Uniportal video-assisted thoracoscopic anatomic segmentectomy for small-sized lung cancer

Abstract

Increasing evidences prove video-assisted thoracic surgery (VATS) segmentectomy is accepted as a valid alternative to lobectomy esp. a greater number of small lung nodules have been detected.Uniportal VATS segmentectomy for small-sized lung cancer is more challenging not only for technical issues in simple or complex uniportal segmentectomy, but also considering oncological efficacy in terms of localization, safe margin, the extent of lymph node dissection and pathological analysis. In this work, we evaluated our evolving uniportal experience, the surgical technique and decision-making of uniportal VATS segmentectomy for small-sized lung cancer.Keywords: Uniportal; video-assisted thoracic surgery (VATS); segmentectomy; lobectomy; lymph node dissection; localization; small-sized lung cancer Step Procedures already accomplished Jun 4-2016 1 Previous experience in anterior minthoracotomy (>1,000) and biportal lobectomy (>200) and biportal segmentectomy (>71) 2 Uniportal minor procedures (>300) 3 Uniportal lobectomy and segmentectomy (>500) 4 Uniportal for complex cases: segmentectomy 176 (from 2013 Aug 18 th ); sleeve lobectomy 2; sleeve segmentectomy 1; subsegmentectomy 3; segmentectomy with arterioplasty 3; lobectomy with arterioplasty 2; lobectomy with arterioplasty and bronchial reconstruction 1; pneumonectomy 3; central tumor 8; huge tumor >5 cm (6.1-7.0 cm) 9; severe adhesions 45; calcified lymph node 58; bilateral lobectomy 4; bilateral segmentectomy 5; bilobectomy 4; after chemotherapy 3; after TKI therapy 1; mediastinal tumor >50; LVRS >30; subxiphoid approach major resections 3; semisupine position for anterior mediastinal tumor and lobectomy with systematic lymphadectomy 1 5Non-intubated uniportal lobectomy/segmentectomy 18 (from 2015 Dec 31 to 2016 Mar 10)VATS, video-assisted thoracic surgery; LVRS, lung volume reduction surgery; TKI, tyrosine kinase inhibitor. Our uniportal VATS learning curve I evolve my uniportal approach from thoracoscopy-guided anterior minithoracotomy, then two incisions, not ever using the three or four incisions approach. Tables 1 and 2 s u m m a r i z e o u r l e a r n i n g c u r v e a n d a b u n d l e o f troubleshooting solutions to the major pitfalls frequently come across in uniportal VATS learning curve. We believe experienced uniportal lobectomy is a prerequisite for starting uniportal segmentectomy (4-6).Uniportal VATS segmentectomy for small-size lung cancer: patient selection and workup The indication was either a benign lesion or suspected metastasis in which wedge resection is not possible (42 patients), a suspicion of clinical stage I (≤2 cm in diameter) NSCLC (134 patients). The reason for performing a uniportal segmentectomy for patients with an impaired lung function and/or a previous history of pulmonary resection or multiple pure GGO lesions with concurrent resection or a likelihood of having a second or even a third NSCLC resected in the future. However, in spite of controversy still remaining, most of them are good-risk suspected NSCLC patients ...

Anatomical segmentectomy under uniportal video-assisted thoracoscopic surgery for early staged non-small cell lung cancer: a case report

“…There are several recommendations to ensure the safe enough margins: Ginsberg and Rubenstein suggested the extension ≥ of 2 cm or margin-to-tumor ratio ≥1 (18), while Giraud et al concluded the extension <8 and <6 mm for adenocarcinoma and squamous carcinoma respectively (19). In Wang's segmentectomy series, segmental line always 3-5cm beyond which is spacious enough (20). Finally, according to the NCCN guideline, segmentectomy should achieve parenchymal resection margins ≥2 cm or ≥ the size of the nodule.…”

Comparison of uniport versus triport thoracoscopic single or combined basal segmentectomy for stage IA lung cancer

“…Single or combined basal segmentectomy (CBS), excluding common basal segmentectomy, is the most difficult of all types of segmentectomies due to the deeper location of the hilar structures, more structural variation, and more complex intersegmental plane adjacencies. Currently, only a few studies ( 7 , 8 ) have reported on thoracoscopic anatomical basal segmentectomy, and few studies have reported on the uniport approach ( 9 ). We previously published the largest case series on basal segmentectomy ( 10 ) with single-direction lobectomy ( 11 ) and we gradually began exploring uniport thoracoscopic basal segmentectomy (UTBS) and had good results ( 12 ).…”

Uniportal video‐assisted thoracoscopic left S4 anatomical segmentectomy

“…Studies of VATS segmentectomy have mainly focused on posterior, superior, dorsal, basal, and lingular segmentectomy . Lingulectomy is performed with left S4 + S5 segmentectomy.…”

“…1,5 Studies of VATS segmentectomy have mainly focused on posterior, superior, dorsal, basal, and lingular segmentectomy. [6][7][8] Lingulectomy is performed with left S4 + S5 segmentectomy. To the best of our knowledge, left S4 segmentectomy alone has never been reported.…”