The evolution of uniportal video assisted thoracic surgery in Costa Rica

Abstract

Video-assisted thoracic surgery (VATS) has become one of the most important advances in thoracic surgery in this generation. It has evolved continuously into a less invasive approach, being uniportal VATS the last step in this evolution. Since the first uniportal VATS lobectomy was performed in La Coruña in 2010, the procedure has suffered and exponential growth that has allowed it to widespread around the world, expanding the indications from initially early stage lung cancer cases to complex advance cases nowadays. In Costa Rica, uniportal VATS started to be used for major pulmonary resection in June 2014, thanks to the tutoring from Dr. Gonzalez-Rivas. In our center, uniportal VATS is the standard approach for minimally invasive procedures, and major pulmonary resections had only been done through the single port approach. In order to evolve and progress in the experience of the procedure, and to expand the indications in which it was being performed, a "uniportal VATS master class" was held in Rafael Angel Calderón Guardia Hospital in San José, Costa Rica, from September 16 to September 18 2015. The master class was led by Dr. Diego Gonzalez-Rivas and it counted with the contribution of Dr. Li Wentao and Dr. Yang Yang, from Shanghai Pulmonary Hospital. The course attracted almost every thoracic surgeon in our country and participants also included anesthesiologists, pulmonologists, nurses and medical students. Three uniportal VATS were performed during the course, a left lower and a right upper lobectomy and a wedge resection that was the first non-intubated VATS procedure ever performed in our country.

Keywords: Costa Rica; Uniportal VATS; lobectomy; minimally invasive; non-intubated thoracic surgery; single port.

Figure 1

The master class was held with the collaboration of Dr. Diego Gonzalez-Rivas, Dr. Wentao Li and Dr. Yang Yang.

Figure 2

Live surgery performed by Dr. Gonzalez-Rivas in Rafael Angel Calderón Guardia Hospital.

Figure 3

Chest CT shows a 1.5 cm central spiculated nodule in the left lower lobe.

Figure 4

This video shows a left lower lobectomy and lymph node dissection in a 77-year-old women with a 1.5 cm adenocarcinoma (5). Available online: http://www.asvide.com/articles/964

Figure 5

Chest CT shows a 4 cm mass with cavitation, located in the right upper lobe.

Figure 6

This video shows a right upper lobectomy with an incomplete fissure in a 76-year-old male with a 4 cm adenocarcinoma (6). Available online: http://www.asvide.com/articles/965

Figure 7

Chest CT shows a 1.4 cm nodule located in the right upper lobe. This patient had a prior right mastectomy.