Feasibility of single-incision thoracoscopic surgery using a modified chest wall pulley for primary spontaneous pneumothorax: a propensity score matching analysis

Tsuboshima, Kenji; Nagata, Machiko; Wakahara, Teppei; Matoba, Yasumi; Maniwa, Yoshimasa

doi:10.1007/s00595-017-1483-0

Cited by 13 publications

(11 citation statements)

References 14 publications

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“…Other authors have used different devices such as a mini loop retractor, 11 a percutaneous hookwire, 12 or pulled traction threads to lift the target lesion without the need for a grasper. 13 In this way, the port accommodates only 2 instruments at any one time instead of three, which theoretically reduces the risk of collision between surgical instruments and the length of the port incision. However, none of these strategies has yet come into widespread use because they need more expensive devices and/or particular technical skills to lift the lesion in the loop retractor or to suture the parietal pleura from the thoracic cavity with a chest wall pulley.…”

Section: Discussionmentioning

confidence: 99%

“…Gentle extrathoracic manipulation of the suture lifts the lesion and creates an angle that facilitates stapler wedge resection. Compared to previous methods, 7–13 our strategy does not need special devices; only a 0 suture and a sponge, widely available. Yet, as the suture traction is not accommodated within a uniportal incision, it does not interfere with the movement of other surgical devices inside or outside the thoracic cavity, facilitating handling and resection of the lesion.…”

Section: Discussionmentioning

confidence: 99%

“…During uniportal VATS, the camera and endoscopic instruments are inserted into the thoracic cavity through the same incision, which may increase the risk of collision between surgical instruments and limit their manipulation. To facilitate this procedure, several techniques have been proposed, 7–13 often requiring special tools or cumbersome surgical maneuvers, which limits their wide adoption into clinical practice. We describe a new strategy to facilitate the management of PSP during uniportal VATS, and to test its validity, we compared the outcomes of our modified technique with those of conventional 3-port VATS.…”

Section: Introductionmentioning

confidence: 99%

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Uniportal thoracoscopic surgical management using a suture traction for primary pneumothorax

Fiorelli

Cascone

Carlucci

et al. 2020

Asian Cardiovasc Thorac Ann

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Background We devised a new strategy using suture traction to facilitate the management of primary spontaneous pneumothorax during uniportal thoracoscopy. To test its validity, we compared the outcomes of our modified technique with those of conventional three-port thoracoscopy. Methods This retrospective study included all 43 consecutive patients with primary spontaneous pneumothorax undergoing thoracoscopy between January 2017 and December 2019. They were divided within two groups: uniportal thoracoscopy using suture traction ( n = 21) and conventional 3-port thoracoscopy ( n = 22). Postoperative pain, paresthesia, patient satisfaction, and surgical outcomes were compared to test the validity of our technique. Results There were no significant differences in operative time (47 ± 4.8 vs. 43 ± 7.9 min), number of staples used (2.5 ± 0.9 vs. 2.3 ± 0.6), postoperative drainage (235 ± 15 vs. 240 ± 19 mL), chest tube drainage time (3.2 ± 0.8 vs. 3.4 ± 1.8 days), and hospital stay (4.2 ± 1.2 vs. 4.3 ± 0.9 days). However, uniportal thoracoscopy was associated with less pain at 24 ( p = 0.01), 48 ( p = 0.02), and 72 h ( p = 0.03) postoperatively, less paresthesia at 24 ( p = 0.03), 48 ( p = 0.02), and 72 h ( p = 0.02) postoperatively, and greater patient satisfaction at 24 ( p = 0.04), 48 ( p = 0.02), and 72 h ( p = 0.02) postoperatively. Conclusions Our technique may facilitate the use of uniportal thoracoscopy for treatment of primary spontaneous pneumothorax, reducing neurological sequelae and improving patient satisfaction compared to the traditional three-port thoracoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Uniportal thoracoscopic surgical management using a suture traction for primary pneumothorax

Fiorelli

Cascone

Carlucci

et al. 2020

Asian Cardiovasc Thorac Ann

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“…Transthoracic thoracoscopic surgery is the most commonly employed approach to the thoracic cavity. Liu CC [4] reported that they had performed a case of thoracoscopic lobectomy through the subxiphoid approach as an access to the chest for a patient with lung cancer in the left upper lobe. Recently, Hernandez-Arenas reported their initial experience of 153 consecutive patients with uniportal, video-assisted, subxiphoid approach to major lung resection [7].…”

Section: Discussionmentioning

confidence: 99%

Subxiphoid vs transthoracic approach thoracoscopic surgery for spontaneous pneumothorax: a propensity score-matched analysis

et al. 2019

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Background The transthoracic thoracoscopic surgery is currently accepted as a favorable technique for bullectomy for primary spontaneous pneumothorax. Recently, uniportal subxiphoid thoracoscopic surgery has been proposed as an alternative to conventional transthoracic thoracoscopic surgery. Methods From November 2014 and January 2016, 127 consecutive patients who met the inclusion criteria were enrolled in this study. Among these patients, 32 were treated using subxipoid approach, whereas 95 were treated using transthoracic approach. Propensity score case-matching was performed to adjust for patient backgrounds. Results The two groups of 32 pairs were well matched for baseline and surgical characteristics. Patients who underwent subxipoid approach had a longer operation time than transthoracic approach ( p = 0.004). The subgroup analysis showed that the operation time for bilateral bullectomy was similar between the groups ( p = 0.986). There were no differences between the groups with respect to the hospital stay after surgery, chest drain duration, the number of the staples used for the operation, and postoperative recurrence. However, the provoked arrhythmias events during surgery were significantly higher in the subxiphoid approach group ( p = 0.011). Conclusions Although transthoracic thoracoscopic surgery for spontaneous pneumothorax is well established, uniportal subxiphoid thoracoscopic surgery may be a potentially alternative way to management of patients with spontaneous pneumothorax in selected cases, especially for bilateral surgery, but causions should be taked.

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“…Recently Tsuboshima et al (12) described good results using a technique called modified Chest Wall Pulley (mPulLE) for Lung Excision. In their approach the lung is suspended using a kind of pulley through a single incision.…”

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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Feasibility of single-incision thoracoscopic surgery using a modified chest wall pulley for primary spontaneous pneumothorax: a propensity score matching analysis

Abstract: The surgical results of mPulLE in patients with PSP with multiple lesions were equivalent to those achieved with three-port VATS under the same conditions.

Cited by 13 publications

References 14 publications

Uniportal thoracoscopic surgical management using a suture traction for primary pneumothorax

Uniportal thoracoscopic surgical management using a suture traction for primary pneumothorax

Subxiphoid vs transthoracic approach thoracoscopic surgery for spontaneous pneumothorax: a propensity score-matched analysis

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

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