Comparison of Postoperative Pain and Recovery between Single-Port and Two-Port Thoracoscopic Lobectomy for Lung Cancer

Objective To investigate whether the single-port (SP) technique had more favorable postoperative outcomes than had the two-port (TP) technique. Methods One hundred sixty-six single-port video-assisted thoracoscopic surgery (SP-VATS) lobectomy and 162 two-port video-assisted thoracoscopic surgery (TP-VATS) lobectomy had been successfully completed between August 2015 and September 2016. A single incision of ∼3 cm was made in an intercostal space along the anterior axillary line. Perioperative outcomes and the safety between SP-VATS and TP-VATS lobectomy for NSCLC was compared. Results In the SP-VATS group, incision size was kept to a minimum, with a median of 3 cm; mediastinal lymph node dissection was performed in all patients with malignancy. Overall, median operative time was 89 minutes, and median chest tube duration was 3.1 days. The VAS on postoperative days 3, 7, and 14 was less in the SP-VATS group than that in the TP-VATS group. The VAS on days 1, 30, 60, 90, 180, and 360 did not differ significantly between the two groups. The number of days of use of analgesic agents after surgery was less in the SP-VATS group. The pathological symptoms of wound pain were significantly less in the SP-VATS group. Conclusions Compared with the multiport approach, SP VATS lobectomy might reduce postoperative pain and lead to faster recovery.

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Nonintubated Uniportal Thoracoscopic Thymectomy with Laryngeal Mask

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1696950 ◽

2019 ◽

Vol 68 (05) ◽

pp. 450-456 ◽

Cited By ~ 1

Author(s):

Zhengcheng Liu ◽

Rusong Yang ◽

Yang Sun

Keyword(s):

Thoracoscopic Surgery ◽

Anterior Mediastinum ◽

Laryngeal Mask ◽

Double Lumen Tube ◽

Perioperative Outcomes ◽

Video Assisted ◽

Incision Size ◽

The Mean ◽

End Tidal ◽

Video Assisted Thoracoscopic Surgery

Abstract Objective To investigate whether laryngeal mask anesthesia had more favorable postoperative outcomes than double-lumen tube intubation anesthesia in uniportal thoracoscopic thymectomy. Methods Data were collected retrospectively from December 2013 to December 2017. A total of 96 patients with anterior mediastinum mass underwent nonintubated uniportal video-assisted thoracoscopic thymectomy with laryngeal mask, and 129 patients underwent intubated uniportal video-assisted thoracoscopic thymectomy. A single incision of ∼3 cm was made in an intercostal space along the anterior axillary line. Perioperative outcomes between nonintubated uniportal video-assisted thoracoscopic surgery (NU-VATS) and intubated uniportal video-assisted thoracoscopic surgery (IU-VATS) were compared. Results In both groups, incision size was kept to a minimum, with a median of 3 cm, and complete thymectomy was performed in all patients. Mean operative time was 61 minutes. The mean lowest SpO2 during operation was not significantly different. However, the mean peak end-tidal carbon dioxide in the NU-VATS group was higher than in the IU-VATS group. Mean chest tube duration in NU-VATS group was 1.9 days. Mean postoperative hospital stay was 2.5 days, with a range of 1 to 4 days. Time to oral fluid intake in the NU-VATS group was significantly less than in the IU-VATS group (p < 0.01). Several complications were significantly less in the NU-VATS group than in the IU-VATS group, including sore throat, nausea, irritable cough, and urinary retention. Conclusion Compared with intubated approach, nonintubated uniportal thoracoscopic thymectomy with laryngeal mask is feasible for anterior mediastinum lesion, and patients recovered faster with less complications.

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Thoracic Epidural for Postoperative Pain Control after Video-Assisted Thoracoscopic Surgery (VATS) Lobectomy in a Patient with Mild Hemophilia A

Austin Journal of Anesthesia and Analgesia ◽

10.26420/austinjanesthesiaanalgesia.2017.1054 ◽

2017 ◽

Vol 5 (1) ◽

Author(s):

Finzer B

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Hemophilia A ◽

Thoracoscopic Surgery ◽

Postoperative Pain Control ◽

Vats Lobectomy ◽

Thoracic Epidural ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

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A Comparison of Operative Outcomes between Single-Port and Multi-Port Video-Assisted Thoracoscopic Surgery (VATS) in Pulmonary Lobectomy

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.10.10696 ◽

2020 ◽

Vol 103 (10) ◽

pp. 1011-1016

Keyword(s):

Surgical Outcomes ◽

Rating Scale ◽

Single Port ◽

Thoracoscopic Surgery ◽

Patient Characteristics ◽

Perioperative Outcomes ◽

Safe Procedure ◽

Pulmonary Lobectomy ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

Background: Single-port video-assisted thoracoscopic surgery (VATS) have been performed in Southeast Asian countries for several years. However, the outcomes of the single-port VATS are still under investigation. Objective: To compare the surgical outcomes between single-port VATS and multi-port VATS in pulmonary lobectomy and to validate its efficacy and safety. Materials and Methods: The outcomes of 130 patients that underwent VATS at the Central Chest Institute of Thailand between January 2015 and May 2018, were reviewed. Patients were classified into two groups, single-port, and multi-port VATS with 68 as single-port and 62 as multi-port cases. Patient characteristics and perioperative outcomes were analyzed and compared. Results: There were no significant differences in patient characteristics between the two groups. The single-port group had a lower Pain Numeric Rating Scale at 24 hours (p=0.022) and shorter length of hospital stay (p=0.044) than the multi-port group. The number of N2 lymph nodes retrieved in the single-port group was significantly higher than in the multi-port group (p=0.022) while other surgical outcomes were not significantly different. There were no significant differences in intraoperative and post-operative complications (p=0.338 and p=0.142, respectively) and no perioperative mortality in both groups. Conclusion: The authors’ experience showed that single-port VATS is a practical technique and safe procedure when compared to multi-port VATS. Keywords: Video-assisted thoracoscopic surgery (VATS), lobectomy, minimally invasive surgery

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Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01590-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jian Wei Tan ◽

Jameelah Sheik Mohamed ◽

John Kit Chung Tam

Keyword(s):

Postoperative Pain ◽

Length Of Stay ◽

Urinary Retention ◽

Feasibility Study ◽

Thoracoscopic Surgery ◽

Early Recovery ◽

Rescue Analgesia ◽

Video Assisted ◽

Pain Scores ◽

Video Assisted Thoracoscopic Surgery

Abstract Background Well-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS. Methods In this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay. Results No technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0–2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1–2). Mean post-operative length of stay was 4.17 ± 2.50 days. Conclusions Incorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.

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