Uniportal video-assisted thoracic surgery: the Middle East experience

Abstract

Background: The application of uniportal video-assisted thoracic surgery (VATS) for both minor and major thoracic procedures is gaining widespread use across the globe. Believing its advantages, both in superb surgical results and less morbidity, our center has the privilege to be one of the first centers in the Middle East to introduce this surgical technique into our standard practice. This study presents our initial experience using this technique in 192 procedures and demonstrates the results of postoperative pain level in a sample of 90 patients.

Methods: In a retrospective study of prospectively collected data, 192 uniportal VATS procedures were analyzed between November 2013 and June 2016. The level of early post-operative pain (postoperative days 1-4) was analyzed in the first 90 cases between November 2013 and March 2015. Uniportal technique was used for a wide array of procedures: blebectomies, pleurectomies, wedge resections, anatomical major lung resections, mediastinal tumors, empyema drainage and decortications.

Results: The mean age of patients was 49.6 years, and 72 patients were females (37%). Thirty-five (18.2%) patients underwent anatomical resections with conversion to thoracotomy in three patients (8%). Six (3%) patients had air leak >4 days. The average chest drain duration was 3.25 days. The average length of stay was 4.2 days. Postoperative pain level was low in the first 4 days following the surgery and 30 days mortality was 0%.

Conclusions: Uniportal VATS surgery is a safe and established technique with a minimal invasive thoracic surgery. Excellent results with minimal morbidity, short hospital stay and low postoperative pain are amongst its strong points. Thoracic surgeons experienced in thoracic surgical approaches can safely perform uniportal VATS.

Keywords: Video-assisted thoracic surgery (VATS); initial experience in VATS; minimally invasive thoracic surgery; single-port thoracic surgery; uniportal VATS.

Figure 1

Lateral decubitus position.

Figure 2

Positioning of the surgical team during the operation (both the surgeon and the assistant should be positioned in front of the patient).

Figure 3

Location of the incision in uniportal VATS (fifth intercostal space, anterior axillary line). VATS, video-assisted thoracic surgery.

Figure 4

Using wound protector (A) or two stitches (B) to open the wound and preventing the contamination of the camera.

Figure 5

Intraoperative ultrasonography.

Figure 6

Using intra-operative ultrasonography for finding small lung lesions (42). Available online: http://www.asvide.com/articles/1363

Figure 7

Analysis of pain in the first 4 post-operative days according to visual analog scale (VAS) in the first 90 patients.