Uniportal Thoracoscopic Pulmonary Segmentectomy Provides Good Perioperative Results and Early Postoperative Recovery

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2022 Sep 8

PMID 36071752

Authors

Kazuki Numajiri

Natsumi Matsuura

Hitoshi Igai

Fumi Ohsawa

Mitsuhiro Kamiyoshihara

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Methods: 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.

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.

Conclusions: U-VATS segmentectomy appears as safe and feasible as H/M-VATS segmentectomy. An experienced surgeon can make a smooth transition to U-VATS.

Citing Articles

Uniportal Video-Assisted Thoracoscopic Segmentectomy for Early-Stage Non-Small Cell Lung Cancer: Overview, Indications, and Techniques.

Watanabe T, Tanahashi M, Suzuki E, Yoshii N, Kohama T, Iguchi K Cancers (Basel). 2024; 16(13).

PMID: 39001405 PMC: 11240445. DOI: 10.3390/cancers16132343.

Application of uniportal video-assisted thoracoscopic surgery for segmentectomy in early-stage non-small cell lung cancer: A narrative review.

Wang L, Cao J, Feng Y, Jia R, Ren Y Heliyon. 2024; 10(9):e30735.

PMID: 38742067 PMC: 11089358. DOI: 10.1016/j.heliyon.2024.e30735.

Uniportal video-assisted thoracic surgery: segmentectomy versus lobectomy-early outcomes.

Sachs E, Jackson V, Al-Ameri M, Sartipy U Eur J Cardiothorac Surg. 2024; 65(4).

PMID: 38547393 PMC: 11009028. DOI: 10.1093/ejcts/ezae127.

Feasibility and safety of uniportal thoracoscopy for chronic pulmonary aspergillosis.

Wang B, Yao L, Sheng J, Liu X, Jiang Y, Shen L Sci Rep. 2023; 13(1):16480.

PMID: 37777661 PMC: 10542798. DOI: 10.1038/s41598-023-43781-9.

Pulmonary segmentectomy for early stage non-small cell lung cancer: when, for which cases and how.

Matsuura N, Yajima T J Thorac Dis. 2023; 15(3):956-959.

PMID: 37065570 PMC: 10089869. DOI: 10.21037/jtd-23-66.

References

Nakamura K, Saji H, Nakajima R, Okada M, Asamura H, Shibata T . A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol. 2009; 40(3):271-4. DOI: 10.1093/jjco/hyp156. View

Chen Y, Huang W, Chang C, Yen Y, Tseng Y . Uniportal versus Multiportal Thoracoscopic Complex Segmentectomy: Propensity Matching Analysis. Ann Thorac Cardiovasc Surg. 2020; 27(4):237-243. PMC: 8374094. DOI: 10.5761/atcs.oa.20-00231. View

Shen C, Che G . No drains in thoracic surgery with ERAS program. J Cardiothorac Surg. 2020; 15(1):112. PMC: 7247170. DOI: 10.1186/s13019-020-01164-5. View

Matsuura N, Igai H, Ohsawa F, Yazawa T, Kamiyoshihara M . Uniport multiport video-assisted thoracoscopic surgery for anatomical lung resection-which is less invasive?. J Thorac Dis. 2021; 13(1):244-251. PMC: 7867835. DOI: 10.21037/jtd-20-2759. View

Matsuura N, Igai H, Ohsawa F, Yazawa T, Kamiyoshihara M . Safety and feasibility of uniportal video-assisted thoracoscopic uncommon segmentectomy. J Thorac Dis. 2021; 13(5):3001-3009. PMC: 8182544. DOI: 10.21037/jtd-21-292. View

Xie D, Wu J, Hu X, Gonzalez-Rivas D, She Y, Chen Q . Uniportal versus multiportal video-assisted thoracoscopic surgery does not compromise the outcome of segmentectomy. Eur J Cardiothorac Surg. 2020; 59(3):650-657. DOI: 10.1093/ejcts/ezaa372. View

McElnay P, Molyneux M, Krishnadas R, Batchelor T, West D, Casali G . Pain and recovery are comparable after either uniportal or multiport video-assisted thoracoscopic lobectomy: an observation study. Eur J Cardiothorac Surg. 2014; 47(5):912-5. DOI: 10.1093/ejcts/ezu324. View

Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N . Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006; 132(4):769-75. DOI: 10.1016/j.jtcvs.2006.02.063. View

Perna V, Carvajal A, Torrecilla J, Gigirey O . Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: a randomized study. Eur J Cardiothorac Surg. 2016; 50(3):411-5. DOI: 10.1093/ejcts/ezw161. View

10.

Gonzalez-Rivas D, Paradela M, Fernandez R, Delgado M, Fieira E, Mendez L . Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Ann Thorac Surg. 2012; 95(2):426-32. DOI: 10.1016/j.athoracsur.2012.10.070. View

11.

Suzuki K, Koike T, Asakawa T, Kusumoto M, Asamura H, Nagai K . A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol. 2011; 6(4):751-6. DOI: 10.1097/JTO.0b013e31821038ab. View

12.

Han K, Kim H, Choi Y . Comparison of single port versus multiport thoracoscopic segmentectomy. J Thorac Dis. 2016; 8(Suppl 3):S279-86. PMC: 4783718. DOI: 10.3978/j.issn.2072-1439.2016.02.31. View

13.

Yazawa T, Igai H, Numajiri K, Ohsawa F, Matsuura N, Kamiyoshihara M . Comparison of stapler and electrocautery for division of the intersegmental plane in lung segmentectomy. J Thorac Dis. 2022; 13(11):6331-6342. PMC: 8662472. DOI: 10.21037/jtd-21-1397. View

14.

Igai H, Kamiyoshihara M, Furusawa S, Ohsawa F, Yazawa T, Matsuura N . The learning curve of thoracoscopic surgery in a single surgeon and successful implementation of uniportal approach. J Thorac Dis. 2021; 13(7):4063-4071. PMC: 8339743. DOI: 10.21037/jtd-21-500. View

15.

Jutley R, Khalil M, Rocco G . Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: comparison of post-operative pain and residual paraesthesia. Eur J Cardiothorac Surg. 2005; 28(1):43-6. DOI: 10.1016/j.ejcts.2005.02.039. View

16.

Yang X, Li M, Yang X, Zhao M, Huang Y, Dai X . Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis. 2018; 10(4):2186-2195. PMC: 5949473. DOI: 10.21037/jtd.2018.03.74. View

17.

Dai F, Meng S, Mei L, Guan C, Ma Z . Single-port video-assisted thoracic surgery in the treatment of non-small cell lung cancer: a propensity-matched comparative analysis. J Thorac Dis. 2016; 8(10):2872-2878. PMC: 5107542. DOI: 10.21037/jtd.2016.10.27. View

18.

Nomori H, Yamazaki I, Machida Y, Otsuki A, Cong Y, Sugimura H . Lobectomy versus segmentectomy: a propensity score-matched comparison of postoperative complications, pulmonary function and prognosis. Interact Cardiovasc Thorac Surg. 2022; 34(1):57-65. PMC: 8743134. DOI: 10.1093/icvts/ivab212. View

19.

Okubo Y, Yoshida Y, Yotsukura M, Nakagawa K, Watanabe S . Complex segmentectomy is not a complex procedure relative to simple segmentectomy. Eur J Cardiothorac Surg. 2021; 61(1):100-107. DOI: 10.1093/ejcts/ezab367. View

20.

Handa Y, Tsutani Y, Mimae T, Tasaki T, Miyata Y, Okada M . Surgical Outcomes of Complex Versus Simple Segmentectomy for Stage I Non-Small Cell Lung Cancer. Ann Thorac Surg. 2018; 107(4):1032-1039. DOI: 10.1016/j.athoracsur.2018.11.018. View