A clinical analysis on the efficacy and characteristics of single-direction uniportal thoracoscopic pulmonary lobectomy

doi:10.3877/cma.j.issn.2095-8773.2018.04.01

Abstract

Abstract:

Objective

To explore the feasibility and clinical characteristics of single-direction uniportal video-assisted thoracoscopic surgery (SU-VATS) lobectomy in the treatment of lung cancer.

Methods

Clinical data of patients who underwent consecutive lobectomy with systematic lymph nodes dissection by one same surgeon from January 2016 to December 2017 in Xuzhou Central Hospital was collected and retrospectively analyzed. Suitable cases were divided into three groups, single-direction uniportal VATS(SU-VATS), conventional uniportal VATS (U-VATS), and multiple-port VATS (M-VATS) group, with 60 patients in each group. The operation time, intraoperative blood loss, numbers and stations of dissected lymph nodes, postoperative chest drainage time, complications, and hospital stay were compared respectively among the three groups.

Results

There was no significant difference among the groups in terms of age, complication, diameter and location of the tumor(P>0.05). The surgical margins were negative in all cases, with no conversion to thoracotomy or dead case occured. The operation time of SU-VATS group was significantly shorter than that of U-VATS and M-VATS groups [(100.6±20.3) min vs (123.8±27.4) min vs (119.5±26.4) min, P<0.05]. In addition, the chest drainage time of SU-VATS group was noticeably shorter than that of U-VATS group [(3.1±1.5) d vs (4.0±2.1) d, P=0.02], while postoperative drainage volume in the SU-VATS group was much smaller than that in U-VATS group [(485.8±180.9) ml vs (582.5±291.4) ml, P=0.02], and the postoperative hospital stay shorter [(6.0±1.6) d vs (6.9±2.0) d, P=0.01]. However, in terms of postoperative drainage volume and postoperative hospital stay, there was no significant differences between SU-VATS and M-VATS groups (P>0.05). Besides, on the 1st day after surgery, the pain scores of the patients in SU-VATS group were lower than in U-VATS and M-VATS groups[(4.6±1.1) vs (5.9±1.1) vs (5.4±1.0), P<0.05]. However, On the 3rd after surgery, the pain scores of the patients in SU-VATS group were lower than in U-VATS group [(4.0±1.0) vs (4.6±1.1), P=0.003], without noticeable difference compared with the M-VATS group (P=0.15). Moreover, on the 5th after surgery, the pain scores in SU-VATS group were still lower than those of U-VATS group [(3.2±1.0) vs (3.8±1.2), P=0.007], with no significant difference compared with the M-VATS group (P=0.15). All three groups did not indicated differences in terms of stations and numbers of the dissected lymph nodes, and operation-related complications (P>0.05).

Conclusions

SU-VATS lobectomy for lung cancer is reliable, followed by certain advantages as compared with U-VATS and M-VATS.

Key words: Single-direction, Single-port /Uniport, Video-assisted thoracoscopic surgery, Lobectomy

Tian Zhao, Miao Zhang, Wenbin Wu, Dong Liu, Xuefeng Pan, Cunjiang Li, Hui Zhang, Zhengqun Hu, Dunpeng Yang, Min Li. A clinical analysis on the efficacy and characteristics of single-direction uniportal thoracoscopic pulmonary lobectomy[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(04): 201-207.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhxbwkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8773.2018.04.01

https://zhxbwkdzzz.cma-cmc.com.cn/EN/Y2018/V05/I04/201

Figures/Tables 2

References 21

1	Mu J W, Gao S G, 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]. J Thorac Dis, 2016, 8(7):1469-1476.
2	卢礼卿，程远大，张春芳. 单孔胸腔镜手术无胸管留置在胸外科快速康复中的应用[J]. 中华胸部外科电子杂志，2017, 4(3):159-163.
3	Yu PS, Capili F, Ng CS. Single port VATS: recent developments in Asia [J]. J Thorac Dis, 2016, 8(Suppl3):S302-S307.
4	刘伦旭，车国卫，蒲强，等. 单向式全胸腔镜肺叶切除术[J]. 中华胸心血管外科杂志，2008, 24(3):156-158.
5	刘成武，郭成林，林锋，等. 单向式胸腔镜肺叶或肺段切除术治疗Ⅰ期肺癌的远期疗效[J]. 中华外科杂志，2015，53(10):742-746.
6	王珩，张淼，武文斌，等. 单孔胸腔镜肺叶切除术治疗肺癌的经验与反思[J]. 中华胸心血管外科杂志，2017, 33(8):493-498.
7	高文，张智. 肺癌的外科治疗进展[J]. 中华胸部外科电子杂志，2017, 4(4):234-238.
8	Lyscov A, Obukhova T, Ryabova V, et al. Double-sleeve and carinal resections using the uniportal VATS technique: a single centre experience [J]. J Thorac Dis, 2016, 8(Suppl3):S235-S241.
9	Oncel M, Sunam GS, Ylldlran H. Training with Video-Assisted Thoracic Surgery [J]. Thorac Cardiovasc Surg, 2017, 65(5):430-430.
10	Harris CG, James RS, Tian DH, et al. Systematic review and meta-analysis of uniportal versus multiportal video-assisted thoracoscopic lobectomy for lung cancer[J]. Ann Cardiothorac Surg，2016, 5(2):76-84.
11	Mcelnay PJ, Molyneux M, Krishnadas R, et al. Pain and recovery are comparable after either uniportal or multiport video-assisted thoracoscopic lobectomy: an observation study[J]. Eur J Cardiothorac Surg, 2015, 47(5):912-915.
12	Sihoe AD. Reasons not to perform uniportal VATS lobectomy [J]. J Thorac Dis, 2016, 8(Suppl3):S333-S343.
13	Akter F, Routledge T, Toufektzian L, et al. In minor and major thoracic procedures is uniport superior to multiport video-assisted thoracoscopic surgery[J] Interact Cardiovasc Thorac Surg. 2015, 20(4):550-555.
14	魏常，邓娟娟，杨为贵. 高龄低肺功能肺癌患者的围手术期肺保护[J]. 中华胸部外科电子杂志，2017, 4(1):31-37.
15	周坤，苏建华，赖玉田，等. 术前肺康复训练对肺癌患者术后肺炎的影响[J]. 中华胸部外科电子杂志，2017, 4(3):164-170.
16	中国加速康复外科专家组. 中国加速康复外科围手术期管理专家共识(2016) [J]. 中华外科杂志. 2016, 54:413-418.
17	Chen-Yoshikawa TF, Date H. Update on three-dimensional image reconstruction for preoperative simulation in thoracic surgery [J]. J Thorac Dis, 2016，8(Suppl3):S295-S301.
18	阎石，吴楠，王兴，等. 右肺上叶肺动脉分支特点[J]. 中国胸心血管外科临床杂志. 2018，25(6):1-5.
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]. J Thorac Dis, 2016，8(8):2281-2283.
20	刘成武，蒲强，马林，等. 单孔与单向式胸腔镜肺癌切除术的结合——单孔单向式胸腔镜肺癌切除术[J]. 中国胸心血管外科临床杂志，2017, 24(12):907-910.
21	Guerrero WG, González-Rivas D. Multiportal video-assisted thoracic surgery, uniportal video-assisted thoracic surgery and minimally invasive open chest surgery-selection criteria. J Vis Surg, 2017, 3:56.

项目		SU-VATS组(n＝60)	U-VATS组(n＝60)	M-VATS组(n＝60)	F/χ²值	P值
年龄(±s，岁)		60.6±10.6	63.1±10.5	61.8±10.4	0.85	0.43
性别(男/女，n/n)		41/19	39/21	45/15	1.47	0.48
BMI(±s，kg/m²)		24.9±1.3	24.4±1.7	24.5±2.0	1.76	0.18
内科合并症(n)		12	15	17	1.14	0.56
?	高血压	3	5	9	?	?
?	冠心病	6	7	1	?	?
?	糖尿病	2	2	6	?	?
?	慢性阻塞性肺疾病	1	1	1	?	?
吸烟史(n)		?	?	?	4.95	0.29
?	不吸烟	34	42	31	?	?
?	≤10包年	16	11	20	?	?
?	>10包年	10	7	9	?	?
新辅助化疗(n)		12	11	14	0.48	0.79
?	1个周期	2	5	9	?	?
?	2个周期	10	6	5	?	?
肿瘤分布(n)		?	?	?	7.96	0.44
?	左上叶	5	2	6	?	?
?	左下叶	15	17	12	?	?
?	右上叶	24	31	29	?	?
?	右中叶	0	1	2	?	?
?	右下叶	16	9	11	?	?
肿瘤T分期(n)		?	?	?	9.70	0.14
?	T1a期	10	6	15	?	?
?	T1b期	17	24	21	?	?
?	T2a期	31	29	20	?	?
?	T2b期	2	1	4	?	?

项目		SU-VATS组(n＝60)	U-VATS组(n＝60)	M-VATS组(n＝60)	F/χ²值	P值
年龄(±s，岁)		60.6±10.6	63.1±10.5	61.8±10.4	0.85	0.43
性别(男/女，n/n)		41/19	39/21	45/15	1.47	0.48
BMI(±s，kg/m²)		24.9±1.3	24.4±1.7	24.5±2.0	1.76	0.18
内科合并症(n)		12	15	17	1.14	0.56
?	高血压	3	5	9	?	?
?	冠心病	6	7	1	?	?
?	糖尿病	2	2	6	?	?
?	慢性阻塞性肺疾病	1	1	1	?	?
吸烟史(n)		?	?	?	4.95	0.29
?	不吸烟	34	42	31	?	?
?	≤10包年	16	11	20	?	?
?	>10包年	10	7	9	?	?
新辅助化疗(n)		12	11	14	0.48	0.79
?	1个周期	2	5	9	?	?
?	2个周期	10	6	5	?	?
肿瘤分布(n)		?	?	?	7.96	0.44
?	左上叶	5	2	6	?	?
?	左下叶	15	17	12	?	?
?	右上叶	24	31	29	?	?
?	右中叶	0	1	2	?	?
?	右下叶	16	9	11	?	?
肿瘤T分期(n)		?	?	?	9.70	0.14
?	T1a期	10	6	15	?	?
?	T1b期	17	24	21	?	?
?	T2a期	31	29	20	?	?
?	T2b期	2	1	4	?	?

临床参数		SU-VATS(n＝60)	U-VATS(n＝60)	M-VATS(n＝60)	F/χ²值	P值
操作孔切口长度(±s，cm)		4.5±0.4	4.7±0.5*	4.4±0.5	7.23	<0.01
手术时间(±s，min)		100.6±20.3	123.8±27.4*	119.5±26.4*	14.65	<0.01
术中出血(±s，ml)		194.2±56.8	218.3±81.8*	200.0±70.9	1.92	0.15
淋巴结清扫(±s)		?	?	?	?	?
?	站数	7.8±1.6	8.0±1.7	8.0±1.6	0.21	0.81
?	个数	12.4±2.4	12.4±2.8	12.3±2.4	0.06	0.94
术后胸腔管引流时间(±s，d)		3.1±1.5	4.0±2.1*	3.5±2.3	3.01	0.05
术后胸腔管引流量(±s，ml)		485.8±180.9	582.5±291.4*	526.7±180.5	2.82	0.06
术后并发症(n)		5 (0.1 %)	8 (0.1 %)	7 (0.1 %)	0.79	0.67
?	肺漏气时间>7d	1	2	2	?	?
?	肺部感染	1	1	0	?	?
?	肺不张	0	0	1	?	?
?	乳糜胸	0	1	0	?	?
?	心律失常	3	4	4	?	?
术后住院时间(±s，d)		6.0±1.6	6.9±2.0*	6.6±2.2	3.78	0.03
VAS疼痛评分(±s，分)		?	?	?	?	?
?	术后第1天	4.6±1.1	5.9±1.1*	5.4±1.0*	22.89	<0.01
?	术后第3天	4.0±1.0	4.6±1.1*	4.3±1.1	4.66	0.01
?	术后第5天	3.2±1.0	3.8±1.2*	3.5±1.1	3.70	0.03

临床参数		SU-VATS(n＝60)	U-VATS(n＝60)	M-VATS(n＝60)	F/χ²值	P值
操作孔切口长度(±s，cm)		4.5±0.4	4.7±0.5*	4.4±0.5	7.23	<0.01
手术时间(±s，min)		100.6±20.3	123.8±27.4*	119.5±26.4*	14.65	<0.01
术中出血(±s，ml)		194.2±56.8	218.3±81.8*	200.0±70.9	1.92	0.15
淋巴结清扫(±s)		?	?	?	?	?
?	站数	7.8±1.6	8.0±1.7	8.0±1.6	0.21	0.81
?	个数	12.4±2.4	12.4±2.8	12.3±2.4	0.06	0.94
术后胸腔管引流时间(±s，d)		3.1±1.5	4.0±2.1*	3.5±2.3	3.01	0.05
术后胸腔管引流量(±s，ml)		485.8±180.9	582.5±291.4*	526.7±180.5	2.82	0.06
术后并发症(n)		5 (0.1 %)	8 (0.1 %)	7 (0.1 %)	0.79	0.67
?	肺漏气时间>7d	1	2	2	?	?
?	肺部感染	1	1	0	?	?
?	肺不张	0	0	1	?	?
?	乳糜胸	0	1	0	?	?
?	心律失常	3	4	4	?	?
术后住院时间(±s，d)		6.0±1.6	6.9±2.0*	6.6±2.2	3.78	0.03
VAS疼痛评分(±s，分)		?	?	?	?	?
?	术后第1天	4.6±1.1	5.9±1.1*	5.4±1.0*	22.89	<0.01
?	术后第3天	4.0±1.0	4.6±1.1*	4.3±1.1	4.66	0.01
?	术后第5天	3.2±1.0	3.8±1.2*	3.5±1.1	3.70	0.03

[1]	Banghan Cui, Jun Hu, Xinglin Wang, Liyuan Wu, Qiuyue Chen. Comparative study of ultrasound-guided radiofrequency ablation and laparoscopic caudate lobectomy for hepatocellular carcinoma in the caudate lobe with diameter ≤ 5 cm [J]. Chinese Archives of General Surgery(Electronic Edition), 2022, 16(03): 188-193.
[2]	Jingzhu Zhao, Xiangqian Zheng, Ming Gao, Jiadong Chi, Xinwei Yun, Dapeng Li, Xianhui Ruan. Surgical selection and prognostic analysis of sporadic medullary thyroid carcinoma [J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(06): 429-431.
[3]	Chen Yan, Tao Liu, Fei Xuan. Effects of ultrasound guidance combined with general anesthesia on serum NGF-β and MBP in elderly patients with lung lobectomy and postoperative outcome [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(02): 192-196.
[4]	Xiaokuang Ning, Puming Hao, Rui Yan, Yunze Liu, Chengrun Li. Analysis of a study about single-direction three-port thoracoscopic surgery lobectomy for early-stage lung cancer [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2023, 16(04): 227-232.
[5]	Pengyu Zhou, Zhijian Tu, Chuanfu Li, Xiaohua Lei, Guodong Chen. Robotic anatomical right posterior hepatic lobectomy [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2023, 16(01): 56-59.
[6]	Ye Ning, Zhigang Chen, Wentian Zhang, Lei Jiang. Non-intubated right middle lobe sleeve-lobectomy via uniport-VATS with monitored anesthesia care [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(03): 191-192.
[7]	Juntang Guo, Bin Wang, Leilei Shen, Chaoyang Liang, Yang Liu. Comparative analysis of clinical outcomes of video-assisted thoracic surgery for anterior mediastinal tumors via subxiphoid and lateral intercostal approaches [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(04): 221-225.
[8]	Wei Luo, Yize Li, Ran Cao, Xugang Zhang, Qing Yin, Kun Wang. Uniportal thoracoscopic right upper lobectomy: a case series of double-stapling technique [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2023, 10(04): 200-206.
[9]	Ao Liu, Yandong Zhao, Tong Qiu, Yunpeng Xuan, Xiao Sun, Yi Qin, Rongjian Xu, Wenxing Du, Zhe Wu, Wenjie Jiao. Robot-assisted bronchial sleeve lobectomy—from margin to prognosis [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2022, 09(04): 217-222.
[10]	Jianqiao Cai, Jing Huang, Lei Jiang. Double sleeve uniportal video-assisted thoracoscopic lobectomy—a retrospective study from shanghai pulmonary hospital [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2022, 09(03): 144-149.
[11]	Jiawei Chen, Rui Wang, Jiaxi He, Shuben Li. Application the integrated operating room on localization and resection of pulmonary nodule: a systematic review [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2022, 09(02): 80-85.
[12]	Yufeng Xie, Song Wang, Daliang Yan, Jiangfeng Shen. Video-assisted thoracoscopic surgery versus open thoracotomy for pulmonary sequestration: a meta-analysis of efficacy and safety [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2021, 08(04): 257-263.
[13]	Zhanliang Ren, Xiaopeng Ren, Yong Zhang, Taiping He, Yingjie Han, Weifeng Zhang, Yunhao Liu, Mingliang Xing. Application of accelerated rehabilitation surgical procedure in the perioperative period of single-port thoracoscopic lobectomy [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2021, 08(04): 229-234.
[14]	Julio Sesma, Sergio Bolufer, Carlos Galvez, Francisco Lirio, Juan José Mafé, Jone Miren Del Campo, Sergio Maroto, Leyre Sebastian, Marta Ortega, Luis Jorge Cerezal. Technical aspects of uniportal VATS lung major resections with bronchovascular reconstruction [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2021, 08(04): 209-217.
[15]	Patrick Zardo, Norman Zinne, Alaa Selman, Hayan Merhej, Tobias Goecke, Henning Starke, Daniel Jaeger, Jan Karsten, Axel Haverich. Non-intubated minimally-invasive lung surgery in Germany-current status and outlook [J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2021, 08(04): 205-208.

Please choose a citation manager

Content to export