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Needlescopic-assisted thoracoscopic pulmonary anatomical lobectomy and segmentectomy for lung cancer: a bridge between multiportal and uniportal thoracoscopic surgery

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Abstract

Purpose

Needlescopic instruments allow us to perform complex laparoscopic procedures, which are almost painless and scarless postoperatively; however, their utilization in thoracoscopic surgery has been limited to minor procedures, including bullectomy and sympathectomy. We present our initial experience of performing thoracoscopic anatomical lung resection via a single utility incision with additional needlescopic working ports and compare the operative results with those of uniportal video-assisted thorascopic surgery (VATS).

Methods

We reviewed data on 75 consecutive patients with lung cancer, who underwent anatomical lung resections, including lobectomy and segmentectomy, between February 2015 and September 2017. Of the 75 patients, 39 underwent uniportal VATS (uniportal group), and 36 underwent needlescopic-assisted VATS (n-VATS group). We compared the peri- and postoperative outcomes of the two groups.

Results

The clinical characteristics did not differ significantly between the groups, except in the ages of the patients. The n-VATS group had a shorter operation time (mean 159.3 min vs. 198.8 min, P = 0.023) and lower intraoperative blood loss (mean 40.9 mL vs. 143.2 mL, P = 0.047). Two major pulmonary arterial bleeding events and one conversion to thoracotomy occurred in the uniportal group.

Conclusion

Uniportal VATS can be performed more efficiently and safely with the assistance of additional needlescopic ports and instruments, without compromising the benefits of less postoperative pain and early recovery.

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References

  1. Bao F, Ye P, Yang Y, Wang L, Zhang C, Lv X, et al. Segmentectomy or lobectomy for early stage lung cancer: a meta-analysis. Eur J Cardiothorac Surg. 2014;46:1–7.

    Article  Google Scholar 

  2. Zhang L, Li M, Yin R, Zhang Q, Xu L. Comparison of the oncologic outcomes of anatomic segmentectomy and lobectomy for early-stage non-small cell lung cancer. Ann Thorac Surg. 2015;99:728–37.

    Article  Google Scholar 

  3. Tu CC, Hsu PK. Global development and current evidence of uniportal thoracoscopic surgery. J Thorac Dis. 2016;8(Suppl 3):308–18.

    Google Scholar 

  4. Yu PS, Capili F, Ng CS. Single port VATS: recent developments in Asia. J Thorac Dis. 2016;8(Suppl 3):302–7.

    Google Scholar 

  5. Rocco G. One-port (uniportal) video-assisted thoracic surgical resections–a clear advance. J Thorac Cardiovasc Surg. 2012;144:27–31.

    Article  Google Scholar 

  6. Gonzalez-Rivas D, Fieira E, Delgado M, Mendez L, Fernandez R, de la Torre M. Evolving from conventional video-assisted thoracoscopic lobectomy to uniportal: the story behind the evolution. J Thorac Dis. 2014;6(Suppl 6):599–603.

    Google Scholar 

  7. Ismail M, Swierzy M, Nachira D, Rückert JC, Gonzalez-Rivas D. Uniportal video-assisted thoracic surgery for major lung resections: pitfalls, tips and tricks. J Thorac Dis. 2017;9:885–97.

    Article  Google Scholar 

  8. Gonzalez-Rivas D, Yang Y, Ng C. Advances in uniportal video-assisted thoracoscopic surgery: pushing the envelope. Thorac Surg Clin. 2016;26:187–201.

    Article  Google Scholar 

  9. Kim TS, Kim KH, An CH, Kim JS. Single center experiences of needlescopic grasper assisted single incision laparoscopic cholecystectomy for gallbladder benign disease: comparison with conventional 3-port laparoscopic cholecystectomy. Ann Surg Treat Res. 2016;91:233–8.

    Article  Google Scholar 

  10. Inoue S, Kajiwara M, Teishima J, Matsubara A. Needlescopic-assisted laparoendoscopic single-site adrenalectomy. Asian J Surg. 2016;39:6–11.

    Article  Google Scholar 

  11. Krpata DM, Ponsky TA. Needlescopic surgery: what’s in the toolbox? Surg Endosc. 2013;27:1040–4.

    Article  Google Scholar 

  12. Yim AP, Liu HP, Lee TW, Wan S, Arifi AA. ‘Needlescopic’ video-assisted thoracic surgery for palmar hyperhidrosis. Eur J Cardiothorac Surg. 2000;17:697–701.

    Article  CAS  Google Scholar 

  13. Chen JS, Hsu HH, Kuo SW, Tsai PR, Chen RJ, Lee JM, et al. Needlescopic versus conventional video-assisted thoracic surgery for primary spontaneous pneumothorax: a comparative study. Ann Thorac Surg. 2003;75:1080–5.

    Article  Google Scholar 

  14. Kim HK, Jo WM, Jung JH, Chung WJ, Shim JH, Choi YH, et al. Needlescopic lung biopsy for interstitial lung disease and indeterminate pulmonary nodules: a report on 65 cases. Ann Thorac Surg. 2008;86:1098–103.

    Article  Google Scholar 

  15. McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18:1007–19.

    Article  CAS  Google Scholar 

  16. Migliore M, Halezeroglu S, Molins L, Van Raemdonck D, Mueller MR, Rea F, et al. Uniportal video-assisted thoracic surgery or single-incision video-assisted thoracic surgery for lung resection: clarifying definitions. Fut Oncol. 2016;12:5–7.

    Article  CAS  Google Scholar 

  17. Bertolaccini L, Rocco G, Pardolesi A, Solli P. The geometric and ergonomic appeal of uniportal video-assisted thoracic surgery. Thorac Surg Clin. 2017;27:331–8.

    Article  Google Scholar 

  18. Sihoe AD. The evolution of minimally invasive thoracic surgery: implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis. 2014;6(Suppl 6):604-17.

    Google Scholar 

  19. Tagaya N, Kubota K. Reevaluation of needlescopic surgery. Surg Endosc. 2012;26:137–43.

    Article  Google Scholar 

  20. Gould JC, Frydman J. Reverse-alignment surgical skills assessment. Surg Endosc. 2007;21:669–71.

    Article  Google Scholar 

  21. Dunnican WJ, Singh TP, Ata A, Bendana EE, Conlee TD, Dolce CJ, et al. Reverse alignment “mirror image” visualization as a laparoscopic training tool improves task performance. Surg Innov. 2010;17:108–13.

    Article  Google Scholar 

  22. Johnston WK, Low RK, Das S. Image converter eliminates mirror imaging during laparoscopy. J Endourol. 2003;17:327–31.

    Article  Google Scholar 

  23. Gill RS, Al-Adra DP, Mangat H, Wang H, Shi X, Sample C. Image inversion and digital mirror-image technology aid laparoscopic surgery task performance in the paradoxical view: a randomized controlled trial. Surg Endosc. 2011;25:3535–9.

    Article  Google Scholar 

  24. Hirai K, Takeuchi S, Usuda J. Single-incision thoracoscopic surgery and conventional video-assisted thoracoscopic surgery: a retrospective comparative study of perioperative clinical outcomes. Eur J Cardiothorac Surg. 2016;49(Suppl 1):i37–41.

    PubMed  Google Scholar 

  25. McElnay PJ, Molyneux M, Krishnadas R, Batchelor TJ, West D, Casali G. Pain and recovery are comparable after either uniportal or multiport video-assisted thoracoscopic lobectomy: an observation study. Eur J Cardiothorac Surg. 2015;47:912–5.

    Article  Google Scholar 

  26. Yang HC, Cho S, Jheon S. Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery. Surg Endosc. 2013;27:139–45.

    Article  CAS  Google Scholar 

  27. Song IH, Lee SY, Lee SJ. Can single-incision thoracoscopic surgery using a wound protector be used as a first-line approach for the surgical treatment of primary spontaneous pneumothorax? A comparison with three-port video-assisted thoracoscopic surgery. Gen Thorac Cardiovasc Surg. 2015;63:284–9.

    Article  Google Scholar 

  28. Sihoe AD, Manlulu AV, Lee TW, Thung KH, Yim AP. Pre-emptive local anesthesia for needlescopic video-assisted thoracic surgery: a randomized controlled trial. Eur J Cardiothorac Surg. 2007;31:103–8.

    Article  Google Scholar 

  29. Sandri A, Sihoe AD, Salati M, Gonzalez-Rivas D, Brunelli A. Training in uniportal video-assisted thoracic surgery. Thorac Surg Clin. 2017;27:417–23.

    Article  Google Scholar 

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Acknowledgements

We thank the staff of Biotechnology R&D Center, National Taiwan University Hospital, Hsin-Chu Branch for their assistance with the study design and statistical analysis.

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Authors and Affiliations

  1. Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan

    Huan-Jang Ko, Shun-Mao Yang & Ming-Chi Yang

  2. Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Xu-Heng Chiang & Shun-Mao Yang

Authors
  1. Huan-Jang Ko
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  2. Xu-Heng Chiang
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Correspondence to Shun-Mao Yang.

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Conflict of interest

Drs. Huan-Jang Ko, Xu-Heng Chiang, Shun-Mao Yang, and Ming-Chi Yang have no conflicts of interest or financial ties to disclose.

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Ko, HJ., Chiang, XH., Yang, SM. et al. Needlescopic-assisted thoracoscopic pulmonary anatomical lobectomy and segmentectomy for lung cancer: a bridge between multiportal and uniportal thoracoscopic surgery. Surg Today 49, 49–55 (2019). https://doi.org/10.1007/s00595-018-1707-y

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  • DOI: https://doi.org/10.1007/s00595-018-1707-y

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