Sano Atsushi
Department of Thoracic Surgery, Chigasaki Municipal Hospital, Chigasaki, Kanagawa, Japan.
J Thorac Dis. 2019 Apr;11(4):1514-1518. doi: 10.21037/jtd.2019.03.26.
We previously described the technique for single-port thoracoscopic lung wedge resection using the Endo GIA Radial Reload surgical stapler. The GIA Radial Reload has a curved cut line that is perpendicular to the direction of instrument insertion, facilitating the approach to the lung tissue behind the lesion. Herein, we report the outcomes of 15 cases using this procedure.
Between August 2016 and February 2018, 15 patients underwent single-port thoracoscopic wedge resection using the Endo GIA Radial Reload. Single-port thoracoscopic surgery was performed through 3-5-cm incisions. For the first stapler, we used a GIA Radial Reload cartridge. For the second and subsequent staplers, we used the GIA Radial Reload cartridge or a straight cartridge based on the direction of the cut.
In one patient, we extended the incision up to 7 cm and performed video-assisted thoracotomy because the lesion was too small to find. In the other 14 patients, the procedure was completed through a 3-5-cm port. In one patient, we added a suture for air leakage detected intraoperatively. Postoperative air leakage occurred in two patients. These three patients had emphysema based on computed tomography. In the remaining 12 patients, no air leakage was found and the chest tube was removed on postoperative day 1.
This procedure is suitable for resecting small nodules, because palpation with two fingers is easy. The GIA Radial Reload cartridge may not be a good choice for emphysematous lung, because air leakage sometimes occurs.
我们之前描述了使用Endo GIA Radial Reload手术吻合器进行单孔胸腔镜肺楔形切除术的技术。GIA Radial Reload具有一条与器械插入方向垂直的弯曲切割线,便于接近病变后方的肺组织。在此,我们报告使用该手术方法的15例患者的手术结果。
2016年8月至2018年2月期间,15例患者使用Endo GIA Radial Reload进行单孔胸腔镜楔形切除术。单孔胸腔镜手术通过3 - 5厘米的切口进行。对于第一个吻合器,我们使用GIA Radial Reload钉仓。对于第二个及后续吻合器,我们根据切割方向使用GIA Radial Reload钉仓或直钉仓。
1例患者因病变过小难以找到,将切口延长至7厘米并进行了电视辅助胸腔镜手术。其他14例患者通过3 - 5厘米的切口完成了手术。1例患者因术中发现漏气而加缝了一针。2例患者术后出现漏气。这3例患者经计算机断层扫描显示有肺气肿。其余12例患者未发现漏气,术后第1天拔除胸腔引流管。
该手术方法适合切除小结节,因为用双指触诊很容易。对于肺气肿肺,GIA Radial Reload钉仓可能不是一个好选择,因为有时会发生漏气。