Stamenovic Davor, Messerschmidt Antje, Jahn Tillmann, Schneider Thomas
Thoraxchirurgie, St. Vincentius-Kliniken, Karlsruhe, Deutschland.
Zentralbl Chir. 2018 Feb;143(1):84-89. doi: 10.1055/s-0043-111795. Epub 2017 Jun 27.
Uniportal video-assisted thoracoscopic surgery (UVATS) for anatomical lung resections has gained popularity of late. This study aimed to elucidate the impediments to implementing the uniportal access method into the daily routine of VATS lung resections. To this end, we reviewed our initial experience and evaluated our progress.
From January to May 2016, 24 consecutive UVATS anatomical lung resections (UVATS group) were performed by a single surgeon without any previous experience in UVATS surgery. These cases were matched in a one-to-one fashion with a cohort of 102 patients who had undergone "classical" VATS anatomical lung resections (VATS group) in the past 2years performed by the same surgeon, using the nearest estimated propensity score. Based on an initial analysis, the UVATS group was further divided into two subgroups, UVATS and UVATS, consisting of the first and last 12 cases.
No UVATS patient required conversion to thoracotomy or needed an additional port. The VATS group had a shorter mean operation time if compared with the UVATS subgroup (MVATS = 152, MUVATS = 191; p = 0.019), but not if compared with the UVATS subgroup (MVATS = 152, MUVATS = 152; p = 1). There was no difference between the groups in the number of lymph node stations sampled (MVATS = 7, MUVATS = 7, MUVATS = 7; p = 0.92), the average number of dissected lymph nodes (MVATS = 19, MUVATS = 15, MUVATS = 18; p = 0.659), and the number and type of postoperative complications. As demonstrated on an audio-analogue pain scale (AAS), the UVATS groups needed significantly less pain medication until discharge (p < 0.001).
The adoption of uniportal VATS for anatomical lung resections can be accomplished without any impact on operative or clinical success, if performed by a surgeon already experienced in "classical" VATS. In our experience, there was no need for additional courses, proctored cases or modification of surgical instruments, although all options mentioned above may facilitate adoption.
单孔电视辅助胸腔镜手术（UVATS）用于解剖性肺切除术近来越来越受欢迎。本研究旨在阐明将单孔入路方法应用于VATS肺切除术日常操作中的障碍。为此，我们回顾了我们的初步经验并评估了我们的进展。
2016年1月至5月，由一名此前无UVATS手术经验的外科医生连续进行了24例UVATS解剖性肺切除术（UVATS组）。这些病例与同一外科医生在过去2年中进行的102例“经典”VATS解剖性肺切除术患者（VATS组）以一对一的方式进行匹配，采用最近似的倾向评分。基于初步分析，UVATS组进一步分为两个亚组，即UVATS1和UVATS2，分别由前12例和后12例病例组成。
没有UVATS患者需要转为开胸手术或需要额外的切口。与UVATS1亚组相比，VATS组的平均手术时间较短（MVATS = 152，MUVATS1 = 191；p = 0.019），但与UVATS2亚组相比则无差异（MVATS = 152，MUVATS2 = 152；p = 1）。两组之间在采样的淋巴结站数量（MVATS = 7，MUVATS1 = 7，MUVATS2 = 7；p = 0.92）、切除的淋巴结平均数量（MVATS = 19，MUVATS1 = 15，MUVATS2 = 18；p = 0.659）以及术后并发症的数量和类型方面均无差异。如在视觉模拟疼痛量表（AAS）上所示，UVATS组在出院前需要的止痛药物明显更少（p < 0.001）。
如果由已经有“经典”VATS经验的外科医生进行，采用单孔VATS进行解剖性肺切除术可以在不影响手术或临床成功率的情况下完成。根据我们的经验，虽然上述所有选项可能有助于采用，但无需额外的课程、带教病例或手术器械的修改。
