Wang Wei, Zhang Shaowen, Dong Ping, Mao Zhangfan
Department of Thoracic Surgery, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, People's Republic of China.
Surg Endosc. 2025 Sep 11. doi: 10.1007/s00464-025-12177-3.
Periareolar video-assisted thoracoscopic surgery (VATS) provides cosmetic advantages but poses technical challenges due to limited working space. The novel 2-mm needle-type intracorporeal assembly endoscopic forceps is designed to minimize incision size while retaining full surgical functionality. This study aimed to evaluate the feasibility, safety, and effectiveness of this novel endoscopic forceps in periareolar VATS.
This single-center retrospective observational study included patients who underwent periareolar VATS using either the 2-mm forceps or a conventional 5-mm grasper between January and December 2024. Outcomes included operative time, complications, visual analog scale (VAS) pain scores at 1 week and 1 month, patient and observer scar assessment scale (POSAS) scores at 6 months, and surgeon feedback. Patients were stratified as follows: 2-mm group (n = 78; uniportal 45, biportal 33) and a historical 5-mm control (n = 37; all uniportal) from the same team under identical indications and perioperative protocols. Because the control contained only uniportal cases, all between-group comparisons were prespecified for the uniportal subset (2 mm: 45 vs. 5 mm: 37); 2-mm biportal cases were summarized descriptively.
A total of 115 periareolar VATS procedures were completed without severe complications or perioperative mortality. Instrument assembly and disassembly required 100 ± 28 s and 25 ± 11 s, respectively. The needle-type puncture sites required no suturing and showed minimal-to-virtually no scarring at follow-up. In the uniportal subset, the 2-mm group had significantly lower POSAS totals and early VAS scores than the 5-mm group, with comparable operative time and surgeon-reported difficulty. Three minor mammary gland injuries occurred overall (two in the 2-mm group and one in the 5-mm group), with no lasting sensory impairment.
The novel 2-mm intracorporeal forceps is safe and effective for periareolar VATS, significantly enhancing cosmetic outcomes and surgical efficiency, suggesting broad clinical application potential.
乳晕周围电视辅助胸腔镜手术（VATS）具有美容优势，但由于工作空间有限，存在技术挑战。新型2毫米针型体内组装式内镜钳旨在在保持完整手术功能的同时，将切口尺寸最小化。本研究旨在评估这种新型内镜钳在乳晕周围VATS中的可行性、安全性和有效性。
这项单中心回顾性观察研究纳入了2024年1月至12月期间使用2毫米钳或传统5毫米抓钳进行乳晕周围VATS的患者。结果包括手术时间、并发症、1周和1个月时的视觉模拟量表（VAS）疼痛评分、6个月时的患者和观察者瘢痕评估量表（POSAS）评分以及外科医生的反馈。患者分层如下：2毫米组（n = 78；单孔45例，双孔33例）和同一团队在相同适应症和围手术期方案下的历史5毫米对照组（n = 37；均为单孔）。由于对照组仅包含单孔病例，所有组间比较均预先指定为单孔亚组（2毫米：45例 vs. 5毫米：37例）；2毫米双孔病例进行描述性总结。
共完成115例乳晕周围VATS手术，无严重并发症或围手术期死亡。器械组装和拆卸分别需要100±28秒和25±11秒。针型穿刺部位无需缝合，随访时瘢痕极小或几乎无瘢痕。在单孔亚组中，2毫米组的POSAS总分和早期VAS评分显著低于5毫米组，手术时间和外科医生报告的难度相当。总体发生3例轻微乳腺损伤（2毫米组2例，5毫米组1例），无持久感觉障碍。
新型2毫米体内钳在乳晕周围VATS中安全有效，显著提高了美容效果和手术效率，具有广阔的临床应用潜力。
