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

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

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1666835 ◽

2018 ◽

Vol 67 (02) ◽

pp. 142-146 ◽

Cited By ~ 1

Author(s):

Zhengcheng Liu ◽

Rusong Yang ◽

Feng Shao

Keyword(s):

Postoperative Pain ◽

Single Port ◽

Thoracoscopic Surgery ◽

Mediastinal Lymph Node ◽

Perioperative Outcomes ◽

Vats Lobectomy ◽

Video Assisted ◽

Incision Size ◽

Wound Pain ◽

Video Assisted Thoracoscopic Surgery

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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What counts more: the patient, the surgical technique, or the hospital? A multivariable analysis of factors affecting perioperative complications of pulmonary lobectomy by video-assisted thoracoscopic surgery from a large nationwide registry

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz187 ◽

2019 ◽

Vol 56 (6) ◽

pp. 1097-1103

Author(s):

Maurizio V Infante ◽

Cristiano Benato ◽

Ronaldo Silva ◽

Gaetano Rocco ◽

Alessandro Bertani ◽

...

Keyword(s):

Thoracoscopic Surgery ◽

Complication Rates ◽

Safe Procedure ◽

Pulmonary Lobectomy ◽

Vats Lobectomy ◽

Video Assisted ◽

Nationwide Registry ◽

Significant Difference ◽

Low Volume ◽

Video Assisted Thoracoscopic Surgery

Abstract OBJECTIVES Inherent technical aspects of pulmonary lobectomy by video-assisted thoracoscopic surgery (VATS) may limit surgeons’ ability to deal with factors predisposing to complications. We analysed complication rates after VATS lobectomy in a prospectively maintained nationwide registry. METHODS The registry was queried for all consecutive VATS lobectomy procedures from 49 Italian Thoracic Units. Baseline condition, tumour features, surgical techniques, devices, postoperative care, complications, conversions and the reasons thereof were detailed. Univariable and multivariable regressions were used to assess factors potentially linked to complications. RESULTS Four thousand one hundred and ninety-one VATS lobectomies in 4156 patients (2480 men, 1676 women) were analysed. The median age-adjusted Charlson index of the patients was 4 (interquartile range 3–6). Grade 1 and 2 and Grade 3–5 complications were observed in 20.1% and in 5.8%, respectively. Ninety-day mortality was 0.55%. The overall conversion rate was 9.2% and significantly higher in low-volume centres (<100 cases, P < 0.001), but there was no significant difference between intermediate- and high-volume centres under this aspect. Low-volume centres were significantly more likely to convert due to issues with difficult local anatomy, but not significantly so for bleeding. Conversion, lower case-volume, comorbidity burden, male gender, adhesions, blood loss, operative time, sealants and epidural analgesia were significantly associated with increased postoperative morbidity. CONCLUSIONS VATS lobectomy is a safe procedure even in medically compromised patients. An improved classification system for conversions is proposed and prevention strategies are suggested to reduce conversion rates and possibly complications in less-experienced centres.

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Single utility port or single port complete video-assisted thoracoscopic surgery for pulmonary lobectomy

Heart Lung and Circulation ◽

10.1016/j.hlc.2014.12.101 ◽

2015 ◽

Vol 24 ◽

pp. e49

Author(s):

Qeng Qing ◽

Fan Tao

Keyword(s):

Single Port ◽

Thoracoscopic Surgery ◽

Pulmonary Lobectomy ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

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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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Rhomboid intercostal block combined with sub-serratus plane block versus rhomboid intercostal block for postoperative analgesia after video-assisted thoracoscopic surgery: a prospective randomized-controlled trial

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01432-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wei Deng ◽

Xiao-min Hou ◽

Xu-yan Zhou ◽

Qing-he Zhou

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Thoracoscopic Surgery ◽

Controlled Trial ◽

Ultrasound Guided ◽

Video Assisted ◽

Prospective Randomized Controlled Trial ◽

Numerical Rating ◽

Intercostal Block ◽

Video Assisted Thoracoscopic Surgery

Abstract Background Rhomboid intercostal block (RIB) and Rhomboid intercostal block with sub-serratus plane block (RISS) are the two types of plane blocks used for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). This prospective randomized controlled trial was performed to analyze the postoperative analgesic effects of ultrasound-guided RIB block and RISS block after video-assisted thoracoscopic surgery. Methods Ninety patients aged between 18 and 80 years, with American Society of Anesthesiologists physical status Classes I–II and scheduled for elective unilateral VATS were randomly allocated into three groups. In group C, no block intervention was performed. Patients in group RIB received ultrasound-guided RIB with 20-mL 0.375% ropivacaine and those in group RISS received ultrasound-guided RIB and serratus plane block using a total of 40-mL 0.375% ropivacaine. All patients received intravenous sufentanil patient-controlled analgesia upon arrival in the recovery room. Postoperative sufentanil consumption and pain scores were compared among the groups. Results The dosages of sufentanil consumption at 24 h after the surgery in the RIB and RISS groups were significantly lower than that in group C (p < 0.001 and p < 0.001 for all comparisons, respectively), the postoperative Numerical Rating Scale (NRS) scores in the RIB and RISS groups at 0.5, 1, 3, 6, 12, 18, and 24 h after surgery when patients were at rest or active were significantly lower than that in group C (p < 0.05 for all comparisons). The required dosage of sufentanil and time to first postoperative analgesic request in groupRISS were less than those in the group RIB at 24 h after the surgery (p < 0.001 and p < 0.001 for all comparisons, respectively). Similarly, the Numerical Rating Scale scores for group RISS at 12, 18, and 24 h after the surgery when the patients were active were significantly lower than those for group RIB (p < 0.05 for all comparisons). Conclusion Both ultrasound-guided RIB block and RISS block can effectively reduce the demand for sufentanil within 24 h after VATS, and less sufentanil dosage is needed in patient with RISS block. Ultrasound-guided RIB block and RISS block can effectively relieve pain within 24 h after VATS, and RISS block is more effective.

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Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562015000000212 ◽

2016 ◽

Vol 42 (3) ◽

pp. 185-190 ◽

Cited By ~ 6

Author(s):

Ricardo Mingarini Terra ◽

Pedro Henrique Xavier Nabuco de Araujo ◽

Leticia Leone Lauricella ◽

José Ribas Milanez de Campos ◽

Herbert Felix Costa ◽

...

Keyword(s):

Robotic Surgery ◽

Thoracic Surgery ◽

Thoracoscopic Surgery ◽

Sao Paulo ◽

Pathological Examination ◽

São Paulo ◽

Pulmonary Lobectomy ◽

Video Assisted ◽

Tertiary Teaching ◽

Video Assisted Thoracoscopic Surgery

ABSTRACT Objective: To describe the implementation of a robotic thoracic surgery program at a public tertiary teaching hospital and to analyze its initial results. Methods: This was a planned interim analysis of a randomized clinical trial aimed at comparing video-assisted thoracoscopic surgery and robotic surgery in terms of the results obtained after pulmonary lobectomy. The robotic surgery program developed at the Instituto do Câncer do Estado de São Paulo, in the city of São Paulo, Brazil, is a multidisciplinary initiative involving various surgical specialties, as well as anesthesiology, nursing, and clinical engineering teams. In this analysis, we evaluated the patients included in the robotic lobectomy arm of the trial during its first three months (from April to June of 2015). Results: Ten patients were included in this analysis. There were eight women and two men. The mean age was 65.1 years. All of the patients presented with peripheral tumors. We performed right upper lobectomy in four patients, right lower lobectomy in four, and left upper lobectomy in two. Surgical time varied considerably (range, 135-435 min). Conversion to open surgery or video-assisted thoracoscopic surgery was not necessary in any of the cases. Intraoperative complications were not found. Only the first patient required postoperative transfer to the ICU. There were no deaths or readmissions within the first 30 days after discharge. The only postoperative complication was chest pain (grade 3), in two patients. Pathological examination revealed complete tumor resection in all cases. Conclusions: When there is integration and proper training of all of the teams involved, the implementation of a robotic thoracic surgery program is feasible and can reduce morbidity and mortality.

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