Gonfiotti Alessandro, Jaus Massimo Osvaldo, Barale Daniel, Viggiano Domenico, Battisti Natalia, Macchiarini Paolo
From the European Center of Thoracic Research (CERT), Florence, Italy.
Innovations (Phila). 2015 Sep-Oct;10(5):309-13. doi: 10.1097/IMI.0000000000000199.
We present our experience with uniportal videothoracoscopic surgery (VATS-U), examining its indications, limits, and results.
Since January 2009, 66 patients underwent VATS-U for the following indications: pneumothorax (n = 25), lung nodule (n = 15; n = 10 with preoperative radiolocalization), wedge biopsy (n = 15), hyperhidrosis (n = 10), and chest wall schwannoma (n = 1). The conversion rate to conventional video-assisted thoracic surgery (VATS), postoperative pain, complications, residual paraesthesia, and hospitalization were analyzed. Operative time, postoperative pain, and paraesthesia were retrospectively compared with a cohort of 172 cases of conventional multiportal VATS, performed in the same period.
Conversion to traditional VATS was necessary in two cases (pulmonary nodule, n = 1; pneumothorax, n = 1). The mean pain score was 0.8, the mean operation time was 42 minutes, and 10 patients had postoperative paraesthesia that lasted a mean of 7 days. No postoperative complications were reported, and the mean postoperative hospital stay was 3 days (range, 1-6 days). The comparison between the VATS-U and the standard multiportal VATS group showed in the VATS-U group a lower but not statistically significant pain score and paraesthesia as well as a lower and statistically significant operative time.
Uniportal videothoracoscopic surgery has a wide range of indications: lung apex resections and pleurodesis for spontaneous pneumothorax treatment; pulmonary nodule assessment with or without preoperative localization; lung biopsy for interstitial diseases; unilateral or bilateral sympathectomy to treat hyperhidrosis; benign chest wall tumor evaluation. The limits of this technique are linked to pleural adhesions or lung nodules in difficult positions. In our experience, VATS-U results in minimal postoperative pain, allowing for fast functional recovery and a consequent short hospital stay; thus, we suggest that VATS-U is a valid alternative to traditional multiportal VATS for indications beyond cosmetic benefits. Prospective randomized trials are necessary to validate the advantages of uniportal VATS.
我们介绍单孔电视胸腔镜手术（VATS - U）的经验，探讨其适应证、局限性及手术效果。
自2009年1月起，66例患者因以下适应证接受了VATS - U手术：气胸（n = 25）、肺结节（n = 15；其中10例术前进行了放射性定位）、楔形活检（n = 15）、多汗症（n = 10）及胸壁神经鞘瘤（n = 1）。分析了中转开胸手术的发生率、术后疼痛、并发症、残余感觉异常及住院情况。将手术时间、术后疼痛及感觉异常情况与同期进行的172例传统多孔VATS手术患者进行回顾性比较。
2例（肺结节1例、气胸1例）需要中转开胸手术。平均疼痛评分为0.8分，平均手术时间为42分钟，10例患者术后出现感觉异常，平均持续7天。未报告术后并发症，术后平均住院时间为3天（范围1 - 6天）。VATS - U组与标准多孔VATS组比较，VATS - U组疼痛评分及感觉异常较低，但差异无统计学意义，手术时间较短且差异有统计学意义。
单孔电视胸腔镜手术有广泛的适应证：肺尖切除及胸膜固定术用于治疗自发性气胸；肺结节评估，无论术前是否定位；间质性疾病的肺活检；单侧或双侧交感神经切除术治疗多汗症；良性胸壁肿瘤评估。该技术的局限性与胸膜粘连或位置困难的肺结节有关。根据我们的经验，VATS - U术后疼痛极小，能实现快速功能恢复，从而缩短住院时间；因此，我们认为对于除美容效果外的适应证，VATS - U是传统多孔VATS的有效替代方法。需要进行前瞻性随机试验以验证单孔VATS的优势。
