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Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery

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Abstract

Background

Single-incision thoracoscopic surgery (SITS) is postulated to cause less incisional pain, less paresthesia, and less wound scarring than the conventional three-port approach. The difficulties performing the technique have prevented it from being widely accepted. This study shows how the authors overcame the difficulties by using the SILS port and proved it to be a safe and useful procedure for the treatment of primary spontaneous pneumothorax (PSP).

Methods

The same surgeon operated on all the patients using the three-port technique (n = 13) and SITS (n = 27) under the same procedural and management policy. The two groups were retrospectively compared in terms of operation time, postoperative complications, hospital stay, pain score, residual paresthesia, satisfaction regarding the wound scar, and surgical material cost.

Results

The mean age, sex ratio, and previous pneumothorax episodes were similar between the two groups. The uniport and three-port groups did not differ statistically in terms of mean operation time (74.6 ± 22.8 vs 72.4 ± 20.2 min; p = 0.77), hospital stay (2.3 ± 0.7 vs 2.5 ± 0.8 days; p = 0.72), visual analog pain scale (on the day of surgery: 4.1 ± 1.7 vs 4.8 ± 2.2, p = 0.26; on day 1: 3.2 ± 1.4 vs 2.8 ± 1.4, p = 0.33; on day 2: 2.7 ± 1.0 vs 2.6 ± 1.1, p = 0.61), or total surgical material cost (US$1,810 ± $320 vs $1,741 ± $329; p = 0.58). However, the uniport group had a lower incidence of paresthesia than the three-port group (33.3 vs 76.9 %; p = 0.01) and showed a higher satisfaction rate regarding wound scarring (70.4 vs 30.7 %; p = 0.03).

Conclusions

Compared with the three-port approach, SITS using the SILS port in PSP patients proved to be a safe and feasible procedure that can be clinically implemented without additional economic burden or operation time. Additionally, SITS showed better cosmesis with minimized neurologic sequelae, which contributed to higher satisfaction among patients. Progress in uniport instruments and surgical experience will lead to wider applications of SITS.

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References

  1. Levi JF, Kleinmann P, Riquet M, Debesse B (1990) Percutaneous parietal pleurectomy for recurrent spontaneous pneumothorax. Lancet 336:1577–1578

    Article  CAS  PubMed  Google Scholar 

  2. McKenna R Jr (1995) Vats lobectomy with mediastinal lymph node sampling or dissection. Chest Surg Clin North Am 5:223–232

    Google Scholar 

  3. Rocco G, Martin-Ucar A, Passera E (2004) Uniportal VATS wedge pulmonary resections. Ann Thorac Surg 77:726–728

    Article  PubMed  Google Scholar 

  4. Jutley RS, Khalil MW, Rocco G (2005) Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: comparison of postoperative pain and residual paraesthesia. Eur J Cardiothorac Surg 28:43–46

    Article  PubMed  Google Scholar 

  5. Rocco G, Khalil M, Jutley R (2005) Uniportal video-assisted thoracoscopic surgery wedge lung biopsy in the diagnosis of interstitial lung diseases. J Thorac Cardiovasc Surg 129:947–948

    Article  PubMed  Google Scholar 

  6. Rocco G, La Rocca A, La Manna C, Scognamiglio F, D’Aiuto M, Jutley R, Martucci N (2006) Uniportal video-assisted thoracoscopic surgery pericardial window. J Thorac Cardiovasc Surg 131:921–922

    Article  PubMed  Google Scholar 

  7. Salati M, Brunelli A, Xiume F, Refai M, Sciarra V, Soccetti A, Sabbatini A (2008) Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax: clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thorac Surg 7:63–66

    Article  PubMed  Google Scholar 

  8. Chen P-R, Chen C-K, Lin Y-S, Huang H-C, Tsai J-S, Chen C-Y, Fang H-Y (2011) Single-incision thoracoscopic surgery for primary spontaneous pneumothorax. J Cardiothorac Surg 6:58

    Article  PubMed  Google Scholar 

  9. Prasad R, Arthur LG, Timmapuri SJ, Schwartz MZ, Fairbanks TJ, Mendelson KG, Thatch K, Moront ML (2011) Early experience with single-incision thoracoscopic surgery in the pediatric population. J Laparoendosc Adv Surg Tech A 21:189–192

    Article  PubMed  Google Scholar 

  10. Rocco G, La Rocca A, Martucci N, Accardo R (2011) Awake single-access (uniportal) video-assisted thoracoscopic surgery for spontaneous pneumothorax. J Thorac Cardiovasc Surg 142:944–945

    Google Scholar 

  11. Gonzalez D, de la Torre M, Paradela M, Fernandez R, Delgado M, Garcia J, Fieira E, Mendez L (2011) Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases. Eur J Cardiothorac Surg 40:e21–e28

    Article  PubMed  Google Scholar 

  12. Castro OG, Gonzalez LB, Gomez ES (2010) Single-port thorascopic surgery using the SILS tool as a novel method in the surgical treatment of pneumothorax. Arch Bronconeumol 46:439–441

    Article  Google Scholar 

  13. Sihoe AD, Au SS, Cheung ML, Chow IK, Chu KM, Law CY, Wan M, Yim AP (2004) Incidence of chest wall paresthesia after video-assisted thoracic surgery for primary spontaneous pneumothorax. Eur J Cardiothorac Surg 25:1054–1058

    Article  PubMed  Google Scholar 

  14. Sawada S, Watanabe Y, Moriyama S (2005) Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: evaluation of indications and long-term outcome compared with conservative treatment and open thoracotomy. Chest 127:2226–2230

    Article  PubMed  Google Scholar 

  15. Waller DA, Forty J, Morritt GN (1994) Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax. Ann Thorac Surg 58:372–376 discussion 376–377

    Article  CAS  PubMed  Google Scholar 

  16. Mouroux J, Elkaim D, Padovani B, Myx A, Perrin C, Rotomondo C, Chavaillon JM, Blaive B, Richelme H (1996) Video-assisted thoracoscopic treatment of spontaneous pneumothorax: technique and results of one hundred cases. J Thorac Cardiovasc Surg 112:385–391

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to J. Patrick Barron, Professor, International Medical Communications Center, Tokyo Medical College and Advisory Professor, Seoul National University Bundang Hospital for pro bono review of the manuscript. We also thank Jieun Han, RN, for her excellent assistance with the data collection and analysis.

Disclosures

Hee Chul Yang, Sukki Cho, and Sanghoon Jheon have no conflicts of financial ties to disclose.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    Hee Chul Yang, Sukki Cho & Sanghoon Jheon

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  1. Hee Chul Yang
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  2. Sukki Cho
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Correspondence to Sanghoon Jheon.

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Yang, H.C., Cho, S. & Jheon, S. Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery. Surg Endosc 27, 139–145 (2013). https://doi.org/10.1007/s00464-012-2381-6

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  • DOI: https://doi.org/10.1007/s00464-012-2381-6

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