Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS)

Abstract

OBJECTIVES Our goal was to report the results of the first consensus paper among international experts in uniportal video-assisted thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi process, the objective of which was to define and standardize the main procedural steps, optimize its indications and perioperative management and identify elements to assist in future training. METHODS The 40 members of the working group were convened and organized on a voluntary basis by the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). An e-consensus finding exercise using the Delphi method was applied to require 75% agreement for reaching consensus on each question. Repeated iterations of anonymous voting continued for 3 rounds. RESULTS Overall, 31 international experts from 18 countries completed all 3 rounds of questionnaires. Although a technical quorum was not achieved, most of the responders agreed that the maximum size of a UniVATS incision should be ≤4 cm. Agreement was reached on many points outlining the currently accepted definition of a UniVATS lobectomy, its indications and contraindications, perioperative clinical management and recommendations for training and future research directions. CONCLUSIONS The UVIG Consensus Report stated that UniVATS offers a valid alternative to standard VATS techniques. Only longer follow-up and randomized controlled studies will predict whether UniVATS represents a valid alternative approach to multiport VATS for major lung resections or whether it should be performed only in selected cases and by selected centres. The next step for the ESTS UVIG is the establishment of a UniVATS section inside the ESTS databases.

Subxiphoid uniportal video assisted thoracoscopic lobectomy in a pediatric patient

“…Besides the cosmetic and early postoperative morbidity concerns, some of the crucial benefits of thoracoscopic surgery in children (which may not affect the adult patients) are decreasing the risk of musculoskeletal deformity (asymmetric chest wall, scoliosis, rib fusion, and winged scapula) that may be noted after posterolateral thoracotomy in younger patients [10][11][12] . In adult patients, a natural progression and evolving of thoracoscopic techniques resulted recently in the evolution of uniportal VATS technique [3][4][5][6]13] . Mastering the technique of uniportal VATS in adults requires intensive training to pass the learning curve to be applied safely in adults [6] .…”

“…The surgical literature contains very few cases, which have been conducted only by experts in this field, and most centers in the world still adopt the traditional methods, either open thoracotomy or the multiportal VATS technique [1,2] . After gaining extensive experience in single-port surgery in all its forms in adults and performing it at an advanced level, we started to apply this technique in children as well [3][4][5][6][7] . One of the challenges a surgeon may face during a lobectomy in children through the intercostal approach is the small space between the ribs, which may make the instrumentation very difficult and challenging [7] .…”

Thoracic cancer surgery during the COVID-19 pandemic: a consensus statement from the Thoracic Domain of the Asian Society for Cardiovascular and Thoracic Surgery

“…The ideal number of experts in the panel needed to reach a useful consensus in the medical field using the Delphi method is unknown. 12,14 Therefore, the number of further experts invited was based on recently published consensus statements in the field of thoracic surgery in which the Delphi method was used. 14 The survey was emailed to all experts in the COVID-19 Thoracic Experts Panel (Thoracic Domain members plus invited experts) via the secretariat of the ASCVTS president in two rounds.…”

“…12,14 Therefore, the number of further experts invited was based on recently published consensus statements in the field of thoracic surgery in which the Delphi method was used. 14 The survey was emailed to all experts in the COVID-19 Thoracic Experts Panel (Thoracic Domain members plus invited experts) via the secretariat of the ASCVTS president in two rounds. The first round of the survey took place in April 11-12, 2020, and all experts answered the questions without consulting each other.…”

Oncological advantage of nonintubated thoracic surgery: Better compliance of adjuvant treatment after lung lobectomy

“…We performed multiportal and uniportal VATS methods for intubated and NITS procedures as previously mentioned in the literature. [19][20][21] The multiportal procedure was used until June 2015.…”