Lyscov Andrei, Obukhova Tatyana, Ryabova Victoria, Sekhniaidze Dmitrii, Zuiev Vladimir, Gonzalez-Rivas Diego
1 Tyumen Regional Cancer Centre, Tyumen, Russia ; 2 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 3 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
J Thorac Dis. 2016 Mar;8(Suppl 3):S235-41. doi: 10.3978/j.issn.2072-1439.2016.02.25.
Video-assisted thoracic surgery (VATS) double-sleeve lobectomy and carinal resections are two of the most complex procedures in thoracic surgery. The uniportal approach provides an advantage for performing these procedures successfully; however, knowledge of the important technical details is required. This study describes the experience of implementing these procedures by Russian specialists.
Six patients (one woman; mean age, 57.3±3.6 years) who underwent a uniportal VATS double sleeve and carinal resections were consecutively included in this study. A 5- to 6-cm incision was made at the fifth intercostal space on the middle axillary line.
Double sleeve left upper lobectomy was completed in four cases. One case of the right sleeve carinal pneumonectomy and one case of the right sleeve carinal upper lobectomy were completed. The mean operation time was 280±13 minutes. There was no conversion to thoracotomy. The mean postoperative hospital stay was 10.8±0.8 days. There was no postoperative mortality. In one case of double-sleeve lobectomy, postoperative pneumonia developed. The postoperative diagnoses of the four uniportal double-sleeve cases were as follows: T2aN2M0 in one case, T3N1M0 in two cases, and T2aN0M0 in one case. The postoperative diagnoses of the two uniportal totally carinal resections were as follows: T4N0M0 and T3N0M0.
This study results suggest that a uniportal VATS approach might be a feasible option for complex sleeve resections with acceptable postoperative outcomes in the advanced stages of lung cancer. To further evaluate the feasibility, safety, and efficacy of this technique, more experience would be required.
电视辅助胸腔镜手术（VATS）双袖状肺叶切除术和隆突切除术是胸外科中最复杂的两种手术。单孔入路为成功实施这些手术提供了优势；然而，需要了解重要的技术细节。本研究描述了俄罗斯专家实施这些手术的经验。
本研究连续纳入6例接受单孔VATS双袖状和隆突切除术的患者（1名女性；平均年龄57.3±3.6岁）。在腋中线第5肋间做一个5至6厘米的切口。
4例完成了双袖状左上肺叶切除术。1例完成了右袖状隆突全肺切除术，1例完成了右袖状隆突上叶切除术。平均手术时间为280±13分钟。无中转开胸。术后平均住院时间为10.8±0.8天。无术后死亡。1例双袖状肺叶切除术后发生肺炎。4例单孔双袖状手术的术后诊断如下：1例为T2aN2M0，2例为T3N1M0，1例为T2aN0M0。2例单孔全隆突切除术的术后诊断如下：T4N0M0和T3N0M0。
本研究结果表明，对于晚期肺癌的复杂袖状切除术，单孔VATS入路可能是一种可行的选择，术后结果可接受。为进一步评估该技术的可行性、安全性和有效性，还需要更多经验。
