Skip to main content

Advertisement

SpringerLink
Log in

Totally thoracoscopic versus standard VATS lobectomies: perioperative differences

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

Minimally invasive surgery is considered the gold standard approach for early stage lung cancer. Techniques range from a standard three-port approach to uniportal lobectomies, with no technique emerging as superior thus far. We retrospectively compared the pain outcomes of a standard approach using a utility incision with a totally thoracoscopic technique.

Methods

Between January 2015 and December 2019, 168 patients received a VATS lobectomy in our centers. Two groups were created, Group A (82 patients, totally thoracoscopic approach) and Group B (86 patients, standard approach with utility incision). Perioperative outcomes, such as operative time, complications, length of stay, perioperative and chronic pain using visual analog scale (VAS), and rescue doses of painkillers were examined. A one-way analysis of covariance (ANCOVA) was conducted to investigate the impact of surgical time and days of drainage on VAS score.

Results

Pain was less on postoperative day (POD) 1 and 2 (p = 0.025 and p = 0.020, respectively) in Group A. No differences were found in the baseline and perioperative characteristics of the two groups, in the mean VAS score at 1 month (p = 0.429), 1 year (p = 0.561), doses of NSAIDs (p = 0.609), and chronic pain (3vs7 patients, p = 0.220). The ANCOVA test showed no significant effect of surgical time and days of drainage on VAS score (p > 0.05).

Conclusions

In our experience, a totally thoracoscopic approach may improve acute postoperative pain without compromising the oncological results of the procedure and the safety of the patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ettinger DS, Wood DE, Aisner DL, et al. Non-small cell lung cancer, version 5.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2017;15:504–35.

    Article  Google Scholar 

  2. McKenna RJ, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1100 cases. Ann Thorac Surg. 2006;81(2):421–5 (discussion 425-6).

    Article  Google Scholar 

  3. Roviaro G, Varoli F, Rebuffat C, et al. Major pulmonary resections: pneumonectomies and lobectomies. Ann Thorac Surg. 1993;56(3):779–83.

    Article  CAS  Google Scholar 

  4. Peng Z, Li H, Zhang C, et al. A retrospective study of chronic post-surgical pain following thoracic surgery: prevalence, risk factors, incidence of neuropathic component, and impact on qualify of life. PLoS ONE. 2014;9(2):e90014.

    Article  Google Scholar 

  5. Wildgaard K, Ravn J, Nikolajsen L, et al. Consequences of persistent pain after lung cancer surgery: a nationwide questionnaire study. Acta Anaesthesiol Scand. 2011;55(1):60–8.

    Article  CAS  Google Scholar 

  6. Taioli E, Lee DS, Lesser M, et al. Long-term survival in video-assisted thoracoscopic lobectomy vs open lobectomy in lung-cancer patients: a meta-analysis. Eur J Cardiothorac Surg. 2013;44(4):591–7.

    Article  Google Scholar 

  7. Hernandez-Vaquero D, Vigil-Escalera C, Pérez-Méndez I, et al. Survival after thoracoscopic surgery or open lobectomy: systematic review and meta-analysis. Ann Thorac Surg. 2021;111(1):302–13.

    Article  Google Scholar 

  8. Dolci G, Campisi A, Giunta D, et al. Video-assisted thoracoscopic surgery lobectomy using “the caudal approach”: results and evolution. J Vis Surg. 2017;14(3):187.

    Article  Google Scholar 

  9. Bin Yameen TA, Gupta V, Behzadi A. Uniportal versus multiportal video-assisted thoracoscopic surgery in the treatment of lung cancer: a Canadian single-centre retrospective study. Can J Surg. 2019;62(6):468–74.

    Article  Google Scholar 

  10. Balderson SS, D’Amico TA. Thoracoscopic lobectomy for the management of non-small cell lung cancer. Curr Oncol Rep. 2008;10(4):283–6.

    Article  Google Scholar 

  11. Fournel L, Zaimi R, Grigoroiu M, Stern JB, Gossot D. Totally thoracoscopic major pulmonary resections: an analysis of perioperative complications. Ann Thorac Surg. 2014;97(2):419–24.

    Article  Google Scholar 

  12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  13. Maguire MF, Ravenscroft A, Beggs D, et al. A questionnaire study investigating the prevalence of the neuropathic component of chronic pain after thoracic surgery. Eur J Cardiothorac Surg. 2006;29:800–5.

    Article  Google Scholar 

  14. Merskey H, Bogduk H. Classification of chronic pain. In: Merskey H, Bogduk H, editors. Descriptions of chronic pain syndromes and definitions of pain terms. 2nd ed. Seattle, WA: IASP Press; 1994. p. 143–4.

    Google Scholar 

  15. Vannucci F, Gonzalez-Rivas D. Is VATS lobectomy standard of care for operable non-small cell lung cancer? Lung Cancer. 2016;100:114–9.

    Article  Google Scholar 

  16. Bendixen M, Jørgensen OD, Kronborg C, et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol. 2016;17(6):836–44.

    Article  Google Scholar 

  17. Tosi D, Nosotti M, Bonitta G, Italian VATS Group, et al. Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database. Interact Cardiovasc Thorac Surg. 2019;29(5):714–21. https://doi.org/10.1093/icvts/ivz153 (Erratum in: Interact Cardiovasc Thorac Surg. 2019 Nov 1;29(5):821).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ko HJ, Chiang XH, Yang SM, Yang MC. Needlescopic-assisted thoracoscopic pulmonary anatomical lobectomy and segmentectomy for lung cancer: a bridge between multiportal and uniportal thoracoscopic surgery. Surg Today. 2019;49(1):49–55.

    Article  Google Scholar 

  19. Dunning J, Elsaegh M, Nardini M, et al. Microlobectomy: a novel form of endoscopic lobectomy. Innovations (Phila). 2017;12(4):247–53.

    Article  Google Scholar 

  20. Lutz JA, Seguin-Givelet A, Grigoroiu M, et al. Oncological results of full thoracoscopic major pulmonary resections for clinical stage I non-small-cell lung cancer. Eur J Cardiothorac Surg. 2019;55:263–70.

    Article  Google Scholar 

  21. Alzahrani T. Pain relief following thoracic surgical procedures: a literature review of the uncommon techniques. Saudi J Anaesth. 2017;11(3):327–31.

    Article  Google Scholar 

  22. Dell’Amore A, Campisi A, Giunta D, et al. The influence of the trocar choice on post-operative acute pain after thoracoscopy. J Vis Surg. 2018;4:104.

    Article  Google Scholar 

  23. Fournel L, Zaimi R, Grigoroiu M, et al. Totally thoracoscopic major pulmonary resections: an analysis of perioperative complications. Ann Thorac Surg. 2014;97(2):419–24.

    Article  Google Scholar 

Download references

Funding

No funding used.

Author information

Authors and Affiliations

  1. Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy

    Alessio Campisi, Angelo Paolo Ciarrocchi, Giorgio Grani, Desideria Argnani, Marco Trotta, Jessica Nesci, Fabio Davoli, Franco Stella & Maurizio Salvi

Authors
  1. Alessio Campisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angelo Paolo Ciarrocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giorgio Grani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Desideria Argnani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marco Trotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jessica Nesci
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fabio Davoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Franco Stella
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Maurizio Salvi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization—AC, MS, and FS. Data curation—AC, MT, and JN. Formal analysis—AC, APC, and JN. Funding acquisition—None. Investigation—AC and FD. Methodology—AC, GG, DA, and FD. Project administration—MS and FS. Resources—none. Softwares—AC. Supervision—MS and FS. Validation—AC and APC. Visualization—AC. Writing—original draft—AC and APC. Writing—review & editing—MS and FS.

Corresponding author

Correspondence to Alessio Campisi.

Ethics declarations

Conflict of interest

No conflict of interest to declare.

Ethical approval

The study was approved by the institutional review board of University of Bologna (the ID approval number was not produced) and written informed consent was obtained from all patients. All figures and tables are original and have not been published before.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Campisi, A., Ciarrocchi, A.P., Grani, G. et al. Totally thoracoscopic versus standard VATS lobectomies: perioperative differences. Gen Thorac Cardiovasc Surg 70, 642–650 (2022). https://doi.org/10.1007/s11748-022-01787-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-022-01787-6

Keywords

Search

Navigation