, 30: 231-235.
21. Suda T. Robotic subxiphoid thymectomy. J Vis Surg, 2016, 2: 118.
22. 胡晓星, 李辉. 单孔胸腔镜肺手术的扶镜体会与思考. 中国胸心血管外科临床杂志, 2018, 25(12): 1096-1099.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical application and learning curve of uniportal thoracoscopy

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