Uniportal thoracoscopic right middle lobectomy via posterior approach in 52 patients: A prospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAN Xiuji ^1,2 , ZHANG Hanlu ¹ , CHEN Longqi ¹ , GU Yimin ¹ ,  WANG Wenping ¹

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Plastic and Burns Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

WANG Wenping, Email: wangwp@163.com

Keywords：

Uniportal video-assisted thoracoscopic surgery; right middle lobectomy; improvement of surgical technology

DOI：

10.7507/1007-4848.202310002

Video：

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Objective To explore the short-term surgical outcomes of the modified surgical procedure for uniportal thoracoscopic right middle lobectomy (RML). Methods In this modified approach, the incision was created at sixth or seventh intercostal space inferior to the subscapular angle. The surgeon stood on the opposite side of the operating table. The surgery was performed by serial division of the anterior oblique fissure, the vein, bronchus, artery, and horizontal fissure following the single-direction strategy. As for patients with malignant lesions, hilar and mediastinal lymph node dissection was performed. Clinical characteristics and early surgical outcomes were collected and analyzed. Results Fifty two patients were included in this study in the Department of Thoracic Surgery, West China Hospital, Sichuan University between January 2021 and June 2023. There were 20 males and 32 females at an average age of 48.0±10.5 years. No conversion or perioperative mortality was occurred. Mean surgical time was 68.1±16.8 min, mean blood loss was 16.5±4.9 mL, median chest tube duration was 2 (2-22) d and median postoperative hospital stay was 3 (3-24) d. There was no intraoperative or postoperative complication but one patient developed postoperative prolonged air leak (>5 d). Mean postoperative visual-analog scale on postoperative day 1, day 2 and day 3 was 1.5±0.8, 1.7±0.4, 0.8±0.7, respectively. Conclusion Trans-posterior-approach uniportal thoracoscopic single-direction RML is a safe, feasible, and effective procedure, which provides an appropriate direction and angle for dissection and stapling, solving the challenge of conventional uniportal RML lobectomy.

Citation： YAN Xiuji, ZHANG Hanlu, CHEN Longqi, GU Yimin, WANG Wenping. Uniportal thoracoscopic right middle lobectomy via posterior approach in 52 patients: A prospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(9): 1281-1287. doi: 10.7507/1007-4848.202310002 Copy

1.	Wang L, Liu D, Lu J, et al. The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC Cancer, 2017, 17(1): 75.
2.	Wang BY, Liu CY, Hsu PK, et al. Single-incision versus multiple-incision thoracoscopic lobectomy and segmentectomy: A propensity-matched analysis. Ann Surg, 2015, 261(4): 793-799.
3.	Gonzalez-Rivas D, Garcia A, Chen C, et al. Technical aspects of uniportal video-assisted thoracoscopic double sleeve bronchovascular resections. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i14-i22.
4.	Liu C, Wang W, Mei J, et al. Uniportal thoracoscopic single-direction basal subsegmentectomy (left s10a+ci): Trans-inferior-pulmonary-ligament approach. Ann Surg Oncol, 2022, 29(2): 1389-1391.
5.	Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
6.	董懂, 韩丁培, 曹羽钦, 等. 《单孔胸腔镜手术治疗肺癌中国专家共识》解读. 中国胸心血管外科临床杂志, 2021, 28(2): 137-145.Dong D, Han DP, Cao YC, et al. Chinese expert consensus on the uniportal video-assisted thoracoscopic surgery for lung cancer: An interpreation. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(2): 137-145.
7.	Vieira A, Bourdages-Pageau E, Kennedy K, et al. The learning curve on uniportal video-assisted thoracic surgery: An analysis of proficiency. J Thorac Cardiovasc Surg, 2020, 159(6): 2487-2495.
8.	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.
9.	Sihoe AD. Uniportal video-assisted thoracic (VATS) lobectomy. Ann Cardiothorac Surg, 2016, 5(2): 133-144.
10.	Liu R, Tan Q, Huang J, et al. Uniportal video assisted thoracic surgery with 2 cm skin incision for right middle lobectomy with systematic lymphadenectomy. J Thorac Dis, 2017, 9(11): 4592-4596.
11.	Zhang H, Yang YS, Nong K, et al. A novel technique to optimize uniportal thoracoscopic right middle lobectomy. Ann Thorac Surg, 2022, 113(4): e303-e305.
12.	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.Wu ZQ, Tang XJ. Progress in the application of single port thoracoscopy surgery. Chin J Minim Invasive Surg, 2020, 26(6): 553-556.
13.	Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
14.	Gonzalez-Rivas D, Sihoe ADL. Important technical details during uniportal video-assisted thoracoscopic major resections. Thorac Surg Clin, 2017, 27(4): 357-372.
15.	Wei S, Guo C, He J, et al. Effect of vein-first vs artery-first surgical technique on circulating tumor cells and survival in patients with non-small cell lung cancer: A randomized clinical trial and registry-based propensity score matching analysis. JAMA Surg, 2019, 154(7): e190972.
16.	Ray MA, Smeltzer MP, Faris NR, et al. Survival after mediastinal node dissection, systematic sampling, or neither for early stage NSCLC. J Thorac Oncol, 2020, 15(10): 1670-1681.
17.	Rucker AJ, Raman V, Jawitz OK, et al. Effect of lymph node assessment on outcomes in surgery for limited stage small cell lung cancer. Ann Thorac Surg, 2020, 110(6): 1854-1860.
18.	Perna V, Carvajal AF, Torrecilla JA, et al. Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: A randomized study. Eur J Cardiothorac Surg, 2016, 50(3): 411-415.

1. Wang L, Liu D, Lu J, et al. The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC Cancer, 2017, 17(1): 75.
2. Wang BY, Liu CY, Hsu PK, et al. Single-incision versus multiple-incision thoracoscopic lobectomy and segmentectomy: A propensity-matched analysis. Ann Surg, 2015, 261(4): 793-799.
3. Gonzalez-Rivas D, Garcia A, Chen C, et al. Technical aspects of uniportal video-assisted thoracoscopic double sleeve bronchovascular resections. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i14-i22.
4. Liu C, Wang W, Mei J, et al. Uniportal thoracoscopic single-direction basal subsegmentectomy (left s10a+ci): Trans-inferior-pulmonary-ligament approach. Ann Surg Oncol, 2022, 29(2): 1389-1391.
5. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
6. 董懂, 韩丁培, 曹羽钦, 等. 《单孔胸腔镜手术治疗肺癌中国专家共识》解读. 中国胸心血管外科临床杂志, 2021, 28(2): 137-145.Dong D, Han DP, Cao YC, et al. Chinese expert consensus on the uniportal video-assisted thoracoscopic surgery for lung cancer: An interpreation. Chin J Clin Thorac Cardiovasc Surg, 2021, 28(2): 137-145.
7. Vieira A, Bourdages-Pageau E, Kennedy K, et al. The learning curve on uniportal video-assisted thoracic surgery: An analysis of proficiency. J Thorac Cardiovasc Surg, 2020, 159(6): 2487-2495.
8. 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.
9. Sihoe AD. Uniportal video-assisted thoracic (VATS) lobectomy. Ann Cardiothorac Surg, 2016, 5(2): 133-144.
10. Liu R, Tan Q, Huang J, et al. Uniportal video assisted thoracic surgery with 2 cm skin incision for right middle lobectomy with systematic lymphadenectomy. J Thorac Dis, 2017, 9(11): 4592-4596.
11. Zhang H, Yang YS, Nong K, et al. A novel technique to optimize uniportal thoracoscopic right middle lobectomy. Ann Thorac Surg, 2022, 113(4): e303-e305.
12. 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.Wu ZQ, Tang XJ. Progress in the application of single port thoracoscopy surgery. Chin J Minim Invasive Surg, 2020, 26(6): 553-556.
13. Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
14. Gonzalez-Rivas D, Sihoe ADL. Important technical details during uniportal video-assisted thoracoscopic major resections. Thorac Surg Clin, 2017, 27(4): 357-372.
15. Wei S, Guo C, He J, et al. Effect of vein-first vs artery-first surgical technique on circulating tumor cells and survival in patients with non-small cell lung cancer: A randomized clinical trial and registry-based propensity score matching analysis. JAMA Surg, 2019, 154(7): e190972.
16. Ray MA, Smeltzer MP, Faris NR, et al. Survival after mediastinal node dissection, systematic sampling, or neither for early stage NSCLC. J Thorac Oncol, 2020, 15(10): 1670-1681.
17. Rucker AJ, Raman V, Jawitz OK, et al. Effect of lymph node assessment on outcomes in surgery for limited stage small cell lung cancer. Ann Thorac Surg, 2020, 110(6): 1854-1860.
18. Perna V, Carvajal AF, Torrecilla JA, et al. Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: A randomized study. Eur J Cardiothorac Surg, 2016, 50(3): 411-415.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Uniportal thoracoscopic right middle lobectomy via posterior approach in 52 patients: A prospective cohort study

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