Louis Scott Gregory, Gibson William James, King Chase Lynn, Veeramachaneni Nirmal Kumar
Department of Cardiothoracic Surgery, University of Kansas Hospital, Kansas City, KS, USA.
J Vis Surg. 2017 Sep 14;3:117. doi: 10.21037/jovs.2017.08.05. eCollection 2017.
Uniportal video-assisted thoracoscopic surgery (VATS) is gaining popularity internationally, but remains an uncommon practice in the United States. One proposed benefit is a decrease in narcotic usage and peri-operative pain when compared to traditional multiple incision VATS. The purpose of this study was to determine the post-operative narcotic usage between patients undergoing anatomic lobectomy via traditional VATS as compared to patients undergoing uniportal VATS.
All consecutive patients undergoing anatomic lobectomy for presumed malignancy by a single surgeon at an academic medical institution were recorded between July 2013 and September 2015. Patients were excluded if they were narcotic dependent prior to the operation, if they had an epidural catheter placed, or if they were under 18 years of age. All narcotics were converted to oral morphine equivalents (OMEq) using standard formulas.
Data were collected on 84 patients. There was no difference between groups with regard to age, gender, tumor size, length of stay, or duration of post-operative thoracostomy. The groups had a similar rate of complications including post-operative atrial fibrillation and need for prolonged thoracostomy. Patients undergoing uniportal VATS had significantly lower narcotic usage in the recovery room, and on post-operative days 1 and 2. In addition, the total narcotic usage during their inpatient stay was significantly lower for patients undergoing uniportal VATS.
Uniportal VATS is a safe and effective strategy for the surgical management of benign and malignant lung disease. In patients undergoing anatomic lobectomy, there was an association with significantly less post-operative narcotic usage in patients undergoing uniportal VATS when compared to traditional VATS. This emerging technology may benefit patients by allowing less narcotic usage during their post-operative hospitalization.
单孔电视辅助胸腔镜手术（VATS）在国际上越来越受欢迎，但在美国仍然是一种不常见的手术方式。与传统的多切口VATS相比，其一个潜在益处是减少了麻醉药物的使用和围手术期疼痛。本研究的目的是确定接受传统VATS解剖性肺叶切除术的患者与接受单孔VATS的患者术后麻醉药物的使用情况。
记录2013年7月至2015年9月期间在一家学术医疗机构由一名外科医生为疑似恶性肿瘤进行解剖性肺叶切除术的所有连续患者。如果患者在手术前依赖麻醉药物、放置了硬膜外导管或年龄在18岁以下，则将其排除。所有麻醉药物均使用标准公式换算为口服吗啡当量（OMEq）。
收集了84例患者的数据。两组在年龄、性别、肿瘤大小、住院时间或术后胸腔闭式引流持续时间方面没有差异。两组的并发症发生率相似，包括术后房颤和需要延长胸腔闭式引流时间。接受单孔VATS的患者在恢复室以及术后第1天和第2天的麻醉药物使用量显著较低。此外，接受单孔VATS的患者住院期间的总麻醉药物使用量也显著较低。
单孔VATS是治疗良性和恶性肺部疾病的一种安全有效的手术策略。在接受解剖性肺叶切除术的患者中，与传统VATS相比，接受单孔VATS的患者术后麻醉药物使用量明显减少。这项新兴技术可能通过减少患者术后住院期间的麻醉药物使用量而使患者受益。
