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Single-port Video-Assisted Thoracic Surgery for Lung Cancer.

Kang do K, Min HK, Jun HJ, Hwang YH, Kang MK - Korean J Thorac Cardiovasc Surg (2013)

Bottom Line: Video-assisted thoracic surgery (VATS) is a minimally invasive technique that has many advantages in postoperative pain and recovery time.Most surgeons perform VATS for lung cancer with three or more incisions.We describe our experiences of VATS for lung cancer with a single incision in this report.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Korea.

ABSTRACT
Video-assisted thoracic surgery (VATS) is a minimally invasive technique that has many advantages in postoperative pain and recovery time. Because of its advantages, VATS is one of the surgical techniques widely used in patients with lung cancer. Most surgeons perform VATS for lung cancer with three or more incisions. As the technique of VATS has evolved, single-port VATS for lung cancer has been attempted and its advantages have been reported. We describe our experiences of VATS for lung cancer with a single incision in this report.

No MeSH data available.


Related in: MedlinePlus

Surgical incision.
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Figure 1: Surgical incision.

Mentions: Under general anesthesia, the patient was placed in a lateral decubitus position and one lung ventilation was performed. A 3- to 4-cm incision was made in the 6th intercostal space on the anterior axillary line. The soft tissue and intercostal muscles were retracted with an X-small Alexis (Applied Medical, Rancho Santa Margarita, CA, USA) wound retractor for securing the intercostal space (Fig. 1). A 5-mm, 30° thoracoscope (Karl Storz endoscope; Karl Storz, Tuttlingen, Germany) was used in all of the patients. There was no pleural adhesion in any of the patients. Complete fissure was found in one case and incomplete fissure in two cases. Optimal surgical vision was achieved with pulmonary traction using endoscopic ring forceps. The pulmonary vessels and bronchus were dissected with a 5-mm endoscopic grasper, spatula-shaped electrocautery, and 5-mm endoscopic harmonic scalpel (Harmonic Ace; Ethicon Endo-Surgery, Cincinnati, OH, USA). First, the pulmonary veins were divided, and then branches of the pulmonary artery and bronchus were divided. The pulmonary veins and bronchus were divided with endoscopic flexible linear staplers (Ethicon Echelon Flex; Ethicon Endo-Surgery) in all cases. The branches of pulmonary artery were also divided with endoscopic linear staplers in two left lower lobe cases. In a left upper lobe case, the segmental arteries were divided at the level of the proximal portion with endoscopic scissors after clipping with hemoclips (Hem-o-lok; Teleflex Medical Co., Westmeath, Ireland) because optimal angulation could not be achieved for stapling with endoscopic linear staplers. In the patients with incomplete fissure, the fissure was divided with an endoscopic linear stapler and harmonic scalpel. After lobectomy, the resected lobe was removed using a protective bag in all cases. Routine systematic mediastinal and hilar lymph node dissection was performed with a harmonic scalpel in all cases. The lymph nodes, including perinodal tissue, were removed. In all of the cases, the lower paratracheal (no. 4), subaortic (no. 5), paraaortic (no. 6), subcarinal (no. 7), lower paraesophageal (no. 8), inferior pulmonary ligament (no. 9), hilar (no. 10), interlobar (no. 11), and lobar (no. 12) nodes were removed. At the end of the procedure, a 24-French chest tube was placed in the posterior part of the single incision (Fig. 2).


Single-port Video-Assisted Thoracic Surgery for Lung Cancer.

Kang do K, Min HK, Jun HJ, Hwang YH, Kang MK - Korean J Thorac Cardiovasc Surg (2013)

Surgical incision.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756164&req=5

Figure 1: Surgical incision.
Mentions: Under general anesthesia, the patient was placed in a lateral decubitus position and one lung ventilation was performed. A 3- to 4-cm incision was made in the 6th intercostal space on the anterior axillary line. The soft tissue and intercostal muscles were retracted with an X-small Alexis (Applied Medical, Rancho Santa Margarita, CA, USA) wound retractor for securing the intercostal space (Fig. 1). A 5-mm, 30° thoracoscope (Karl Storz endoscope; Karl Storz, Tuttlingen, Germany) was used in all of the patients. There was no pleural adhesion in any of the patients. Complete fissure was found in one case and incomplete fissure in two cases. Optimal surgical vision was achieved with pulmonary traction using endoscopic ring forceps. The pulmonary vessels and bronchus were dissected with a 5-mm endoscopic grasper, spatula-shaped electrocautery, and 5-mm endoscopic harmonic scalpel (Harmonic Ace; Ethicon Endo-Surgery, Cincinnati, OH, USA). First, the pulmonary veins were divided, and then branches of the pulmonary artery and bronchus were divided. The pulmonary veins and bronchus were divided with endoscopic flexible linear staplers (Ethicon Echelon Flex; Ethicon Endo-Surgery) in all cases. The branches of pulmonary artery were also divided with endoscopic linear staplers in two left lower lobe cases. In a left upper lobe case, the segmental arteries were divided at the level of the proximal portion with endoscopic scissors after clipping with hemoclips (Hem-o-lok; Teleflex Medical Co., Westmeath, Ireland) because optimal angulation could not be achieved for stapling with endoscopic linear staplers. In the patients with incomplete fissure, the fissure was divided with an endoscopic linear stapler and harmonic scalpel. After lobectomy, the resected lobe was removed using a protective bag in all cases. Routine systematic mediastinal and hilar lymph node dissection was performed with a harmonic scalpel in all cases. The lymph nodes, including perinodal tissue, were removed. In all of the cases, the lower paratracheal (no. 4), subaortic (no. 5), paraaortic (no. 6), subcarinal (no. 7), lower paraesophageal (no. 8), inferior pulmonary ligament (no. 9), hilar (no. 10), interlobar (no. 11), and lobar (no. 12) nodes were removed. At the end of the procedure, a 24-French chest tube was placed in the posterior part of the single incision (Fig. 2).

Bottom Line: Video-assisted thoracic surgery (VATS) is a minimally invasive technique that has many advantages in postoperative pain and recovery time.Most surgeons perform VATS for lung cancer with three or more incisions.We describe our experiences of VATS for lung cancer with a single incision in this report.

View Article: PubMed Central - PubMed

Affiliation: Department of Thoracic and Cardiovascular Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Korea.

ABSTRACT
Video-assisted thoracic surgery (VATS) is a minimally invasive technique that has many advantages in postoperative pain and recovery time. Because of its advantages, VATS is one of the surgical techniques widely used in patients with lung cancer. Most surgeons perform VATS for lung cancer with three or more incisions. As the technique of VATS has evolved, single-port VATS for lung cancer has been attempted and its advantages have been reported. We describe our experiences of VATS for lung cancer with a single incision in this report.

No MeSH data available.


Related in: MedlinePlus