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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 159-162

Single-port video-assisted thoracoscopic surgery for the diagnosis of intrathoracic lesions


1 Department of Surgery, Taif University, Saudi Arabia
2 Department of Surgery, Taif University, Saudi Arabia; Department of Surgery, Benha Teaching Hospital, General Organization of Teaching Hospitals and Institutes, Cairo 11341, Egypt
3 Department of Surgery, Taif University, Saudi Arabia; Department of Surgery, Damanhur Teaching Hospital, General Organization of Teaching Hospitals and Institutes, Cairo 11341, Egypt
4 Department of Surgery, King Abdul-Aziz Medical City, National Guard, Jeddah, Saudi Arabia
5 Department of Surgery, Taif University, Saudi Arabia; Department of Surgery, Faculty of Medicine, Ain Shams University, Cairo 11341, Egypt

Date of Web Publication6-Feb-2019

Correspondence Address:
Dr. Majed Al-Mourgi
Department of Surgery, Taif University, Al-Haweiah, P.O. Box. 888, 21974, Taif
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_115_18

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  Abstract 


Background and Aim of Study: Diagnostic and therapeutic uniportal video-assisted thoracic surgery (VATS) is now considered a feasible and safe procedure with good results. In this retrospective chart review study, I will present our experience in diagnostic VATS at King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia. Materials and Methods: The data of 108 patients undergoing uniportal diagnostic VATS in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia, from January 2013 to June 2015, were collected through a review of their hospital records. Results: The study included 108 patients (75 males and 33 females) with a mean age of 36.4 ± 8.1 years. The mean operative time was 28.5 ± 6.7 min. The most common morbidity was intraoperative bleeding that occurred in 15 cases (13.9%) and was easily controlled. Failure of VATS occurred in three cases (2.8%) due to massive adhesions, necessitating minithoracotomy. Reinsertion of the intercostal tube was required in 12 cases (11.1%). The mean duration to removal of the intercostal tube was 4.4 ± 0.9 days. The mean hospital stay was 6.4 ± 1.4 days. No operative or early postoperative mortality was recorded. Conclusion: Uniportal VATS is a safe and effective method for the diagnosis of intrathoracic lesions allowing resection of small localized lesions. It has a limited operative time that is improving with progress in the learning curve.

Keywords: Diagnostic, intrathoracic lesions, Taif, uniportal video-assisted thoracic surgery


How to cite this article:
Al-Mourgi M, Al Saeed M, Al-Jiffry BO, Abdel-Rahman T, Badr S, Younes A, Asaad H, Hatem M. Single-port video-assisted thoracoscopic surgery for the diagnosis of intrathoracic lesions. Saudi J Health Sci 2018;7:159-62

How to cite this URL:
Al-Mourgi M, Al Saeed M, Al-Jiffry BO, Abdel-Rahman T, Badr S, Younes A, Asaad H, Hatem M. Single-port video-assisted thoracoscopic surgery for the diagnosis of intrathoracic lesions. Saudi J Health Sci [serial online] 2018 [cited 2019 Aug 24];7:159-62. Available from: http://www.saudijhealthsci.org/text.asp?2018/7/3/159/251588




  Introduction Top


Uniportal diagnostic and therapeutic video-assisted thoracic surgery (VATS) is accepted by most thoracic surgeons for the management of intrathoracic lesions.[1] The procedure has gained acceptance since it has the same oncological principles of open thoracotomy and multiportal VATS.[2],[3],[4] Uniportal VATS is associated with less pain, less operative trauma, a shorter hospital stay, and a faster postoperative recovery.[1],[2],[3],[4],[5],[6] Although global utilization of the uniportal technique in research and clinical practice has shown promising short-term results, long-term results are lacking.[7],[8],[9] In this retrospective chart review study, we will present our experience using diagnostic VATS in the Department of Thoracic Surgery at King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia.


  Materials and Methods Top


This retrospective chart review study involved 108 patients who underwent uniportal diagnostic VATS in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia, from January 2013 to June 2015. After receiving the approval of the hospital's Ethical Committee and obtaining informed consent from the patients or their relatives, data were collected by review of the patient files. Data collected included demographic features, clinical presentation, imaging reports, operative findings, histopathology, and bacteriological culture results. Data were gathered and analyzed with exclusion of cases with incomplete reports. In addition, cases with lesions invading the chest wall and those requiring rib spreading were excluded from the study.

Regarding the procedure, in most cases, an intercostal chest tube was inserted [Figure 1] and removed to create an opening into the thoracic cavity [Figure 2], through which a 10-mm trocar was introduced. In the remainder of cases, a 1-cm incision was made just anterior to the midaxillary line in the fifth intercostal space for trocar introduction. After trocar introduction, a 10-mm 30° scope with a 5-mm working channel was introduced [Figure 3]. Any intrapleural fluid was suctioned and submitted for chemical and microbiological analyses. Subsequently, a panoramic view was used to explore the intrathoracic structures including the lung, pleura, thoracic wall, diaphragmatic surface, mediastinum, and pericardium [Figure 4], allowing identification of the target areas. All localized nodules were excised. If the lesion was not localized, 3–4 biopsies were obtained using diathermy forceps or harmonic scalpel, and hemostasis was accomplished by direct pressure. In cases of traumatic hemothorax, following suction and exploration, actively bleeding vessels were secured by compression or/and diathermy (cases with major vascular injury were not included in this study). Chest tube was inserted if minor oozing was anticipated. The lung was inflated under direct vision, and the incision was closed.
Figure 1: A patient with inserted intercostal tube in operating room

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Figure 2: The site of removed intercostal tube and the field is prepared for surgery

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Figure 3: Inserting a 10-mm 30° scope with a 5-mm working channel through the site of the removed intercostal tube

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Figure 4: Exploring the chest wall

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Statistical analysis

After coding and tabulation of the collected data, statistical analysis was performed using SPSS program version 18.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were done, and quantitative data were expressed as number, percentage, and mean ± standard deviation.


  Results Top


Demographic data and clinical presentation are shown in [Table 1]. Operative findings and final diagnosis are shown in [Table 2] and [Table 3], respectively. The mean operative time was 28.5 ± 6.7 min. The most common morbidity, intraoperative bleeding, occurred in 15 cases (13.9%) and was easily controlled. Failure of VATS occurred in three cases (2.8%) due to massive adhesions, subsequently requiring minithoracotomy. Reinsertion of an intercostal tube after initial removal was required in 12 cases (11.1%). The mean duration to the removal of the intercostal tube was 4.4 ± 0.9 days. The mean length of hospital stay was 6.4 ± 1.4 days. No operative or early postoperative mortality was recorded.
Table 1: Demographic data and mode of presentation

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Table 2: Operative findings

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Table 3: Final diagnosis

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  Discussion Top


Few randomized controlled trials have compared the role of minimally invasive techniques and open procedures in thoracic surgery.[10] However, the use of uniportal VATS is becoming accepted worldwide with promising results for the diagnosis and treatment of minor and major thoracic and mediastinal pathologies.[1],[2],[3],[4],[5],[6],[7],[8],[9] VATS has been proven by many investigators to be feasible and associated with a decreased postoperative morbidity and a faster recovery.[11],[12] Rocco et al.[1] found that the mean operative time was 18 min for diagnostic uniportal VATS versus 22.5 min in our study. This difference can be explained by more progress in the learning curve in their larger series of patients. Intraoperative bleeding was the most common morbidity in this study, occurring in 13.9% of cases, a slightly higher frequency than that reported in other studies.[1],[3]

Tamura et al.[4] compared the outcomes of uniportal versus multiportal VATS and verified that the uniportal technique had better pain control and a decreased length of hospital stay by 0.5 days (P < 0.05). In addition, they found that the duration of time until chest drain removal was decreased by 1 day (P < 0.05).

For minor thoracic procedures, most authors have shown a statistically significant reduction in pain scores during the inpatient stay. Similar results were reported by Salati et al.[5] In this study, postoperative pain was minimal and required a simple analgesic for control, likely because the incision was limited to a single intercostal space.

The mean duration of time to remove the intercostal tube in this study was 4.4 ± 0.9 days, with a mean hospital stay of 6.4 ± 1.4 days. Rocco et al.[1] reported similar results with intercostal tube removal after a mean of 4.3 days and a mean length of hospitalization after uniportal diagnostic VATS of 5.3 days.

Reinsertion of the intercostal chest tube in this study was required in 11.1% of cases, similar to the 10%–15% frequency of chest tube reinsertion in previous studies.[2],[5] Similar results were also reported by Chen et al.[6] and Jutley et al.[7] Their studies compared uniportal and multiportal VATS in minor procedures and reported no serious complications or mortality in either group. No operative or early postoperative mortality was observed in this study. However, Rocco et al.[1] reported a mortality of 2.4% and related this to associated serious comorbidities.

In this study, uniportal VATS helped to confirm the diagnosis in 97.2% of cases. In the other 2.8% of cases, a minithoracotomy was required to establish the diagnosis. In a study by Aragón and Perez Mendez,[3] a minithoracotomy was required in 9.7% of cases.

It appears clear that uniportal VATS used in minor procedures for diagnostic purposes carries a significant advantage over multiport approaches that have been associated with higher pain scores, longer hospital stays, and higher costs.[1],[4],[5],[6],[7],[8] Postoperative pain is decreased in uniportal VATS because there is less contact with surgical instruments. Adverse events are rare, with the possibility of infection or seroma at one surgical site in multiple studies; only one surgical-site infection and one seroma have been reported in patients undergoing uniportal VATS.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] Nonetheless, Mier et al.[12] reported no differences between the uniportal and multiportal approaches in mean operative time, hospital stay, pain scale, or total surgical material cost, even though they reported a higher satisfaction rate in patients of the uniportal group regarding wound scarring. However, additional larger randomized studies should be done to further clarify the potential benefits of uniportal VATS.


  Conclusion Top


Uniportal VATS is a safe and effective method for the diagnosis of intrathoracic lesions. It allows for the resection of small localized lesions and has a limited operative time that is continuing to improve with progress in the learning curve.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rocco G, Martucci N, La Manna C, Jones DR, De Luca G, La Rocca A, et al. Ten-year experience on 644 patients undergoing single-port (uniportal) video-assisted thoracoscopic surgery. Ann Thorac Surg 2013;96:434-8.  Back to cited text no. 1
    
2.
Ismail M, Helmig M, Swierzy M, Neudecker J, Badakhshi H, Gonzalez-Rivas D, et al. Uniportal VATS: The first German experience. J Thorac Dis 2014;6:S650-5.  Back to cited text no. 2
    
3.
Aragón J, Pérez Méndez I. From open surgery to uniportal VATS: Asturias experience. J Thorac Dis 2014;6:S644-9.  Back to cited text no. 3
    
4.
Tamura M, Shimizu Y, Hashizume Y. Pain following thoracoscopic surgery: Retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery. J Cardiothorac Surg 2013;8:153.  Back to cited text no. 4
    
5.
Salati M, Brunelli A, Xiumè F, Refai M, Sciarra V, Soccetti A, et al. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax: Clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thorac Surg 2008;7:63-6.  Back to cited text no. 5
    
6.
Chen YB, Ye W, Yang WT, Shi L, Guo XF, Xu ZH, et al. Uniportal versus biportal video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis. Chin Med J (Engl) 2009;122:1525-8.  Back to cited text no. 6
    
7.
Jutley RS, Khalil MW, Rocco G. Uniportal vs. standard three-port VATS technique for spontaneous pneumothorax: Comparison of post-operative pain and residual paraesthesia. Eur J Cardiothorac Surg 2005;28:43-6.  Back to cited text no. 7
    
8.
Grossi W, Masullo G, Londero F, Morelli A. Small incisions, major complications: Video-assisted thoracoscopic surgery management of intraoperative complications. J Vis Surg 2018;4:12.  Back to cited text no. 8
    
9.
McElnay PJ, Molyneux M, Krishnadas R, Batchelor TJ, West D, Casali G, et al. 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.  Back to cited text no. 9
    
10.
Rocco G, Internullo E, Cassivi SD, Van Raemdonck D, Ferguson MK. The variability of practice in minimally invasive thoracic surgery for pulmonary resections. Thorac Surg Clin 2008;18:235-47.  Back to cited text no. 10
    
11.
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.  Back to cited text no. 11
    
12.
Mier JM, Chavarin A, Izquierdo-Vidal C, Fibla JJ, Molins L. A prospective study comparing three-port video-assisted thoracoscopy with the single-incision laparoscopic surgery (SILS) port and instruments for the video thoracoscopic approach: A pilot study. Surg Endosc 2013;27:2557-60.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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