From open surgery to uniportal VATS: asturias experience

Javier Aragón, Itzell Pérez Méndez

Abstract

Objective: Uniportal video-assisted thoracic surgery (VATS) resections are of increasing interest in many thoracic surgery departments. This study shows our initial experience in uniportal VATS anatomical resections in direct transition from posterolateral thoracotomy.
Patients and methods: We retrospectively reviewed the 82 files of patients on whom anatomical pulmonary resection via uniportal VATS was attempted in our department by a single surgeon experienced in VATS for almost all purposes except major pulmonary resections. Demographic data of patients, smoking habits, chronic obstructive pulmonary disease (COPD), presence of cardiopulmonary comorbidities, general characteristics of pulmonary lesions, preoperative FEV1, intraoperative findings, operative time, postoperative-drain-time, hospital-stay-time, successfully completed or converted to thoracotomy, intraoperative and postoperative complications and 30-day mortality were recorded. The patients were chronologically divided into two groups for analysis (A: operated on in the first year; B: operated on after the first year). We compare our results with the largest published experience in anatomical resections by uniportal VATS started from multiport technique and anterior thoracotomy in order to identify the feasibility of this transition.
Results: From January 2012 to January 2014, 82 uniportal VATS anatomical pulmonary resections were attempted. Of these 82 resections attempted, 74 (90.2%) were completely carried out. The median draintime and hospital-stay-time were 3 days, and 4 days for the first year of experience and 2 and 3 days for the second year of experience respectively. The most frequent intraoperative complication was bleeding in 10 (12.1%), of these 8 occurred in the first year of experience (group A). In 8 (9.75%) cases conversion to thoracotomy widening the incision was needed for different reasons, of these 6 occurred in group A. The most frequent minor complication was chest tube reinsertion in 12 (14.6%) patients. There were no major complications or mortality in the first year of experience (group A). Two cases of mortality in the 8th and 15th postoperative day respectively occurred in group B in two patients with serious comorbidities.
Conclusions: Uniportal VATS for anatomical resections is a feasible and safe technique with good results even if experience is started in direct transition from open surgery, on condition that general recommendations for an initial VATS program were observed. Specific training courses with experts are also necessary. Patient selection is crucial. The number of procedures necessary to obtain appropriate experience may be similar to those reported for transition from open surgery to multiport technique.