Department of Thoracic Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.
Department of Neurology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, People's Republic of China.
Surg Endosc. 2024 Sep;38(9):5457-5463. doi: 10.1007/s00464-024-11121-1. Epub 2024 Aug 5.
Uniportal thoracoscopic right middle lobectomy (RML) poses greater technical challenges than other lobectomies. Although two-port thoracoscopy offers convenience, it results in heightened surgical trauma and scarring. The periareolar incision is rarely used in lobectomy while known for its cosmetic advantages. This study presents the periareolar access (combining a periareolar port and a 1-cm port) for video-assisted thoracoscopic surgery (VATS) in RML, comparing it with the traditional uniportal technique in both male and female patients.
Eighty patients who underwent RML were randomly divided into two groups: the periareolar VATS (PV) approach (n = 40) and the uniportal VATS (UV) approach (n = 40) from August 2020 to February 2023. All patients were followed up for 1 year and clinical data were collected and analyzed.
No significant differences in complications, blood loss, duration of chest tube placement, and length of postoperative hospital stay were observed between two methods. However, the PV group exhibited significantly shorter operative time, reduced postoperative visible scarring and lower visual analogue scores (VAS) for postoperative pain (P < 0.05). Additionally, the PV group demonstrated significantly higher cosmetic and satisfaction scores at the 6-month postoperative assessment (P < 0.05). Notably, breast ultrasound follow-up revealed two cases injuries of the mammary glands in female patients, and sensory function of most nipple and areola remained intact except two cases in all PV group patients.
Periareolar VATS emerges as a promising alternative approach for RML, providing clear benefits in pain management and cosmetic outcomes, while maintaining safety and convenience.
单孔胸腔镜右中叶切除术（RML）比其他肺叶切除术具有更大的技术挑战。虽然两孔胸腔镜提供了便利，但会导致更高的手术创伤和疤痕。乳晕入路在肺叶切除术中很少使用，但因其美容优势而为人所知。本研究提出了一种乳晕入路（结合乳晕入路端口和 1cm 端口）用于电视辅助胸腔镜手术（VATS）中的 RML，将其与男性和女性患者的传统单孔技术进行比较。
2020 年 8 月至 2023 年 2 月，80 例接受 RML 的患者被随机分为两组：乳晕 VATS（PV）组（n = 40）和单孔 VATS（UV）组（n = 40）。所有患者均随访 1 年，并收集和分析临床数据。
两种方法在并发症、出血量、胸腔引流管放置时间和术后住院时间方面无显著差异。然而，PV 组的手术时间明显更短，术后可见疤痕减少，术后疼痛的视觉模拟评分（VAS）较低（P < 0.05）。此外，PV 组在术后 6 个月的评估中表现出更高的美容和满意度评分（P < 0.05）。值得注意的是，乳房超声随访发现 2 例女性患者的乳腺损伤，除 2 例外，PV 组所有患者的乳头和乳晕感觉功能基本完整。
乳晕 VATS 是一种有前途的 RML 替代方法，在疼痛管理和美容效果方面具有明显优势，同时保持安全性和便利性。
