A single-trocar technique for minimally invasive surgery of the chest

Abstract

Background

In thoracic surgery, the classic thoracoscope is used to perform simple maneuvers in the chest. We have devised a minimally invasive technique that requires only a single trocar. This technique is used in our department to diagnose and treat a wide range of thoracic pathologies.

Methods

Between October 1998 and August 1999, 37 patients underwent surgery prospectively for a thoracic disease through a single trocar. There were 19 men and 18 women with a mean age of 60 years (range, 40–85). The trocar was flexible or soft and had a diameter of 15–20 mm. A 2-cm skin incision was made in the planned intercostal space. The chest drain was always inserted under video control.

Results

The mean operative time was 53 ± 5 min. One patient developed intraoperative bleeding that required intubation and a 5-cm mini-thoracotomy. In one patient with stage II empyema, it was necessary to insert another trocar. Chest tubes were removed after 77.7 ± 7 h. Hospital stay was 4 ± 1 days (range, 2–14). Histologic examination revealed malignant disease in 26 cases and benign disease in 11. Two patients (5.4%) developed wound infections. None of the patients had port site metastasis. There were no hospital deaths.

Conclusion

Because of its simplicity, we recommend the use of this mini-invasive technique in place of the classic thoracoscope or video-mediastinoscope.