Numajiri Kazuki, Matsuura Natsumi, Igai Hitoshi, Ohsawa Fumi, Kamiyoshihara Mitsuhiro
Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi City, Japan.
J Thorac Dis. 2022 Aug;14(8):2908-2916. doi: 10.21037/jtd-22-555.
Although video-assisted thoracoscopic surgery (VATS) segmentectomy has become widespread, the advantage of uniportal VATS (U-VATS) segmentectomy over multiportal VATS (M-VATS) remains controversial. The purpose of this study was to verify the safety and usefulness of U-VATS segmentectomy compared with conventional hybrid/multiportal segmentectomy.
Here, we retrospectively reviewed the data from anatomical pulmonary segmentectomy cases in a single institution from March 2010 to March 2021. Patients were divided into the U-VATS and hybrid/multiportal VATS (H/M-VATS) groups. Perioperative results were compared between the groups after matching for patient background characteristics. In addition, cases of complex segmentectomy were selected from each group and compared in terms of perioperative results.
A total of 180 patients underwent pulmonary segmentectomy during the study period at this institution, comprising 57 cases in the U-VATS group and 123 cases in the H/M-VATS group. After matching for age, sex, disease, tumor location, and type of segmentectomy, no significant differences between the groups were seen in blood loss, major intraoperative bleeding, rate of conversion to thoracotomy, postoperative complications, or re-hospitalization within 30 days after discharge. Operation time (141±46 174±45 min, P<0.001), postoperative drainage duration (1.5±1.2 2.3±1.8 days, P=0.007), and postoperative hospital stay (3.4±2.0 4.6±2.5 days, P=0.006) were significantly lower in the U-VATS group. Subgroup analysis of the complex segmentectomy cases also revealed that operation time (146±34 185±47 min, P<0.001), postoperative drainage duration (1.5±1.3 2.2±1.2 days, P=0.021), and postoperative hospital stay (3.0±1.4 4.9±2.1 days, P<0.001) were significantly reduced in the U-VATS group.
U-VATS segmentectomy appears as safe and feasible as H/M-VATS segmentectomy. An experienced surgeon can make a smooth transition to U-VATS.
尽管电视辅助胸腔镜手术（VATS）肺段切除术已广泛应用，但单孔VATS（U-VATS）肺段切除术相较于多孔VATS（M-VATS）的优势仍存在争议。本研究的目的是验证U-VATS肺段切除术与传统混合/多孔肺段切除术相比的安全性和实用性。
在此，我们回顾性分析了2010年3月至2021年3月间一家机构中解剖性肺段切除术病例的数据。患者被分为U-VATS组和混合/多孔VATS（H/M-VATS）组。在匹配患者背景特征后，比较两组的围手术期结果。此外，从每组中选取复杂肺段切除术病例，并比较其围手术期结果。
在本机构的研究期间，共有180例患者接受了肺段切除术，其中U-VATS组57例，H/M-VATS组123例。在匹配年龄、性别、疾病、肿瘤位置和肺段切除术类型后，两组在失血量、术中大出血、开胸转换率、术后并发症或出院后30天内再次住院方面均无显著差异。U-VATS组的手术时间（141±46对174±45分钟，P<0.001）、术后引流持续时间（1.5±1.2对2.3±1.8天，P=0.007）和术后住院时间（3.4±2.0对4.6±2.5天，P=0.006）显著更短。复杂肺段切除术病例的亚组分析也显示，U-VATS组的手术时间（146±34对185±47分钟，P<0.001）、术后引流持续时间（1.5±1.3对2.2±1.2天，P=0.021）和术后住院时间（3.0±1.4对4.9±2.1天，P<0.001）显著缩短。
U-VATS肺段切除术似乎与H/M-VATS肺段切除术一样安全可行。经验丰富的外科医生可以顺利过渡到U-VATS。
