Geometrical characteristics of uniportal VATS

Abstract

In terms of accuracy and efficacy Uniportal Video-Assisted Thoracic Surgery (VATS) resections are comparable to standard VATS. In standard three-ports VATS, the geometric configuration of a parallelogram generates interference with the optical source, creating a plane with a torsion angle not favorable on the flat two-dimensional vision of currently available monitors. The potential advantages of single-port VATS approach include not only the one intercostal space incision (reduction of postoperative pain) but also a translational approach of VATS instruments along a sagittal plane. Accordingly, the Uniportal approach enables VATS instruments to draw two parallel lines on the plane, bringing them to approach the target lesion from a caudo-cranial perspective thus achieving a projective plane. As a consequence, taking advantage of the unique spatial features specific to uniportal VATS, the surgeon is enabled to bring the operative fulcrum inside the chest to address the target lesion in a fashion similar to open surgery.

Keywords: Single access thoracoscopy; geometry; minimally invasive thoracic surgery; three access thoracoscopy.

Figure 1

In the three-port access VATS the geometric configuration of lozenge interferes with optical source creating a new optical plane with the genesis of torsion angle (α) that is not favorable with standard two-dimensional monitors.

Figure 2

The Uniportal VATS approach is along a sagittal plane that reaches the target lesion from caudo-cranial perspective in a projective plane preserving the depth of intraoperative visualization (Image courtesy of Dr. Diego Gonzalez Rivas).