Original Article on Thoracic Surgery
Uniportal video-assisted thoracoscopic lobectomy with en bloc chest wall resection
Diego Gonzalez-Rivas1,2, Boxiong Xie1, Yang Yang1, Gening Jiang1
1Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China; 2Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña Hospitals, Coruña, Spain
Contributions: (I) Conception and design: D Gonzalez-Rivas; (II) Administrative support: Y Yang; (III) Provision of study materials or patients: B Xie; (IV) Collection and assembly of data: G Jiang, B Xie; (V) Data analysis and interpretation: Y Yang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
Correspondence to: Diego Gonzalez-Rivas, MD, FECTS. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, Yangpu District, Shanghai 200433, China. Email: diego@uniportal.es.
Background: Lobectomy with chest wall resection was traditionally performed by thoracotomy or by conventional video-assisted thoracoscopic surgery (VATS) during the last decade. However, this procedure can be performed by using only a single incision thoracoscopic approach.
Methods: The publications of uniportal VATS lobectomy requiring chest wall resection describes the use of one incision for the lobectomy (uniportal approach) and a posterior or lateral incision for the chest wall resection. This additional incision ensures a better control from outside and inside to achieve a costal resection with good oncologic margins.
Results: This video shows a total uniportal VATS lobectomy with en bloc chest wall resection through a single 5-cm incision with no rib spreading. The total surgical time was 150 minutes. The postoperative course of the patient was uneventful.
Conclusions: Uniportal VATS lobectomy with en-bloc chest wall resection is a feasible and safe technique. The full procedure can be performed by using only a single incision in selected cases.
Keywords: Chest wall resection; uniportal lobectomy; rib resection; video-assisted thoracoscopic surgery (VATS)
Received: 30 June 2015; Accepted: 01 July 2015; Published: 14 July 2015.
doi: 10.3978/j.issn.2221-2965.2015.07.01
Lobectomy requiring chest wall resection is usually performed by thoracotomy but thanks to the advances in the field of thoracoscopic surgery this procedure can be performed by video-assisted thoracoscopic surgery (VATS). Recent improvements in surgical devices and the experience gained in VATS enable this complex surgery for advanced stages to be undertaken safely. Most of the thoracoscopic lobectomies with rib resection are performed by using 3-4 incisions. However, the lobectomy and the chest wall resection can be performed by using only one incision. When a lung cancer with chest wall involvement is approached, we can perform the lobectomy first and tackle the chest wall once the lobe is freed. Alternatively, the rib resection can be done first and then finish the procedure with the lobectomy. This video shows a uniportal VATS lobectomy with en bloc chest wall resection through a 5-cm incision with no rib spreading (Figure 1). This surgery was done by first performing the lobectomy and once the lobe was free, the chest wall resection was completed with the help of a conventional and an adapted long thoracoscopic rib cutter instrument. The postoperative course of the patient was uneventful.
Acknowledgements
None.
Conflicts of Interest: The authors have no conflicts of interest to declare.
Informed Consent: Written informed consent was obtained from the patient. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
References
- Gonzalez-Rivas D, Xie B, Yang Y, et al. Uniportal video-assisted thoracoscopic lobectomy with en bloc chest wall resection. Asvide 2015;2:059. Available online: http://www.asvide.com/articles/602
doi: 10.3978/j.issn.2221-2965.2015.07.01
Cite this article as: Gonzalez-Rivas D, Xie B, Yang Y, Jiang G. Uniportal video-assisted thoracoscopic lobectomy with en bloc chest wall resection. J Vis Surg 2015;1:7.
