Uniportal VATS lung resections

Abstract

In this section, information about single-port VATS lung resections is provided. Single-port VATS lung resections were first performed in the early 1990s using 3 or 4 ports. This method has shown excellent results such as less blood loss, reduced pain, shorter hospital stay, and decreased complications. Later, Rocco and others defined single-port access for wedge resections and pleural biopsies in 2004. Single-port VATS lobectomy was first performed by Gonzales-Rivas and others in 2011. This method has been accepted as a popular and beneficial procedure in the following years. In a randomized controlled study conducted by Perna and others in 2016, it was stated that single-port surgery does not have superiority over multi-port surgery. In our clinical opinion, single-port lobectomies provide a safer dissection opportunity due to providing a clear anterior view of the lung hilum. Single-port VATS wedge resection is used in the diagnosis of peripheral lung nodules, metastasectomy, and the treatment of pneumothorax and bullous diseases. The surgical procedure is performed through a 2-3 cm incision in the 4th intercostal space of the patient in the lateral decubitus position. The visible lesion is held with a curved endoscopic clamp and removed by wedge resection using endostaplers. Lesions that cannot be seen or identified by digital palpation can be detected using methylene blue injection under preoperative CT guidance or by using hooked wire or intraoperative ultrasound applications. Single-port VATS lobectomies have indications for multi-port VATS or thoracotomy. All resections should be performed under oncological principles. Hilum dissection should be performed carefully, and mediastinal lymphadenectomy should be applied. In upper lobectomies, the surgeon's positioning only in the anterior part of the patient provides the surgeon with a free range of motion. Usually, an additional incision of 3-5 cm is made in the fourth intercostal space between the mid-axillary lines to access the hilar structures more effectively. Using a wound protector-retractor provides comfortable instrument entry through the incision. However, in patients with adhesions, the ring of the wound protector should not be placed in the thorax before removing the adhesions with finger dissection. The use of special equipment for single-port lobectomies can facilitate the procedure. Especially, a 30-degree video thoracoscope, air-tight devices, vascular clips, and endoscopic staplers make lobectomy much easier. Keeping the camera at the upper part of the incision and having a curved instrument are other facilitating factors of this process. The lobe should be removed in a protective bag, especially in cancer cases. Afterwards, lymphadenectomy should be systematically applied. Intercostal nerve block to be applied after the entire surgical procedure will contribute to postoperative pain management. Finally, a single 24-28 F drain is placed through the additional incision. © 2021 Akademisyen Kitabevi A.Ş. All rights reserved.