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How far will minimally invasive thoracic surgery go? Uniportal video-assisted thoracoscopic lingulectomy with 1 cm incision complicated by a mediastinal lingual artery: A case report.

ABSTRACT: Here, we present the case of a 36-year-old female patient who was found to have a ground-glass nodule (GGN) in the left lingual segment on chest computed tomography (CT) and who successfully underwent lingulectomy via 1?cm incision uniportal video-assisted thoracoscopic surgery (VATS). This is a technically safe and feasible procedure in selected patients and produces better cosmetic results than traditional thoracoscopic surgery.

SUBMITTER: Zhang X

PROVIDER: S-EPMC7919128 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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How far will minimally invasive thoracic surgery go? Uniportal video-assisted thoracoscopic lingulectomy with 1 cm incision complicated by a mediastinal lingual artery: A case report.

Zhang Xining X Lin Gang G Li Jian J

Thoracic cancer 20210118 5

Here, we present the case of a 36-year-old female patient who was found to have a ground-glass nodule (GGN) in the left lingual segment on chest computed tomography (CT) and who successfully underwent lingulectomy via 1 cm incision uniportal video-assisted thoracoscopic surgery (VATS). This is a technically safe and feasible procedure in selected patients and produces better cosmetic results than traditional thoracoscopic surgery. ...[more]

PMID: 33463039

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Project description:Video-assisted thoracoscopic surgery (VATS) is the standard approach in early-stage non-small cell lung cancer (NSCLC) and surgical aspirators play a crucial role. Traditional aspirators lack the ability to pull and lift tissue and cannot achieve optimal exposure. Therefore, we designed a new surgical aspirator that combined the function of thoracoscopic forceps. In this study, we aimed to validate the efficacy and safety of this new surgical aspirator. We performed a prospective non-randomized intervention trial and enrolled 504 consecutive patients scheduled for uniportal VATS in early NSCLC requiring mediastinal lymph node dissection. A novel aspirator we developed with a clamping function via a front pliers-like structure was implemented in intervention group, whereas traditional aspirator was used in control group. Time spent for nodal dissection in No. 2/4R and No. 7R/L (No. 7 lymph nodes resected through right or left side) lymph nodes and perioperative adverse events related to lymph node dissection were recorded. Mann-Whitey U test was applied to analyze sex and pathological type, an independent-samples t-test was applied to analyze surgery time and age. In total, 250 of enrolled patients were allocated into traditional aspirator group and 254 of them were allocated into new aspirator group. Surgeons spent 544.71±120.80 (range, 332-917, median 541) seconds dissecting No. 2/4R lymph nodes with traditional aspirators and 507.54±100.00 (range, 348-702, median 520) seconds dissecting with new aspirators (P=0.008). The traditional aspirator group had an average surgery time of 507.11±104.61 (range, 310-785, median 510) seconds for No. 7R lymph nodes and 608.47±128.50 (range, 397-919, median 606) seconds for No. 7L lymph nodes, while that in the new aspirator group was 465.09±94.94 (range, 271-744, median 476) seconds (P=0.001) and 549.39±102.11 (range, 368-782, median 538) seconds (P<0.001). The new aspirator showed an efficacy advantage in mediastinal lymph node dissection in VATS, without additional risk. This is the first report about a new suction device combining the functions of both traditional surgical aspirators and forceps, which can effectively shorten the time of mediastinal lymph node dissection and improve the efficiency of thoracoscopic surgery without increasing lymph node dissection-related adverse events.

Project description:BackgroundNon-intubated uniportal video-assisted thoracoscopic surgery (niVATS) is a novel approach to major and minor lung resection. It benefits from a holistic anesthesiological concept with adequate pain relief and sedation in a minimal-invasive setup allowing thoracic procedures under spontaneous breathing. At present no anesthesiological gold standard for niVATS exists. The primary aim of our retrospective observational study was to evaluate feasibility and safety of minimally invasive niVATS for both minor and major pulmonary resections at our institution.MethodsAll 88 consecutive patients scheduled for niVATS minor or major thoracic procedures were included into the study. Anaesthesia was performed according to a departmental niVATS algorithm including both regional anaesthesia and sedation. Patient characteristics and early outcome data including intraoperative and postoperative findings were compared between groups. Prediction scores for postoperative complications (LAS VEGAS, ARISCAT, ThRCRI) were calculated and compared.ResultsNo early mortality and a low overall morbidity rate of 28.4% were encountered. Conversion to orotracheal intubation was required in 6.8% of all cases. Postoperative pulmonary complications occurred in 15.9% of total cases and were lower than predicted by both LAS VEGAS and ARISCAT respectively. Cardiac complications were found in 1.1% and lower than predicted by ThRCRI. A persistent air leak occurred in 11.4% of total cases and was significantly higher in major resection. Postoperative chest tube duration and hospital length of stay in the major resection group exceeded times reported by other groups.ConclusionsniVATS appears to be safe in both minor and major thoracic procedures. A minimally invasive anaesthesiological approach foregoing central iv lines, arterial blood pressure measurement and urinary catheterization is feasible. Our niVATS protocol appears to be a viable alternative for both minor and major thoracic procedures in selected patients.

Dataset Information

How far will minimally invasive thoracic surgery go? Uniportal video-assisted thoracoscopic lingulectomy with 1 cm incision complicated by a mediastinal lingual artery: A case report.

Publications

How far will minimally invasive thoracic surgery go? Uniportal video-assisted thoracoscopic lingulectomy with 1 cm incision complicated by a mediastinal lingual artery: A case report.

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