Single utility port video-assisted thoracoscopic anatomic segmentectomy for lung diseases: 155 cases report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAO Haibo , HU Rui , JIANG Lianyong , WANG Lei , WANG Mingsong , HU Fengqing , XIE Xiao ,  MEI Ju

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.China;

Corresponding author：

MEI Ju, Email: meiju@xinhuamed.com.cn

Keywords：

Single utility port; video-assisted thoracoscopic surgery; anatomic segmentectomy

DOI：

10.7507/1007-4848.201806057

Video：

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Objective To evaluate the feasibility and safety of single utility port video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy for lung diseases. Methods We performed a retrospective review of 155 patients undergoing single utility port VATS anatomic segmentectomy from January 2015 to December 2016. There were 62 males and 93 females with a mean age of 53 (24–82) years. Two ports were used. The camera was through the port for observation which was about 1.5 cm in length and located at the 7^th or 6^th intercostal space. The instruments were through port for operation that was about 3–4 cm in length and located at the 4^th or 3^th intercostal space. Pulmonary segment vessel and segmental bronchi were cut and stitched by Hemolock or linear cut stapler. Different segments were separated by linear cut stapler. Perioperative data were collected and analyzed. Results One patient was performed suture under the auxiliary operating hole (three holes) because of pulmonary artery bleeding. The remaining 154 patients underwent single utility port VATS anatomic segmentectomy successfully. No conversion to open procedure or lobectomy was found and there was no perioperative mortality. The median operative time was 102 (65–150) min and the median blood loss in operation was 118 (50–300) ml. The thoracic drainage time was 3.8 (2–7) d and the median hospital stay after operation was 5.6 (3–9) d . Major morbidity occurred in 8 patients (5.2%) including hemoptysis (in 2 patients), pneumonia (in 2 patients), aerodermectasia (in 1 patient), pleural effussion (in 1 patient) and local atelectasis (in 1 patient). All of them above healed after symptomatic treatment. Patholocal examination showed there were 139 patients of primary lung carcinoma (pathologically staged as Tis-T1bN0M0), 9 patients of benign diseases and 7 patients of metastasis tumor. Conclusion Single utility port VATS anatomic segmentectomy procedure is safe and feasible. It can be utilized as an option for those with non-small cell lung cancer staged Ⅰa and those unable to tolerate pulmonary lobectomy.

Citation： XIAO Haibo, HU Rui, JIANG Lianyong, WANG Lei, WANG Mingsong, HU Fengqing, XIE Xiao, MEI Ju. Single utility port video-assisted thoracoscopic anatomic segmentectomy for lung diseases: 155 cases report. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(4): 348-352. doi: 10.7507/1007-4848.201806057 Copy

1.	Iwata H. Therapeutic strategy for small-sized lung cancer. Gen Thorac Cardiovasc Surg, 2016, 64(8): 450-456.
2.	Amore D, Imitazione P, Palma A, et al. Conversion to thoracotomy during VATS segmentectomy for treatment of symptomatic endobronchial hamartoma. Int J Surg Case Rep, 2018, 51: 272-274.
3.	Iwata H1, Shirahashi K, Mizuno Y, et al. Surgical technique of lung segmental resection with two intersegmental planes. Interact Cardiovasc Thorac Surg, 2013, 16(4): 423-425.
4.	Hong TH, Cho JH, Shin S, et al. Extended sleeve lobectomy for centrally located non-small-cell lung cancer: a 20-year single-centre experience. Eur J Cardiothorac Surg, 2018, 54(1): 142-148.
5.	Liu Y, Huang C, Liu H, et al. Sublobectomy versus lobectomy for stage ⅠA (T1a) non-small-cell lung cancer: a meta-analysis study. World J Surg Oncol, 2014, 12: 138-143.
6.	Kodama K, Higashiyama M, Okami J, et al. Oncologic outcomes of segmentectomy versus lobectomy for clinical T1aN0M0 non-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 504-511.
7.	Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage IA lung adenocarcinoma: propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
8.	Bao F, Ye P, Yang Y, et al. Segmentectomy or lobectomy for early stage lung cancer: a meta-analysis. Eur J Cardiothorac Surg, 2014, 46(1): 1-7.
9.	Bé dat B, Abdelnour-Berchtold E, Krueger T, et al. Clinical outcome and risk factors for complications after pulmonary segmentectomy by video-assisted thoracoscopic surgery: results of an initial experience. J Thorac Dis, 2018, 10(8): 5023-5029.
10.	Macke RA, Schuchert MJ, Odell DD, et al. Parenchymal preserving anatomic resections result in less pulmonary function loss in patients with Stage I non-small cell lung cancer. J Cardiothorac Surg, 2015, 10: 49-55.
11.	Zhang G, Yu Z, Wang L, et al. Uniportal video-assisted thoracoscopic S8 segmentectomy and S1a subsegmentectomy for synchronous multiple primary lung cancers. J Thorac Dis, 2018, 10(7): 4475-4480.
12.	Ettinger DS, Wood DE, Aisner DL, et al. Non-small cell lung ancer, version 5.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2017, 15(4): 504-535.
13.	Chang SS, Okamoto T, Tokunaga Y, et al. Intraoperative Computed Tomography Navigation During Thoracoscopic Segmentectomy for Small-sized Lung Tumors. Semin Thorac Cardiovasc Surg, 2018, 30(1): 96-101.
14.	Ohtaki Y, Shimizu K. Anatomical thoracoscopic segmentectomy for lung cancer. Gen Thorac Cardiovasc Surg, 2014, 62(10): 586-593.
15.	Witte B, Stenz C, Vahl CF, et al. Comparative intention-to-treat analysis of the video-assisted thoracoscopic surgery approach to pulmonary segmentectomy for lung carcinoma. Interact Cardiovasc Thorac Surg, 2015, 21(3): 276-283.
16.	Sato M, Kobayashi M, Kojima F., et al Effect of virtual-assisted lung mapping in acquisition of surgical margins in sublobar lung resection. J Thorac Cardiovasc Surg,, 2018, 156(4): 1691-1701.
17.	Song CY, Sakai T, Kimura D, et al. Comparison of perioperative and oncological outcomes between video-assisted segmentectomy and lobectomy for patients with clinical stage IA non-small cell lung cancer: a propensity score matching study. J Thorac Dis, 2018, 10(8): 4891-4901.

1. Iwata H. Therapeutic strategy for small-sized lung cancer. Gen Thorac Cardiovasc Surg, 2016, 64(8): 450-456.
2. Amore D, Imitazione P, Palma A, et al. Conversion to thoracotomy during VATS segmentectomy for treatment of symptomatic endobronchial hamartoma. Int J Surg Case Rep, 2018, 51: 272-274.
3. Iwata H1, Shirahashi K, Mizuno Y, et al. Surgical technique of lung segmental resection with two intersegmental planes. Interact Cardiovasc Thorac Surg, 2013, 16(4): 423-425.
4. Hong TH, Cho JH, Shin S, et al. Extended sleeve lobectomy for centrally located non-small-cell lung cancer: a 20-year single-centre experience. Eur J Cardiothorac Surg, 2018, 54(1): 142-148.
5. Liu Y, Huang C, Liu H, et al. Sublobectomy versus lobectomy for stage ⅠA (T1a) non-small-cell lung cancer: a meta-analysis study. World J Surg Oncol, 2014, 12: 138-143.
6. Kodama K, Higashiyama M, Okami J, et al. Oncologic outcomes of segmentectomy versus lobectomy for clinical T1aN0M0 non-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 504-511.
7. Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage IA lung adenocarcinoma: propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
8. Bao F, Ye P, Yang Y, et al. Segmentectomy or lobectomy for early stage lung cancer: a meta-analysis. Eur J Cardiothorac Surg, 2014, 46(1): 1-7.
9. Bé dat B, Abdelnour-Berchtold E, Krueger T, et al. Clinical outcome and risk factors for complications after pulmonary segmentectomy by video-assisted thoracoscopic surgery: results of an initial experience. J Thorac Dis, 2018, 10(8): 5023-5029.
10. Macke RA, Schuchert MJ, Odell DD, et al. Parenchymal preserving anatomic resections result in less pulmonary function loss in patients with Stage I non-small cell lung cancer. J Cardiothorac Surg, 2015, 10: 49-55.
11. Zhang G, Yu Z, Wang L, et al. Uniportal video-assisted thoracoscopic S8 segmentectomy and S1a subsegmentectomy for synchronous multiple primary lung cancers. J Thorac Dis, 2018, 10(7): 4475-4480.
12. Ettinger DS, Wood DE, Aisner DL, et al. Non-small cell lung ancer, version 5.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2017, 15(4): 504-535.
13. Chang SS, Okamoto T, Tokunaga Y, et al. Intraoperative Computed Tomography Navigation During Thoracoscopic Segmentectomy for Small-sized Lung Tumors. Semin Thorac Cardiovasc Surg, 2018, 30(1): 96-101.
14. Ohtaki Y, Shimizu K. Anatomical thoracoscopic segmentectomy for lung cancer. Gen Thorac Cardiovasc Surg, 2014, 62(10): 586-593.
15. Witte B, Stenz C, Vahl CF, et al. Comparative intention-to-treat analysis of the video-assisted thoracoscopic surgery approach to pulmonary segmentectomy for lung carcinoma. Interact Cardiovasc Thorac Surg, 2015, 21(3): 276-283.
16. Sato M, Kobayashi M, Kojima F., et al Effect of virtual-assisted lung mapping in acquisition of surgical margins in sublobar lung resection. J Thorac Cardiovasc Surg,, 2018, 156(4): 1691-1701.
17. Song CY, Sakai T, Kimura D, et al. Comparison of perioperative and oncological outcomes between video-assisted segmentectomy and lobectomy for patients with clinical stage IA non-small cell lung cancer: a propensity score matching study. J Thorac Dis, 2018, 10(8): 4891-4901.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Single utility port video-assisted thoracoscopic anatomic segmentectomy for lung diseases: 155 cases report

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