Cardiothoracic Surgery |

Uniportal Thoracoscopic Lobectomy: Lessons From the Learning Curve FREE TO VIEW

Alan Sihoe, MA; Peter Yu; Michael Hsin, PhD
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Department of Surgery, The University of Hong Kong, Hong Kong, China

Chest. 2014;146(4_MeetingAbstracts):93A. doi:10.1378/chest.1992744
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SESSION TITLE: Cardiothoracic Surgery Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Uniportal video-assisted thoracoscopic surgery (VATS) is emerging as a new Minimally Invasive Surgical approach for major lung surgery, with the potential to minimize port-operative morbidity compared even to conventional VATS. However, previous publications on its use have tended to be case series without data analyses. We report some practical lessons learned from analyses of our early experience with Uniportal VATS.

METHODS: The first 16 consecutive patients receiving Uniportal VATS anatomical lobectomies for primary lung malignancy by a single experienced VATS surgeon were studied. These included 5 males and 11 females with a mean age of 67 years (range: 42-80).

RESULTS: There was no mortality or major complication. One patient required conversion to open thoracotomy for extremely adherent calcified hilar lymph nodes and was excluded from analysis. The first 5 patients had better pre-operative lung function (110 ± 11% versus 88 ± 11%, p<0.01), fewer upper lobectomies required (20% versus 80%, p=0.03), and a trend for smaller tumor size. Despite this, there were no differences between the first 5 and latter 10 patients in the mean values of: operation duration (161 ± 32mins versus 204 ± 62mins, p=0.10), blood loss (101 ± 122ml versus 161 ± 152ml, p=0.43), number of lymph node stations dissected (4.4 ± 1.8 versus 5.4 ± 1.0, p=0.30), chest drain durations (2.4 ± 0.5days versus 2.4 ± 0.9days, p=0.89, lengths of stay (3.4 ± 0.5days versus 3.7 ± 1.3days, p=0.45) and rate of minor complications (20% versus 20%, p=1.00). Upper lobectomies incurred longer durations (209 ± 60mins versus 159 ± 38mins, p=0.07) and greater blood loss (196 ± 157ml versus 59 ± 55ml, p=0.04), but outcomes were similar to those for middle and lower lobectomies.

CONCLUSIONS: For the surgeon experienced with conventional VATS, the learning curve for Uniportal VATS lobectomy is short, with outcomes comparable to conventional VATS achievable relatively quickly. Upper lobectomies represent a greater technical challenge for beginners to this approach, but not a contra-indication.

CLINICAL IMPLICATIONS: Uniportal VATS is readily mastered by experienced VATS surgeons. With increasing understanding of this technique, patients requiring major lung resection surgery can be confidently and safely offered this approach by such surgeons.

DISCLOSURE: The following authors have nothing to disclose: Alan Sihoe, Peter Yu, Michael Hsin

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