Kaga Kichizo, Hida Yasuhiro, Nakada-Kubota Reiko, Ohtaka Kazuto, Muto Jun, Ishikawa Keidai, Kato Tatsuya, Matsui Yoshiro
Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.
Interact Cardiovasc Thorac Surg. 2013 Aug;17(2):268-72. doi: 10.1093/icvts/ivt194. Epub 2013 May 3.
There are many recent and minimally invasive surgical innovations, yet there has been little evaluation of the limitations of such techniques, particularly those related to video-assisted thoracoscopic surgery. The aims of this study were to determine the usefulness and limitations of video-assisted thoracoscopic surgery using one-port access and needle scope and to evaluate the feasibility of this procedure based on our institutional experience.
This retrospective study involved 127 patients who underwent video-assisted thoracoscopic surgery using the one-window and puncture method at our institute from 1997 to 2011. One hundred patients underwent surgical treatment and 27 underwent diagnostic procedures. If there was one lesion present with only mild adhesion that did not require lymph node dissection, we decided to opt for the one-direction approach that provisionally indicates the one-window and puncture method. We compared the conversion and success groups for factors like age, sex, laterality of surgery, objective of surgery, target organ and surgery location.
Of 127 cases, 115 (91%) successfully underwent the one-window and puncture procedure. Twelve cases (9%) were converted to the two-window method or thoracotomy. Compared with those targeting the lung, patients with mediastinal lesions demonstrated a higher tendency for conversion (P<0.05). However, age (P=0.89), sex (P=0.46), laterality of surgery (P=0.34) and purpose of surgery (P=0.68) did not show any significant differences between the groups.
For lung and mediastinal diseases, video-assisted thoracoscopic surgery with the one-window and puncture method can be performed at any location (upper, middle and lower lobe of lung and anterior, middle and posterior of the mediastinum) under limited indications that include the possibility of one-way resection, mild adhesion and no requirement of lymph node dissection. Under provisional criteria, the procedure may be feasible.
近期有许多微创外科创新技术，但对这些技术的局限性评估较少，尤其是与电视辅助胸腔镜手术相关的技术。本研究的目的是确定使用单孔入路和针式内镜的电视辅助胸腔镜手术的实用性和局限性，并根据我们机构的经验评估该手术的可行性。
这项回顾性研究纳入了1997年至2011年在我院采用单窗口穿刺法接受电视辅助胸腔镜手术的127例患者。100例患者接受了手术治疗，27例接受了诊断性操作。如果存在一个病变且仅有轻度粘连，不需要进行淋巴结清扫，我们决定选择单向入路，这暂时表明采用单窗口穿刺法。我们比较了中转组和成功组在年龄、性别、手术侧别、手术目的、目标器官和手术部位等因素方面的差异。
127例病例中，115例（91%）成功完成了单窗口穿刺手术。12例（9%）中转至双窗口法或开胸手术。与以肺部为目标的患者相比，纵隔病变患者中转的倾向更高（P<0.05）。然而，两组之间的年龄（P=0.89）、性别（P=0.46）、手术侧别（P=0.34）和手术目的（P=0.68）均无显著差异。
对于肺部和纵隔疾病，在包括单向切除可能性、轻度粘连且不需要淋巴结清扫的有限适应症下，采用单窗口穿刺法的电视辅助胸腔镜手术可在任何部位（肺上叶、中叶和下叶以及纵隔前部、中部和后部）进行。根据临时标准，该手术可能是可行的。
