Yin Shun-Ying, Chu Yen, Wu Yi-Cheng, Yeh Chi-Ju, Liu Chien-Ying, Hsieh Ming-Ju, Liu Yun-Hen
Division of Thoracic Surgery and Animal Laboratory Center, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fushing Street, Gueishan Shiang, Taoyuan, 333, Taiwan, ROC.
Surg Endosc. 2014 Oct;28(10):2980-7. doi: 10.1007/s00464-014-3561-3. Epub 2014 May 23.
Transthoracic thoracoscopic lobectomy is the preferred method of surgical treatment for early lung cancer. Current methods require a transthoracic approach and are associated with chronic postoperative pain in up to 25% of patients. Single-port transumbilical uniport surgery may offer advantages over multiport surgery with less postoperative pain and better cosmetic results. The aim of this study was to evaluate the feasibility of a transumbilical anatomic lobectomy of the lung (TUAL) in a canine model.
TUAL was performed in 12 beagle dogs using a 3-cm umbilical incision combined with a 2.5-cm diaphragmatic incision. Variables evaluated for surgical outcomes were operating time, operative complications, body rectal temperature, respiratory rate, white blood cell count, and arterial blood gases.
TUAL was successfully completed in ten animals. There were six bleeding complications related to surgery. In four animals, an avulsion of pulmonary vessel causes intraoperative bleeding, requiring simultaneous pulmonary artery and bronchus resections. In one animal, slipping of endoclip after vessel clipping caused perioperative bleeding. The other animal encountered bleeding complication during dissection of inferior pulmonary vein. Both animals required conventional thoracotomy to complete the surgery.
TUAL in the canine model is feasible but associated with significant morbidity. With further development and refinement of instruments, comparative studies between the novel transumbilical lobectomy and the current video-assisted transthoracic lobectomy will clarify the role of transumbilical lobectomy in thoracic surgery.
经胸电视胸腔镜肺叶切除术是早期肺癌手术治疗的首选方法。目前的方法需要经胸入路，高达25%的患者会出现慢性术后疼痛。单孔经脐单孔手术可能比多孔手术具有优势，术后疼痛更少，美容效果更好。本研究的目的是评估在犬模型中进行经脐肺解剖性肺叶切除术（TUAL）的可行性。
对12只比格犬进行TUAL，采用3厘米的脐部切口联合2.5厘米的膈肌切口。评估手术结果的变量包括手术时间、手术并发症、直肠体温、呼吸频率、白细胞计数和动脉血气。
10只动物成功完成TUAL。有6例与手术相关的出血并发症。4只动物中，肺血管撕裂导致术中出血，需要同时切除肺动脉和支气管。1只动物在血管夹闭后血管夹滑脱导致围手术期出血。另1只动物在解剖下肺静脉时遇到出血并发症。这两只动物都需要进行传统开胸手术来完成手术。
犬模型中的TUAL是可行的，但伴有明显的发病率。随着器械的进一步发展和改进，新型经脐肺叶切除术与当前的电视辅助胸腔镜肺叶切除术之间的比较研究将阐明经脐肺叶切除术在胸外科手术中的作用。
