Needlescopic-assisted uniportal thoracoscopic pulmonary anatomical resection for lung cancer

Xu-Heng Chiang, MD¹, Huan-Jang Ko, MD², Shun-Mao Yang, MD². ¹Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, ²Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch

Introduction: Pulmonary anatomical resection is considered as standard treatment for early staged lung cancer. Uniportal video-assisted thoracoscopic surgery (uVATS) has recently showed favorable surgical outcomes, but remains technically demanding, especially in a complex procedure such as anatomic segmentectomy. Needlescopic instruments facilitates complex laparoscopic surgeries with nearly painless and scarless postoperative outcomes, however, its utilization of thoracoscopic surgery were mostly for minor procedures such as bullectomy and sympathectomy. We presented our initial experience of lung cancer surgery performed by uniportal VATS and additional needlescopic instruments, and we also compare the operative results with conventional uniportal VATS.

Methods: From December 2016 to August 2017, 75 consecutive patients with lung cancer undergoing anatomical lung resections including lobectomies and segmentectomies were reviewed retrospectively. Of these 75 patients, 39 patients received conventional uniportal VATS (uVATS), and 36 patients received needlescopic-assisted uniportal VATS (NA-uVATS). We compared the peri- and post-operative outcomes in these 2 groups.

Results: There was no significant difference in demographic, anesthetic, or operative characteristics in two groups except for age. The mean operation time was statistically less in the NA-uVATS group (198.8±86.8 min vs 159.3±55.4 min, p=0.023). The intraoperative blood loss was significantly less in the NA-uVATS group (143.2±298.1 mL vs 40.9±56.7 mL, p=0.047). There were two major pulmonary arterial bleeding events and one conversion to thoracotomy in the uVATS group. The hospital stay, duration of chest tube drainage and post-operative pain scale were comparative in the two groups.

Conclusion: Under the assistance of additional needlescopic instruments, uniportal VATS can be performed more efficiently and safely without compromising its benefit in less postoperative pain and early recovery.

Figure 1. Needlescopic uniportal VATS setting illustration