The impact of novel instrumentation in promoting uniportal video-assisted thoracoscopic surgery.
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ABSTRACT:
SUBMITTER: Alcasid NJ
PROVIDER: S-EPMC10482622 | biostudies-literature | 2023 Aug
REPOSITORIES: biostudies-literature
Publications
The impact of novel instrumentation in promoting uniportal video-assisted thoracoscopic surgery.
Alcasid Nathan J NJ Banks Kian C KC Velotta Jeffrey B JB
Journal of thoracic disease 20230725 8
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Project description:The management of hemothorax (spontaneous or, more often, due to thoracic trauma lesions), follows basic tenets well-respected by cardiothoracic surgeons. In most, a non-operative approach is adequate and safe, with a defined group of patients requiring only tube thoracostomy. Only a minority of patients need a surgical intervention due to retained hemothorax, persistent bleeding or incoming complications, as pleural empyema or entrapped lung. In the early 1990s, the rapid technological developments determined an increase of diagnostic and therapeutical indications for multiport video-assisted thoracoscopic surgery (VATS) as the gold standard therapy for retained and persistent hemothorax, allowing an earlier diagnosis, total clots removal and better tubes placement with less morbidity, reduced post-operative pain and shorter hospital stay. There is no consensus in the literature regarding the timing for draining hemothorax, but best results are obtained when the drainage is performed within the first 5 days after the onset. The traditional multi-port approach has evolved in the last years into an uniportal approach that mimics open surgical vantage points utilizing a non-rib-spreading single small incision. Currently, in experienced hands, this technique is used for diagnostic and therapeutic interventions as hemothorax evacuation as like as the more complex procedures, such as lobectomies or bronchial sleeve and vascular reconstructions.
| S-EPMC5639032 | biostudies-literature
Project description:With the evolution of uniportal video-assisted thoracoscopic surgery (VATS), the technological aids have come to help skill surgeons to improve the results in thoracic surgery and feasible to perform a complex surgery. The technological aids are divided into three important groups, which make surgical steps easy to perform, besides reducing surgical time and surgical accidents in the hands of experienced surgeons. The groups are: (I) conventional thoracoscopic instruments; (II) sealing devices using in uniportal VATS; (III) high definition cameras, robotic arms prototype and the future robotic aids for uniportal VATS surgery. Uniportal VATS is an example of the continuing search for methods that aim to provide the patient a surgical cure of the disease with the lowest morbidity. That is the reason companies are creating more and new technologies, but the surgeon have to choose properly and to know how, when and where is the moment to use each new aids to avoid mistakes. The future of the thoracic surgery is based on evolution of surgical procedures and innovations to try to reduce even more the surgical and anesthetic trauma. This article summarizes the technological aids to improve and help a thoracoscopics surgeons perform a uniportal VATS feasible and safe.
| S-EPMC5638310 | biostudies-literature
Project description:BackgroundThe clinical efficacy of robot-assisted thoracic surgeries has been explored by numerous recent studies. Nonetheless, since current standard robotic systems (da Vinci Xi system) were intended for multiportal surgical processes and robotic staplers were still unavailable in the developing world, obstacles still remain concerning the feasibility of uniportal robotic surgeries.MethodsA hybrid uniportal robotic-assisted thoracoscopic surgery (RATS) modality utilizing video-assisted thoracoscopic surgery (VATS) staplers was investigated in Shanghai Pulmonary Hospital. Clinicopathological characteristics and perioperative outcomes concerning patients receiving hybrid uniportal RATS between August 2022 and September 2022 were collected.ResultsA total of 40 patients were included in this study. Most of the patients (23/40, 57.5%) received hybrid uniportal RATS lobectomies. One conversion from uniportal RATS to biportal process was encountered due to extensive adhesions discovered intraoperatively. The median procedural duration was 76 min [interquartile range (IQR), 61-99 min], and the median blood loss volume was 50 mL (IQR, 50-50 mL). A median stay length of three days (IQR, 2-4 days) was recorded. Eleven patients (27.5%) developed Clavien-Dindo grade I-II postoperative complications, while no grade III-IV complications were observed. Aside from this, none of the patients were readmitted or died within 30 days post-surgery.ConclusionsThe feasibility of hybrid uniportal RATS procedures using VATS staplers has been preliminarily validated. For early-stage non-small cell lung cancer patients, such a procedure might clinical efficacy comparable to that of uniportal RATS utilizing robotic staplers.
| S-EPMC9922775 | biostudies-literature
Project description:In conventional multiportal video-assisted thoracoscopic surgery, devices such as cotton-tipped applicators are used instead of graspers to avoid injuring the fragile lung tissue while stabilizing the lung and securing the surgical visual field. However, in uniportal video-assisted thoracoscopic surgery, which requires the simultaneous use of multiple instruments, the instruments tend to interfere with each other during the procedure because they share a single incisional port. Here, we describe a simple, easy and cost-effective lung retraction technique using cotton swabs to solve the problem. We present this technique and comment on its advantages, including decreased cost and improved surgical visualization.
| S-EPMC8560209 | biostudies-literature
Project description: Not available
| S-EPMC11388257 | biostudies-literature
Project description:ObjectivesPrior reported learning curves for uniportal video-assisted thoracoscopic lobectomy were predominantly based on surgery duration, while reports on complications are limited. Therefore, our study assessed the learning curve based on both technique-related complications and surgery duration.MethodsWe retrospectively collected data from patients who had undergone uniportal video-assisted thoracoscopic lobectomy between 2015 and 2020. Exclusion criteria were concomitant procedures other than ipsilateral wedge resection, discontinued procedures, or lost to follow-up (less than 30 days). Learning curves were constructed per surgeon who performed over 20 procedures using non-risk adjusted cumulative sum (CUSUM) analysis for technique-related complications and cumulative sum analysis for surgery duration. Based on the literature, an acceptable complication rate was set at 30%, an unacceptable complication rate at 45%, and a mean surgery duration of 145 min.ResultsLearning curves were constructed for three thoracic surgeons and one fellow who performed 324 uniportal video-assisted thoracoscopic lobectomies in total. Each surgeon was experienced in multiportal video-assisted thoracoscopic lobectomy, the fellow was familiar with basic multiportal video-assisted thoracoscopic procedures. Cumulative sum charts of three surgeons reached a statistically significant technique-related complication rate below 30% between 50 and 96 procedures. Regarding surgery duration, typical learning curves were observed for three surgeons with a transition point between 14 and 26 procedures.ConclusionsLearning of uniportal video-assisted thoracoscopic surgery for lobectomy is safe without unacceptable complication rates and has a declining surgery duration over time for thoracic surgeons with experience in multiportal video-assisted thoracoscopic lobectomies. However, it remains unknown when the different stages of mastery are completed.
| S-EPMC10469110 | biostudies-literature
Project description:Video 1Incision and port placement of 4 to 5 cm at the fifth or sixth intercostal space between the anterior and the midaxillary line. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00717-3/fulltext.Video 2Dissection of the anterior mediastinal pleura and division of the superior pulmonary vein. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00717-3/fulltext.Video 3Dissection of the apical mediastinal pleura and division of the anterior and apical branches of the pulmonary artery. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00717-3/fulltext.Video 4Dissection and division of the anterior oblique fissure and division of the lingular branches of the pulmonary artery. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00717-3/fulltext.Video 5Dissection and division of the interlobar fissure and the posterior branch of the pulmonary artery. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00717-3/fulltext.Video 6Dissection and division of the left upper lobe bronchus. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00717-3/fulltext.Video 7Lymph node dissection (subaortic, hilar, subcarinal, or inferior pulmonary ligament) and division of the inferior pulmonary ligament. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00717-3/fulltext.Video 8Specimen retrieval. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00717-3/fulltext.Video 9Chest tube placement. Video available at: https://www.jtcvs.org/article/S2666-2507(21)00717-3/fulltext.
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| S-EPMC7656328 | biostudies-literature
Project description:Intubated general anesthesia with one-lung ventilation was traditionally considered necessary for thoracoscopic major pulmonary resections. However, non-intubated thoracoscopic lobectomy can be performed by using conventional and uniportal video-assisted thoracoscopic surgery (VATS). These non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anesthesia but these procedures must only be performed by experienced anesthesiologists and skilled thoracoscopic surgeons. Here we present a video of a uniportal VATS left upper lobectomy in a non-intubated patient, maintaining the spontaneous ventilation.
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