Uniportal versus three-port single-direction thoracoscopic lobectomy: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Shuai , ZHANG Miao , ZHANG Hui ,  LIU Dong , WU Wenbin

Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, P.R.China;

Corresponding?author：

LIU Dong, Email: liudongdoc@yeah.net

Keywords：

Single-direction; uniport; video-assisted thoracoscopic surgery (VATS); lobectomy; surgery

DOI：

10.7507/1007-4848.201907029

Video：

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Objective To explore the feasibility and short-term efficacy of uniportal and three-port single-direction video-assisted thoracoscopic surgery (S-VATS) anatomical lobectomy for lung cancer.Methods Clinical data of 60 lung cancer patients, including 40 males and 20 females with an average age of 62.2±9.0 years, who received S-VATS anatomic lobectomy and systematic lymph nodes dissection by the same surgeon in our hospital between July 2016 and January 2019 were retrospectively analyzed. These patients were divided into a uniportal S-VATS group and a three-port S-VATS group according to surgical procedures, with 30 patients in each group. The clinical data of the two groups were compared.Results There was no conversion to thoracotomy, surgical port addition, or mortality in this cohort, with tumor-negative surgical margin. There was no statistical difference in the operation time between the two groups (70.8±16.4 min vs. 73.7±14.3 min, P>0.05). Meanwhile, both groups showed similar intraoperative blood loss, stations and numbers of dissected lymph nodes, incidence of operation-related complications, duration and volume of chest tube drainage, as well as postoperative hospital stay (P>0.05). Besides, pain score of the patients in the uniportal S-VATS group was significantly lower than that of the three-port S-VATS group on postoperative 3-14 d (P<0.05). The mean duration of follow-up was 10 months, and all the patients were survived without tumor recurrence or metastasis.Conclusion The transition from three-port S-VATS to uniportal S-VATS anatomical lobectomy for treatment of lung cancer is feasible. However, further studies are needed to elucidate the optimal resection sequence of pulmonary vessels.

Citation： WANG Shuai, ZHANG Miao, ZHANG Hui, LIU Dong, WU Wenbin. Uniportal versus three-port single-direction thoracoscopic lobectomy: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(6): 663-668. doi: 10.7507/1007-4848.201907029 Copy

1.	Mu JW, Gao SG, Xue Q, et al. A propensity matched comparison of effects between video assisted thoracoscopic single-port, two-port and three-port pulmonary resection on lung cancer. J Thorac Dis, 2016, 8(7): 1469-1476.
2.	王珩, 張淼, 武文斌, 等. 單孔胸腔鏡肺葉切除術治療肺癌的經驗與反思. 中華胸心血管外科雜志, 2017, 33(8): 493-498.
3.	劉倫旭, 車國衛, 蒲強, 等. 單向式全胸腔鏡肺葉切除術. 中華胸心血管外科雜志, 2008, 24(3): 156-158.
4.	劉成武, 郭成林, 林鋒, 等. 單向式胸腔鏡肺葉或肺段切除術治療Ⅰ期肺癌的遠期療效. 中華外科雜志, 2015, 53(10): 742-746.
5.	中華醫學會胸心血管外科學分會胸腔鏡外科學組, 中國醫師協會胸外科醫師分會微創胸外科專家委員會. 中國胸腔鏡肺葉切除臨床實踐指南. 中華醫學雜志, 2018, 98(47): 3832-3841.
6.	中華醫學會, 中華醫學會腫瘤學分會, 中華醫學會雜志社. 中華醫學會肺癌臨床診療指南(2018 版). 中華腫瘤雜志, 2018, 40(12): 935-964.
7.	趙田, 張淼, 武文斌, 等. 單向式理念在單孔胸腔鏡肺葉切除術中的應用. 中華腔鏡外科雜志(電子版), 2018, 11(5): 295-299.
8.	鄧康, 許世杰, 錢燕飛, 等. 前鋸肌平面阻滯自控鎮痛在胸腔鏡術后的應用. 中華醫學雜志, 2018, 98(8): 570-575.
9.	劉倫旭, 劉雪梅. 用質量控制和技術規范改善胸心血管外科臨床結果—2018 新春寄語. 中國胸心血管外科臨床雜志, 2018, 25.2): 103-104.
10.	羅清泉, 黃佳, 李函玥. 非小細胞肺癌生物學意義微創治療的研究: 附 700 例 Da Vinci 機器人輔助肺部手術分析. 中華腔鏡外科雜志(電子版), 2017, 10(5): 270-271.
11.	Bertolaccini L, Batirel H, Brunelli A, et al. Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 56(2): 224-229.
12.	Yang X, Li M, Yang X, et al. Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis, 2018, 10(4): 2186-2195.
13.	楊懿, 劉倫旭. 單孔胸腔鏡與傳統多孔胸腔鏡手術治療肺癌有效性及安全性的系統評價與 Meta 分析. 中國胸心血管外科臨床雜志, 2018, 25(3): 222-232.
14.	Sihoe ADL. Uniportal lung cancer surgery: State of the evidence. Ann Thorac Surg, 2019, 107(3): 962-972.
15.	Perna V, Carvajal AF, Torrecilla JA, et al. Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: a randomized study. Eur J Cardiothorac Surg, 2016, 50(3): 411-415.
16.	Tosi D, Nosotti M, Bonitta G, et al. Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database. Interact Cardiovasc Thorac Surg, 2019. doi: 10.1093/icvts/ivz153. [Epub ahead of print].
17.	梅建東, 蒲強, 馬林, 等. 胸腔鏡肺手術中血管損傷出血及其防控策略. 中華外科雜志, 2017, 55(12): 898-902.
18.	Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
19.	Feng M, Lin M, Shen Y, et al. Uniportal video-assisted thoracic surgery for left upper lobe: single-direction lobectomy with systematic lymphadenectomy. J Thorac Dis, 2016, 8(8): 2281-2283.
20.	劉成武, 蒲強, 馬林, 等. 單孔與單向式胸腔鏡肺癌切除術的結合—單孔單向式胸腔鏡肺癌切除術. 中國胸心血管外科臨床雜志, 2017, 24(12): 907-910.
21.	Ma L, Liu C, Mei J, et al. Video-assisted thoracic surgery (VATS) non-grasping en bloc mediastinal lymph node dissection for the left side. J Thorac Dis, 2018, 10(11): 6271-6273.
22.	Ma L, Liu C, Mei J, et al. Video-assisted thoracoscopic surgery non-grasping en bloc mediastinal lymph node dissection for the right side. J Thorac Dis, 2018, 10(7): 4502-4504.
23.	趙田, 張淼, 武文斌, 等. 單孔胸腔鏡單向式解剖性右上肺切除術的臨床分析. 中華解剖與臨床雜志, 2019, 24(2): 176-181.
24.	姜冠潮, 李鳳衛, 李曉, 等. 全胸腔鏡肺葉切除術中肺動、靜脈切斷順序對早期非小細胞肺癌療效的影響. 中華胸心血管外科雜志, 2014, 30(9): 513-516.
25.	Sumitomo R, Fukui T, Marumo S, et al. Effects of vessel interruption sequence during thoracoscopic lobectomy for non-small cell lung cancer. Gen Thorac Cardiovasc Surg, 2018, 66(8): 464-470.
26.	He HH, He JX, Hao ZX, et al. Association between different sequences of vessel ligation during video-assisted thoracoscopic lobectomy and survival in patients with non-small cell lung cancer. J Thorac Dis, 2019, 11(3): 686-693.
27.	Wei S, Guo C, He J, et al. Effect of vein-first vs. artery-first surgical technique on circulating tumor cells and survival in patients with non-small cell lung cancer: a randomized clinical trial and registry-based propensity score matching analysis. JAMA Surg, 2019, 154(7): e190972.
28.	閻石, 吳楠, 王興, 等. 右肺上葉肺動脈分支特點. 中國胸心血管外科臨床雜志, 2018, 25(7): 567-571.
29.	秦志祥, 李春雨, 邢柏春, 等. 前鋸肌間隙阻滯的解剖學觀察及其臨床意義. 中國臨床解剖學雜志, 2017, 35(5): 490-493.
30.	張隆盛, 林旭林, 張歡楷, 等. 前鋸肌平面阻滯與胸椎旁神經阻滯用于胸腔鏡手術患者術后鎮痛效果的比較. 臨床麻醉學雜志, 2019, 35(1): 47-51.

1. Mu JW, Gao SG, Xue Q, et al. A propensity matched comparison of effects between video assisted thoracoscopic single-port, two-port and three-port pulmonary resection on lung cancer. J Thorac Dis, 2016, 8(7): 1469-1476.
2. 王珩, 張淼, 武文斌, 等. 單孔胸腔鏡肺葉切除術治療肺癌的經驗與反思. 中華胸心血管外科雜志, 2017, 33(8): 493-498.
3. 劉倫旭, 車國衛, 蒲強, 等. 單向式全胸腔鏡肺葉切除術. 中華胸心血管外科雜志, 2008, 24(3): 156-158.
4. 劉成武, 郭成林, 林鋒, 等. 單向式胸腔鏡肺葉或肺段切除術治療Ⅰ期肺癌的遠期療效. 中華外科雜志, 2015, 53(10): 742-746.
5. 中華醫學會胸心血管外科學分會胸腔鏡外科學組, 中國醫師協會胸外科醫師分會微創胸外科專家委員會. 中國胸腔鏡肺葉切除臨床實踐指南. 中華醫學雜志, 2018, 98(47): 3832-3841.
6. 中華醫學會, 中華醫學會腫瘤學分會, 中華醫學會雜志社. 中華醫學會肺癌臨床診療指南(2018 版). 中華腫瘤雜志, 2018, 40(12): 935-964.
7. 趙田, 張淼, 武文斌, 等. 單向式理念在單孔胸腔鏡肺葉切除術中的應用. 中華腔鏡外科雜志(電子版), 2018, 11(5): 295-299.
8. 鄧康, 許世杰, 錢燕飛, 等. 前鋸肌平面阻滯自控鎮痛在胸腔鏡術后的應用. 中華醫學雜志, 2018, 98(8): 570-575.
9. 劉倫旭, 劉雪梅. 用質量控制和技術規范改善胸心血管外科臨床結果—2018 新春寄語. 中國胸心血管外科臨床雜志, 2018, 25.2): 103-104.
10. 羅清泉, 黃佳, 李函玥. 非小細胞肺癌生物學意義微創治療的研究: 附 700 例 Da Vinci 機器人輔助肺部手術分析. 中華腔鏡外科雜志(電子版), 2017, 10(5): 270-271.
11. Bertolaccini L, Batirel H, Brunelli A, et al. Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 56(2): 224-229.
12. Yang X, Li M, Yang X, et al. Uniport versus multiport video-assisted thoracoscopic surgery in the perioperative treatment of patients with T1-3N0M0 non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis, 2018, 10(4): 2186-2195.
13. 楊懿, 劉倫旭. 單孔胸腔鏡與傳統多孔胸腔鏡手術治療肺癌有效性及安全性的系統評價與 Meta 分析. 中國胸心血管外科臨床雜志, 2018, 25(3): 222-232.
14. Sihoe ADL. Uniportal lung cancer surgery: State of the evidence. Ann Thorac Surg, 2019, 107(3): 962-972.
15. Perna V, Carvajal AF, Torrecilla JA, et al. Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: a randomized study. Eur J Cardiothorac Surg, 2016, 50(3): 411-415.
16. Tosi D, Nosotti M, Bonitta G, et al. Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database. Interact Cardiovasc Thorac Surg, 2019. doi: 10.1093/icvts/ivz153. [Epub ahead of print].
17. 梅建東, 蒲強, 馬林, 等. 胸腔鏡肺手術中血管損傷出血及其防控策略. 中華外科雜志, 2017, 55(12): 898-902.
18. Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
19. Feng M, Lin M, Shen Y, et al. Uniportal video-assisted thoracic surgery for left upper lobe: single-direction lobectomy with systematic lymphadenectomy. J Thorac Dis, 2016, 8(8): 2281-2283.
20. 劉成武, 蒲強, 馬林, 等. 單孔與單向式胸腔鏡肺癌切除術的結合—單孔單向式胸腔鏡肺癌切除術. 中國胸心血管外科臨床雜志, 2017, 24(12): 907-910.
21. Ma L, Liu C, Mei J, et al. Video-assisted thoracic surgery (VATS) non-grasping en bloc mediastinal lymph node dissection for the left side. J Thorac Dis, 2018, 10(11): 6271-6273.
22. Ma L, Liu C, Mei J, et al. Video-assisted thoracoscopic surgery non-grasping en bloc mediastinal lymph node dissection for the right side. J Thorac Dis, 2018, 10(7): 4502-4504.
23. 趙田, 張淼, 武文斌, 等. 單孔胸腔鏡單向式解剖性右上肺切除術的臨床分析. 中華解剖與臨床雜志, 2019, 24(2): 176-181.
24. 姜冠潮, 李鳳衛, 李曉, 等. 全胸腔鏡肺葉切除術中肺動、靜脈切斷順序對早期非小細胞肺癌療效的影響. 中華胸心血管外科雜志, 2014, 30(9): 513-516.
25. Sumitomo R, Fukui T, Marumo S, et al. Effects of vessel interruption sequence during thoracoscopic lobectomy for non-small cell lung cancer. Gen Thorac Cardiovasc Surg, 2018, 66(8): 464-470.
26. He HH, He JX, Hao ZX, et al. Association between different sequences of vessel ligation during video-assisted thoracoscopic lobectomy and survival in patients with non-small cell lung cancer. J Thorac Dis, 2019, 11(3): 686-693.
27. Wei S, Guo C, He J, et al. Effect of vein-first vs. artery-first surgical technique on circulating tumor cells and survival in patients with non-small cell lung cancer: a randomized clinical trial and registry-based propensity score matching analysis. JAMA Surg, 2019, 154(7): e190972.
28. 閻石, 吳楠, 王興, 等. 右肺上葉肺動脈分支特點. 中國胸心血管外科臨床雜志, 2018, 25(7): 567-571.
29. 秦志祥, 李春雨, 邢柏春, 等. 前鋸肌間隙阻滯的解剖學觀察及其臨床意義. 中國臨床解剖學雜志, 2017, 35(5): 490-493.
30. 張隆盛, 林旭林, 張歡楷, 等. 前鋸肌平面阻滯與胸椎旁神經阻滯用于胸腔鏡手術患者術后鎮痛效果的比較. 臨床麻醉學雜志, 2019, 35(1): 47-51.

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Uniportal versus three-port single-direction thoracoscopic lobectomy: A retrospective cohort study

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