Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 30:9:874983.
doi: 10.3389/fsurg.2022.874983. eCollection 2022.

A New Traceless Technique for Cosmetic Closure of Minimally Invasive Incision and Chest Tube Fixation After Uniportal Video-Assisted Thoracoscopic Surgery

Zihao Chen  1 , Ning Xin  1 , Kenan Huang  1 , Rongqiang Wei  1 , Chengdong Liu  1 , Shiwen Niu  2 , Zhifei Xu  1 , Xinyu Ding  1 , Hua Tang  1
Affiliations

A New Traceless Technique for Cosmetic Closure of Minimally Invasive Incision and Chest Tube Fixation After Uniportal Video-Assisted Thoracoscopic Surgery

Zihao Chen et al. Front Surg. .

Abstract

Background: With uniportal video-assisted thoracoscopic surgery (VATS) becoming mainstream, how to make the incision cosmetic has attracted much attention. This study aimed to introduce a new traceless method for cosmetic closure of the incision and a special procedure for chest tube fixation after uniportal VATS and to evaluate the feasibility, effectiveness, and safety of this new technique.

Methods: In this retrospective study, a total of 258 consecutive patients who underwent uniportal VATS were included. Among them, 127 patients were treated with a conventional method, and 131 patients were treated with a new method.

Results: Patients in the new method group had a significantly less incidence of subcutaneous emphysema after the chest tube was removed. The incidence of pneumothorax after the chest tube was removed and fat liquefaction of chest incision was not significantly different between the two groups. No differences in the incidence of pneumothorax after chest tube removal and fat liquefaction of postsurgical incision were found between the two groups. Additionally, there was also no significant difference in follow-up items.

Conclusions: Taken together, our results showed that this new method for minimally invasive incision closure and chest tube fixation after uniportal VATS was as feasible, effective, and safe as the conventional one but more cosmetic.

Keywords: chest tube fixation; cosmetic closure of minimally invasive incision; removal-free technique; traceless technique; uniportal video-assisted thoracoscopic surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A1) Suture of the muscle layer started in the middle of the incision and some knots were tied to lock up the suture. Then, the muscle was sutured continuously from the middle of the incision to each side. (B1) On the tube side, the side of a2 of the suture passed under the skin and came out through the skin about 1.5 cm from the edge of the incision when the needle reached the end of the incision. On the side of a1, after the suture of muscle finished, the suture of subcutaneous tissue started with a continuous suture technique by the same needle from this side to the chest tube side, and the stitch came out through the skin same as before. (C1) For anchoring the chest tube, a horizontal mattress suture was used to suture the dermis and some subcutaneous tissue followed by a knot in a side of the incision to tighten up the tissue around the tube. Then using the thread twined around the tube with tension in opposite directions orderly. Several rounds in the beginning enlaced at the root of the tube for stabilization, and the following rounds climbed around the tube wall up to 6–8 cm away from the tube root. For closing the dermis layer, a continuous suture was used from the middle of the incision to each side. When reaching each end of the incision, two needles came out through the skin about 1 cm away from each edge of the incision respectively. (D1) Procedure finished as shown in the picture. A-D2 shows the actual operation pictures corresponding to the schematic diagram of A-D1.
Figure 2
Figure 2
(E1) Before the chest tube is removed, loosen the thread twined around the tube and pull it out of the tissue. When the chest tube was removed, the incision was pressed by gauze swiftly, and then pull the rest of the knotless stitches were one by one to tighten the suture, the wound sealed like closing a zipper. (E2) Appearance of the incision after the chest tube is removed. (E3) One month after the chest tube was removed, the wound of uniportal VATS in the new method group was healed cosmetically.
Figure 3
Figure 3
(A) Healing status of the wound with the conventional method 6 months after the operation; (B) Statement of the wound with our modified method 6 months after surgery.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Cerfolio RJ, Bryant AS, Skylizard L, Minnich DJ. Optimal technique for the removal of chest tubes after pulmonary resection. J Thorac Cardiovasc Surg. (2013) 145(6):1535–9. 10.1016/j.jtcvs.2013.02.007 - DOI - PubMed
    1. Refai M, Brunelli A, Varela G, Novoa N, Pompili C, Jimenez MF, et al. The values of intrapleural pressure before the removal of chest tube in non-complicated pulmonary lobectomies. Eur J Cardiothorac Surg. (2012) 41(4):831–3. 10.1093/ejcts/ezr056 - DOI - PubMed
    1. Brunelli A, Salati M, Refai M, Di Nunzio L, Xiume F, Sabbatini A. Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial. Eur J Cardiothorac Surg. (2010) 37(1):56–60. 10.1016/j.ejcts.2009.05.006 - DOI - PubMed
    1. Terzi A, Feil B, Bonadiman C, Lonardoni A, Spilimbergo I, Pergher S, et al. The use of flexible spiral drains after non-cardiac thoracic surgery. A clinical study. Eur J Cardiothorac Surg. (2005) 27(1):134–7. 10.1016/j.ejcts.2004.10.016 - DOI - PubMed
    1. Xu H, Ren S, She T, Zhang J, Zhang L, Jia T, et al. Modified technique of closing the port site after multiport thoracoscopic surgery using the shingled suture technique: a single centre experience. Bmc Surg. (2021) 21(1):223. 10.1186/s12893-021-01220-4 - DOI - PMC - PubMed

LinkOut - more resources