Hirai Kyoji, Takeuchi Shingo, Usuda Jitsuo
1 Division of Thoracic Surgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan ; 2 Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan.
J Thorac Dis. 2016 Mar;8(Suppl 3):S344-50. doi: 10.3978/j.issn.2072-1439.2016.02.26.
Single-port video-assisted thoracic surgery (SPVATS) emerged several years ago as a new, minimally invasive surgery for diseases in the field of respiratory surgery, and is increasingly becoming a subject of interest for some thoracic surgeons in Europe and Asia. However, the adoption rate of this procedure in the United States and Japan remains low. We herein reviewed our experience of SPVATS for early lung cancer in our center, and evaluated the safety and minimal invasiveness of this technique.
We retrospectively analyzed patients who had undergone SPVATS for pathological stage I lung cancer in Nippon Medical School Chiba Hokusoh Hospital between September 2012 and October 2015. In SPVATS, an approximately 4-cm incision was made at the 4(th) or 5(th) intercostal space between the anterior and posterior axillary lines. A rib spreader was not used at the incision site, and surgical manipulation was performed very carefully in order to avoid contact between surgical instruments and the intercostal nerves. The same surgeon performed surgery on all patients, and analyzed laboratory data before and after surgery.
Eighty-four patients underwent anatomical lung resection for postoperative pathological stage I lung cancer. The mean wound length was 4.2 cm. Eighty-four patients underwent lobectomy and segmentectomy, respectively. The mean preoperative forced expiratory volume in 1 second (FEV1%) was 1.85%±0.36%. Our patients consisted of 49 men (58.3%) and 35 women (41.7%), with 64, 18, 1, and 1 having adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma, and small-cell lung cancer, respectively. The mean operative time was 175±21 min, operative blood loss 92±18 mL, and duration of drain placement 1.9±0.6 days. The duration of the postoperative hospital stay was 7.1±1.7 days, numeric rating scale (NRS) 1 week after surgery 2.8±0.6, and occurrence rate of allodynia 1 month after surgery 10.7%. No patient developed serious complications, and no deaths occurred within 30 days of surgery. Two patients (2.4%) were converted to open thoracotomy.
SPVATS is a safe and feasible technique, and is promising for next-generation thoracoscopic surgery. It may also reduce postoperative wound pain and contribute to improvements in the activities of daily living of patients.
单孔电视辅助胸腔镜手术（SPVATS）于数年前出现，是呼吸外科领域一种新型的微创手术，在欧洲和亚洲越来越受到一些胸外科医生的关注。然而，该手术在美国和日本的采用率仍然较低。我们在此回顾了我们中心采用SPVATS治疗早期肺癌的经验，并评估了该技术的安全性和微创性。
我们回顾性分析了2012年9月至2015年10月在日本医科大学千叶北总医院接受SPVATS治疗病理分期为I期肺癌的患者。在SPVATS中，于腋前线和腋后线之间的第4或第5肋间做一个约4厘米的切口。切口处不使用肋骨撑开器，手术操作非常小心，以避免手术器械与肋间神经接触。所有患者均由同一位外科医生进行手术，并分析手术前后的实验室数据。
84例患者接受了解剖性肺切除术，术后病理分期为I期肺癌。平均伤口长度为4.2厘米。84例患者分别接受了肺叶切除术和肺段切除术。术前第1秒用力呼气容积（FEV1%）平均为1.85%±0.36%。我们的患者包括49名男性（58.3%）和35名女性（41.7%），其中腺癌、鳞状细胞癌、腺鳞癌和小细胞肺癌分别有64例、18例、1例和1例。平均手术时间为175±21分钟，术中失血92±18毫升，引流管放置时间为1.9±0.6天。术后住院时间为7.1±1.7天，术后1周数字评分量表（NRS）评分为2.8±0.6，术后1个月痛觉过敏发生率为10.7%。无患者发生严重并发症，术后30天内无死亡病例。2例患者（2.4%）转为开胸手术。
SPVATS是一种安全可行的技术，对下一代胸腔镜手术具有前景。它还可能减轻术后伤口疼痛，并有助于改善患者的日常生活活动能力。
