Uniportal thoracoscopic surgery: from medical thoracoscopy to non-intubated uniportal video-assisted major pulmonary resections

Abstract

The development of thoracoscopy has more than one hundred years of history since Jacobaeus described the first procedure in 1910. He used the thoracoscope to lyse adhesions in tuberculosis patients. This technique was adopted throughout Europe in the early decades of the 20 th century for minor and diagnostic procedures.It is only in the last two decades that interest in minimally invasive thoracic surgery was reintroduced by two key technological improvements: the development of better thoracoscopic cameras and the availability of endoscopic linear mechanical staplers. From these advances the first video-assisted thoracic surgery (VATS) major pulmonary resection was performed in 1992. In the following years, the progress of VATS Currently, experts in the technique are able to use uniportal VATS to encompass the most complex procedures such as bronchial sleeve, vascular reconstructions or carinal resections. In contrast, non-intubated and awake thoracic surgery techniques, described since the early history of thoracic surgery, peaked in the decades before the invention of the double lumen endotracheal tube and have failed to gain widespread acceptance following their re-emergence over a decade ago thanks to the improvements in VATS techniques.

Comparison of Diagnostic Yield and Safety between Semirigid Pleuroscopic Cryobiopsy and Forceps Biopsy for Undiagnosed Pleural Effusion

“…First thoracoscopy was performed by Jacobaeus in 1910 [14]. VATS further developed with the availability of endoscopic linear mechanical staplers and thoracoscopic cameras from thoracoscopy [15]. Conventional VATS included 3-4 ports, and some studies have reported using a uniport approach during surgery [16].…”

Video-assisted thoracic surgery ( conventional and single-port ) - place and role in the improved management of malignant pleural effusions: review article

“…S et al (48). Described and introduced by many authors over the last few years methodology of non-intubation single-port and conventional VATS, performed under potentiated local anesthesia of breathing lung has increased the possibilities for these methods to be applied to patients with contraindications for general anesthesia with one lung ventilation (6,8,13,17,(49)(50)(51)(52)(53)(54)(55)(56)(57)(58). All authors engaged with the topic claim, and we totally support them in our study, that there is no better way to deal with MPE than talc poudrage pleurodesis, performed together with a diagnostic assessment done by VATS methods (1, 2, 4, 6-11, 16-20, 29, 32, 37, 38, 43, 47, 50, 56, 59-62).…”

Bronchusmanschettenresektion: aktuelle Operationstechnik und Komplikationsmanagement

“…Huang et al haben in einem aktuellen Paper sehr ausführlich die verschiedenen Schritte der VATS-Manschettenresektionen beschrieben [30]. Ebenfalls 2013 beschrieben Gonzalez-Rivas et al die erste uniportale (single port) VATS-Lobektomie und zuletzt die "non-intubated-uniportal"-VATS-Resektion mit der gleichen Nahttechnik [12,31]. Vorteile der uniportalen VATS sind der…”