No abstract

Background: We aimed to analyze perioperative complications, postoperative neuropathic pain, and the necessity of epidural anesthesia in uniportal video-assisted thoracoscopic surgery (U-VATS) compared to conventional multiportal VATS (M-VATS) for anatomical lung resection. Methods: This retrospective study included all patients who underwent elective VATS lobectomy and segmentectomy between April 2016 and December 2019. The exclusion criteria were as follows: age ≤19 years, planned thoracotomy, re-operation in thoracic surgery, median sternotomy, robot-assisted thoracic surgery, simultaneous resection of extrathoracic organs, locally invasive lung tumor with bronchoplasty or angioplasty, past or current neuropathic pain, and a large tumor with a minimum diameter ≥5 cm. M-VATS had 4 ports approach. U-VATS port positions were placed by extending the thoracoscope port of M-VATS. Results: U-VATS patients showed significant differences compared to M-VATS patients: smaller intraoperative bleeding (1 vs. 30 mL; P=0.0010), shorter operative time (141 vs. 183 min; P<0.0001), posthospitalization (5 vs. 8 days; P=0.0002), fewer complications (23.9% vs. 40.9%; P=0.048), less acute pain, less postoperative neuropathic pain (32.4% vs. 52.1%; P=0.027) and shorter duration of neuropathic pain (30 vs. 60 days; P=0.041). For the postoperative neuropathic pain and pain score until postoperative day 5, there were no differences between the groups with and without epidural anesthesia. Conclusions: As a single-center initial experience, U-VATS lobectomy and segmentectomy seemed safe and minimally invasive based on not only postoperative neuropathic pain and complications but also time management. U-VATS would provide better pain control, without epidural anesthesia.

No abstract

In Japan, cotton is commonly used in thoracic surgery for the gentle handling of organs as well as obtaining a good surgical field. While uniportal video-assisted thoracoscopic surgery is being recognized as a major surgical approach, use of cotton is not noted in this technique. Uniportal video-assisted thoracoscopic surgery needs curved instruments because they are effective in preventing the interference of instruments. Thus, we developed a novel curved cotton instrument, known as the "CS Two-Way Handle TM ", for uniportal video-assisted thoracoscopic surgery. The CS Two-Way Handle TM can be used not only as a cotton bar but also as a suction aid. Moreover, surgical smoke can be suctioned with the insertion of cotton.This instrument was introduced in our institution in September 2019, along with some other prototypes.When anatomical lung resection using uniportal video-assisted thoracoscopic surgery was first introduced, there were some instances of conversion to conventional multiportal video-assisted thoracoscopic surgery.However, after the CS Two-Way Handle TM introduction, the procedure has become easy to perform and the need for conversion to conventional methods has reduced. The main uses of the CS Two-Way Handle TM are: (I) exposure of the surgical view, (II) lymph node dissection, (III) bleeding control, (IV) suction, and (V) evacuation of surgical smoke. We present our experiences using the CS Two-Way Handle TM in uniportal video-assisted thoracoscopic surgery.

Background: Manual aspiration as the initial management of a large pneumothorax in a clinically stable patient has been reported to be safe and effective. However, the effect with smaller needles, the number of aspiration, the indication other than spontaneous pneumothorax and failure factors are unknown. We assessed the effectiveness and failure risk factors of manual aspiration up to three using a 20-or 22-gauge (G) needle in patients with a large, clinically stable pneumothorax.Methods: We included 107 clinically stable patients with large pneumothorax. Patients who were unstable, required a ventilator, underwent chest tube drainage or had an observed small pneumothorax, bilateral pneumothorax, hemopneumothorax, or postoperative pneumothorax were excluded. Up to three aspirations were performed using 20-or 22-G intravenous needles. When the aspiration volume was ≥2,500 mL or lung expansion did not occur, a chest tube was placed. Results:The first aspiration was successful in 57 patients (53.3%), the second in 16 patients (59.3%), and the third in eight patients (80.0%). No patient experienced any obvious complications or required emergent hospitalization or surgery after aspiration. Aspiration failure was correlated with an inter-pleural distance >20 mm at the level of the hilum (odds ratio: 4.93; 95% confidence interval: 1.49-22.71; P=0.0075), spontaneous secondary pneumothorax (odds ratio: 3.11; 95% confidence interval: 1.14-8.76; P=0.027), and ≤24 h from onset to presentation (odds ratio: 2.95; 95% confidence interval: 1.12-8.26; P=0.028). There were no significant differences in intrathoracic pressure after aspiration or plasma factor XIII levels between patients with resolved and persistent pneumothorax.Conclusions: Manual aspiration up to three times using a small needle might be one of a treatment option in clinically stable patients with any large pneumothorax. Aspiration failure was correlated with an inter-pleural distance >20 mm at the level of the hilum, spontaneous secondary pneumothorax, and ≤24 h from onset to presentation.