Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy.
Ann Thorac Surg. 2013 Aug;96(2):434-8. doi: 10.1016/j.athoracsur.2013.04.044. Epub 2013 Jun 19.
Uniportal video-assisted thoracic surgery (VATS) technique has been described both for diagnostic and therapeutic indications. Outcomes after uniportal VATS have never been reported in large series.
Between January 2000 and December 2010, 644 uniportal VATS procedures (334 male and 310 female patients; median age, 55.5 years; range, 16 to 85) were performed by a single surgeon. This figure represents 27.7% of all the thoracic surgical procedures in the study period (2,369). Of the 644 uniportal VATS, 329 (51.1%) were diagnostic procedures for pleural conditions. Of the remaining 315 uniportal VATS procedures, 14 (2.2%) were performed for pre-thoracotomy exploration for lung cancer, and 115 (17.8%) for miscellaneous conditions including diagnosis of mediastinal masses. In addition, 186 nonanatomic wedge resections (28.9% of the total uniportal VATS procedures) were performed for pulmonary conditions; of these, 146 were done for pulmonary nodules.
Median operative time was 18 and 22 minutes for uniportal VATS for diagnostic non-pulmonary indications and for wedge resections, respectively. Out of 644 patients, conversion to either 2 or 3 port VATS or minithoracotomy was necessary in 3.7% of the patients, often due to incomplete lung collapse (92%). Inclusive of the day of insertion, the chest drain was removed after a median of 4.3 (range, 2 to 20) and 2.4 days (range, 0 to 6) after uniportal VATS for pleural effusions and uniportal VATS lung wedge resections, respectively. Mortality and major morbidity after uniportal VATS was 0.6% and 2.8%, respectively. All deaths reported after uniportal VATS were for pleural effusions. Inclusive of the operative day, median hospitalization after surgery for uniportal VATS for pleural effusions and for wedge resections were 5.3 and 3.4 days, respectively.
In our experience, uniportal VATS was performed in one third of our surgical candidates with limited operative time, a very low conversion rate to conventional VATS or minithoracotomy, a very low morbidity and mortality, and, short hospitalization. Uniportal VATS is an underappreciated procedure that can be reliably used in the diagnostic pathways of several intrathoracic conditions and to resect small pulmonary nodules with either diagnostic or therapeutic purposes. As such, uniportal VATS represents a consolidated addition to the surgical armamentarium.
单孔电视辅助胸腔镜手术（VATS）技术已被用于诊断和治疗适应证。单孔 VATS 后的结果从未在大型系列中报道过。
2000 年 1 月至 2010 年 12 月，一位外科医生共进行了 644 例单孔 VATS 手术（334 例男性和 310 例女性；中位年龄 55.5 岁；范围 16 至 85 岁）。这一数字代表了研究期间所有胸腔外科手术的 27.7%（2369 例）。在 644 例单孔 VATS 中，329 例（51.1%）为胸膜疾病的诊断性手术。在其余的 315 例单孔 VATS 手术中，14 例（2.2%）为肺癌术前开胸探查，115 例（17.8%）为包括纵隔肿块诊断在内的各种情况。此外，还进行了 186 例非解剖性楔形切除术（占总单孔 VATS 手术的 28.9%）用于肺部疾病；其中 146 例用于肺结节。
单孔 VATS 用于诊断非肺部适应证和楔形切除术的中位手术时间分别为 18 分钟和 22 分钟。在 644 例患者中，由于不完全肺塌陷（92%），有 3.7%的患者需要转换为 2 或 3 端口 VATS 或小开胸。包括插入当天，在单孔 VATS 治疗胸腔积液和单孔 VATS 肺楔形切除术后，胸腔引流管分别在中位时间 4.3（范围 2 至 20）和 2.4 天（范围 0 至 6）后被移除。单孔 VATS 的死亡率和主要发病率分别为 0.6%和 2.8%。报告的所有单孔 VATS 后死亡均与胸腔积液有关。包括手术当天，单孔 VATS 治疗胸腔积液和楔形切除术的中位住院时间分别为 5.3 天和 3.4 天。
根据我们的经验，单孔 VATS 用于我们三分之一的手术患者，手术时间有限，转换为常规 VATS 或小开胸的比例非常低，发病率和死亡率非常低，住院时间短。单孔 VATS 是一种被低估的手术，可以可靠地用于多种胸腔内疾病的诊断途径，并切除具有诊断或治疗目的的小肺结节。因此，单孔 VATS 是手术手段的一个巩固性补充。
