Uniportal video-assisted thoracoscopic major pulmonary resections

Abstract

Uniportal thoracic surgery is being continuously adopted by thoracic units around the world.Growing interest in the procedure is demonstrated by numerous workshops and training programs along every continent. The success of the technique lies in that it does not compromise oncologic principles and be carried out safely when proper training is acquired. For a surgeon to be able to perform a uniportal lobectomy successfully and safely proper steps must be ensuring. Multiple key maneuver and tricks are inherent to the uniportal approach. This article summarizes the equipment and key steps necessary to do a uniportal lobectomy. VATS surgeons that are inexperience or just surpass the learning curve should focus on early stage lung cancer lobectomies and avoid complex cases like reinterventions, sleeve resections, big tumor or cases with lots of benign lymphadenopathy around the hilum or fissure in order to avoid complications such as bleeding during the surgery.During the work up, there are two very important aspects that will inform the surgeon of potential difficulties in a particular case. First patient previous history of tuberculosis, bronchiectasis or previous surgery should prepare the surgeon for adhesions and lymphadenopathies that will make dissection especially difficult. Second the CT image will show big lymph nodes in the probable site of dissection, big lung tumors or anatomical relations that will make the procedure especially difficult to finish without conversion (7).Timely conversion should never be considered a complication but an appropriate step during a VATS procedure. Pre-operative preparationPatients that are candidates for a uniportal VATS lobectomy can undergo the same institutional protocols as other approaches lobectomies (multiport or open lobectomies) and the patient has to know that conversion to an open procedure is a possibility during the procedure as a step to avoid complications or risky situations.It is appropriate to accompany single port MITS with fast track protocols that should began when the surgeon interview the patient in the outpatient clinic managing patient expectations and addressing their concerns. An educational program of respiratory exercises and smoke cessation will be helpful for the postoperative recovery (10).When the surgeon is experience to do so, a pre-operative conference with the anesthesiologist discussing the possibility of a non-intubated uniportal VATS lobectomy is important for a good coordination and safe planning for the surgery. Equipment preferenceOptimal equipment can facilitate and made more comfortable the procedure for the surgeon. The ideal equipment necessary to perform a major lung resection includes:• 30-degree lens high definition camera thorocoscope: provides a very detailed image and permits the assistant to move the angle of the camera to obtain the appropriate visualization around structures during visualization; • Distally mounted charge couple device (CCD): it reduces the fighting between the surgeon and the assistant (11);...

Technological aids in uniportal video-assisted thoracoscopic surgery

“…Optimal equipment can facilitate and made more comfortable the procedure for the surgeon. The ideal equipment necessary to perform a major lung resection includes: 30-degree lens high definition camera thorocoscope: provides a very detailed image and permits the assistant to move the angle of the camera to obtain the appropriate visualization around structures during visualization (7).…”