Does 11.5 mm guided single port surgery has clinical advantage than multi-port thoracoscopic surgery in spontaneous pneumothorax?

Jeon, Hyun Woo; Kim, Young-Du

doi:10.21037/jtd.2016.10.56

Cited by 10 publications

(9 citation statements)

References 18 publications

(14 reference statements)

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“…VATS is a well-known standard method in PSP because of its benefit, less postoperative pain and early recovery, compared with a thoracotomy (16). Nevertheless, authors found limitations in surgical exposure and technical feasibility of uniportal VATS, and the operation time could be longer than is necessary for three port VATS (17).…”

Section: Discussionmentioning

confidence: 99%

Uniportal video-assisted thoracic surgery for pneumothorax and blebs/bullae

et al. 2017

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Abstract:The last British Society of Thoracic Surgeons guidelines of 2010 for the management of primary spontaneous pneumothorax (PSP) stated that, after the first recurrence, the treatment of PSP should be a surgical operation, like a bullectomy accompanying with a procedure for inducing pleural adhesions. Therefore, the surgical approach is considered the best treatment to minimise the risk of recurrence in patients who experienced a PSP. There is substantial evidence in the literature demonstrating that the minimally invasive approach should be preferred to the thoracotomic procedure since it can reduce the postoperative pain and it is associated with a faster recovery of the physical and working activity. The video-assisted thoracic surgery (VATS) approach has been shown to offer greater advantages about patient pain and respiratory function when compared to thoracotomic incisions. A single port or single incision or uniportal approach was developed as an alternative to the standard multi-port VATS. Uniportal technique has shown to be safe and efficient not only for pulmonary resections and biopsies but also for lobectomy.When used for PSP, the bullectomy/blebectomy and pleural abrasion/pleurectomy is performed through the single incision through which the chest drain is then inserted. In this perspective, evidence showed that the minimally invasive approach should be preferred, confirming the advantages in comparison with traditional techniques. blebectomy and pleural abrasion/pleurectomy is performed through the single incision through which the chest drain is then inserted (3). In this perspective, evidence showed that the minimally invasive approach should be preferred, confirming the advantages in comparison with traditional techniques (4).Here we described the theoretical aspects of the uniportal VATS approach for PSP. Surgical techniqueUniportal VATS allows performing all the main surgical steps recommended for treating patients affected by PSP with the same clinical advantages of the traditional three-port VATS. The VATS technique achieves the exploration of the chest cavity and the lung parenchyma to find blebs/bullae, to resect the diseased areas of the lung, and to perform adequate pleurodesis procedures (e.g., mechanical parietal pleural abrasion, talc poudrage, pleurectomy, etc.) (2).Patient decubitus is in the lateral position. Otherwise, from the standard three-port VATS approach, where the lesion represents the peak of an ideal pyramid, and the camera and instruments are placed in correspondence of the other three pinnacles, the uniportal VATS technique implies that the target, the thoracoscope, and the instruments all lie in the same sagittal plane. Although the single incision is the fulcrum where the parallel devices reach the target, arranging themselves in a craniocaudal direction (5), the surgeon should be free to move inside the chest cavity without the boundaries due to an unfavourable geometry (6). A 1.5-2 cm skin incision at the sixth intercostal space along the middle axillary line...

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Section: Discussionmentioning

confidence: 99%

Uniportal video-assisted thoracic surgery for pneumothorax and blebs/bullae

et al. 2017

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“…This technique allowed us to perform a uniportal thoracoscopic lung resection and pleural abrasion reducing further the skin and intercostal incision without compromising the effectiveness of pneumothorax treatment. Son et al described the anchoring suture technique for single port VATS wedge resection (10,11); in this case the needle is passed through the lung parenchyma instead of creating a loop anchoring the lung.…”

Section: Discussionmentioning

confidence: 99%

Micro-incision thoracoscopic treatment of primary spontaneous pneumothorax: the “loop” technique

et al. 2018

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Primary spontaneous pneumothorax has been defined as the disease of the 'young and healthy'. There are multiple possible therapies and in recent years, surgery has evolved towards the use of the uniportal thoracoscopic approach. The objective of our study is to describe and present an innovative approach to access to the thoracic cavity in patients with spontaneous pneumothorax. The surgery was performed using a single access of 20 mm at the level of the 8th intercostal space. For the isolation and suspension of any dystrophic area, we use a 'loop' of non-absorbable braided suture inserted through the IV intercostal space and successive wedge resection using an endoscopic 10 mm mechanical stapler. Using this access, we were able to visualize and dissect the pulmonary ligament and perform complete pleural abrasion. We had no complications. The operative time was 60 min, the chest tube was removed the 2th postoperative day and the patient was discharged the day after. The operation we propose permits the reduction of the dimension of the access to the thoracic cavity. We were able to resect blebs without problems, the recovery was excellent and no complications related to the procedure were reported.

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“…Inclusion criteria included the following: (1) recurrent pneumothorax after prior medical treatment; (2) patients whose lung collapse exceeded 30% estimated by chest x-ray, and obvious bullae were identified on computed tomography (CT) images; (3) persistent air leak longer than 1 month after chest tube drainage; (4) patients with normal hematology, electrolytes, and liver and kidney function; (5) patients understood the risk of U-VATS such as conversion and bleeding, and voluntarily provided written informed consent. Exclusion criteria were as follows: (1) patients were afraid of the potential risks and refused U-VATS; (2) estimated severe pleural adhesion due to history of thoracic surgery; (3) spontaneous pneumothorax secondary to diffuse emphysema, asthma, fibrosis, thoracic injury, 2 tuberculosis, and malignancy; (4) no significant bullae on CT images, and the chest tube drainage with or without medical pleurodesis was effective; (5) inability of the patients to provide informed consent. This study was approved by the Ethics Committee and Institutional Review Board of Shaoxing People's Hospital (SXPH-ZJ-20190701-014, July 21, 2015).…”

Section: Patient Selectionmentioning

confidence: 99%

“…The reported method for retraction of the target bullae for resection using an anchoring suture was used, 1 and a small access (with a mean length about 15 mm) was created for U-VATS bullectomy in our hospital starting in August 2015. Most of the patients were discharged uneventfully from the hospital within 24 hours after the surgery.…”

Section: Introductionmentioning

confidence: 99%

Next-day discharge following small uniportal thoracoscopic bullectomy assisted with an anchoring suture

Zhang

et al. 2020

J Int Med Res

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Manipulating the instruments during uniportal video-assisted thoracoscopic surgery (U-VATS) bullectomy requires a relatively large incision. This study aimed to investigate the feasibility of next-day discharge following U-VATS bullectomy using an anchoring suture. Methods: A stapler and a scope were inserted through a single incision in the anchoring group. The bullae were retracted by the suture, which was inserted from outside of the chest wall into the thorax, and then bullectomy was performed. For those in the control group, resection of the bullae was performed with the assistance of a grasping forceps. Results: The length of the incision of the patients in the anchoring group ([13.2 AE 2.2] mm) was significantly smaller than in the control group ([26.2 AE 3.9] mm). In addition, the number of staplers used in the anchoring group was significantly less than in the control group ([1.2 AE 0.4] vs. [1.4 AE 0.5]). Furthermore, 36 (92.3%) cases in the anchoring group were uneventfully discharged within 24 hours after bullectomy. Conclusion: Next-day discharge after U-VATS bullectomy through a small incision assisted with an anchoring suture is safe and feasible.

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Does 11.5 mm guided single port surgery has clinical advantage than multi-port thoracoscopic surgery in spontaneous pneumothorax?

Cited by 10 publications

References 18 publications

Uniportal video-assisted thoracic surgery for pneumothorax and blebs/bullae

Uniportal video-assisted thoracic surgery for pneumothorax and blebs/bullae

Micro-incision thoracoscopic treatment of primary spontaneous pneumothorax: the “loop” technique

Next-day discharge following small uniportal thoracoscopic bullectomy assisted with an anchoring suture

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