Uniportal video-assisted thoracic surgery for esophageal cancer

Abstract

Classical video-assisted thoracic surgery (VATS) approach to esophageal cancer uses four incisions. The rationale is to facilitate movement of the instruments and the esophagus and also suturing during placement of a purse-string suture for an intrathoracic anastomosis. Uniportal VATS (U-VATS) is challenge for surgeons, as you have to do an esophageal mobilization and anastomosis from a single 3-5 cm incision. The incision is placed either at the 5th or 6th intercostal space close to the posterior axillary line. Esophagus is mobilized en bloc with the subcarinal and periesophageal lymph nodes. The crucial parts are inclusion of subcarinal lymph node in the specimen, mobilization of the specimen from the left main bronchus and esophagogastric anastomosis. Esophagus is encircled with a thick penrose drain and retracted anterior and posteriorly during this dissection. Once the esophagus is completely mobilized, if an intrathoracic anastomosis is to be performed, gastric conduit is pulled inside the chest in correct orientation. A linear completely stapled side to side anastomosis is performed. A thick tissue endoscopic stapler is used for posterior and anterior wall. A single chest drain is placed and incision is closed. There are several intrathoracic anastomotic techniques. All of these techniques can be applied through a uniportal approach. Side to side completely stapled anastomosis is safe, fast and easy to perform. There is a single report on esophagectomy comparing uniportal and multiportal VATS approaches in esophageal cancer which showed comparable results in terms of duration of surgery, amount of bleeding, lymph node yield and leak rates. U-VATS for esophageal cancer is emerging as a new approach and the technique is feasible and certainly future studies will show if it is reproducible and provides a clinical advantage for the patient.

Uniportal Thoracoscopic McKeown Esophagectomy

“…In 2016, Lee et al [2] reported the single-incision laparothoracoscopic minimally invasive esophagectomy to treat esophageal cancer for the first time. Dmitrii [3] and Batirel [4] also reported the experience of uniportal thoracoscopic esophagectomy. Recently, Yuan et al [5] have also carried out single-port thoracoscopic esophagectomy.…”

Uniportal, single incision VATS for the skeptics

“…After an historical view, world famous anesthesiologists and thoracic surgeons gave their marvelous contributions to the development of this relatively new "exciting" surgical approach in thoracic surgery (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

Axillary uniportal video-assisted thoracoscopic surgery for bullae is a cosmetically superior approach to primary spontaneous pneumothorax: a case report

“…When the bullae rupture, air enters the pleural cavity from the lung, the negative pressure of the pleural cavity disappears, and the lung tissue is compressed and collapsed, resulting in chest tightness, chest pain, and dyspnea. With the development of medical devices and minimally invasive techniques, video-assisted thoracoscopic surgery (VATS) has been widely used to treat a variety of thoracic diseases including bullae [ 1 ]. To the best of our knowledge, VATS bullectomy via the axillary incision approach has not yet been reported.…”