Posterior approach for uniportal video-assisted thoracic surgery right upper lobectomy in the semiprone position_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIN Zongwu , WANG Lin , XI Junjie ,  XU Songtao , WANG Qun

Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P.R.China;

Corresponding author：

XU Songtao, Email: xu.songtao@zs-hospital.sh.cn

Keywords：

Video-assisted thoracic surgery; right superior lobectomy; non-small cell lung cancer; single port; posterior approach

DOI：

10.7507/1007-4848.201808005

Video：

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Objective To increase the advantage and decrease the disadvantage of posterior approach for uniportal video-assisted thoracic surgery (VATS) right upper lobectomy.Methods Data of 97 consecutive patients who received uniportal VATS right upper lobectomy using posterior approach in the semiprone position were retrospectively analyzed from Dec, 2014 to Dec, 2017. There were 41 males and 56 females at age of 26–79 (57.8±10.6) years. The hilar structure was cut from posterior to anterior one by one. The mediastinal lymph nodes were dissected if lung cancer was diagnosed.Results Ninety three of 97 patients were successfully completed with uniportal VATS right upper lobectomy using posterior approach, 3 of them were completed with posterior approach combined with anterior approach, and 1 of them needed thoracotomy. The mean operative time was 76–192 (127.0±32.0) min. The thoracic drainage time was 2–20 (3.4±2.7) d. The postoperative length of hospital stay was 3–23 (5.4±3.1) d. There were postoperative complications in 7 patients and no postoperative mortality.Conclusion Posterior approach for uniportal video-assisted thoracic surgery right upper lobectomy is safe and feasible, which can decrease the fatigue of both the surgeon and the assistant. It also provides with better exposure of posterior mediastinum, less dragging lung, and less interference of the instruments and help keep the clear surgical field. In complicated cases, posterior approach could combine with anterior approach to complete the VATS lobectomy.

Citation： LIN Zongwu, WANG Lin, XI Junjie, XU Songtao, WANG Qun. Posterior approach for uniportal video-assisted thoracic surgery right upper lobectomy in the semiprone position. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(1): 53-56. doi: 10.7507/1007-4848.201808005 Copy

1.	Shen Y, Feng M, Tan L, et al. Thoracoscopic esophagectomy in prone versus decubitus position: ergonomic evaluation from a randomized and controlled study. Ann Thorac Surg, 2014, 98(3): 1072-1078.
2.	Lin Z, Xu S, Wang Q. Uniportal video-assisted thoracoscopic surgery right upper lobectomy with systematic lymphadenectomy in a semiprone position. J Thorac Dis, 2014, 6(12): 1840-1842.
3.	蒋伟, 奚俊杰, 汪灏, 等. 全胸腔镜肺叶切除术治疗临床早期非小细胞肺癌的疗效评价. 中国胸心血管外科临床杂志, 2012, 19(2): 120-124.
4.	林宗武, 徐松涛, 王群. 半俯卧位单孔胸腔镜肺叶切除术的初步探讨. 中国临床医学, 2015, 22(2): 159-164.
5.	Lin Z, Xi J, Xu S, et al. Uniportal video-assisted thoracic surgery lobectomy in semiprone position: primary experience of 105 cases. J Thorac Dis, 2015, 7(12): 2389-2395.
6.	林宗武, 奚俊杰, 蒋伟, 等. 无抓持整块纵隔淋巴结清扫在单孔胸腔镜肺癌手术中的应用. 中华胸心血管外科杂志, 2015, 31(11): 645-648.
7.	刘伦旭, 刘成武, 朱云柯, 等. 胸腔镜无抓持整块纵隔淋巴结切除. 中国胸心血管外科临床杂志, 2015, 22(1): 1-3.
8.	Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg, 2015, 15: 38.
9.	Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg, 2011, 12(3): 514-515.
10.	Shen Y, Wang H, Feng M, et al. Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study? Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i48-i53.
11.	Xie D, Wang H, Fei K, et al. Single-port video-assisted thoracic surgery in 1063 cases: a single-institution experience. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i31-36.
12.	Guo C, Liu C, Lin F, et al. Intrathoracic vertical overhanging approach for placement of an endo-stapler during single-port video-assisted thoracoscopic lobectomy? Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i84-i86.
13.	Lin Z, Xu S, Wang Q. Uniportal video-assisted thoracic lobectomy in a semiprone position for the treatment of a huge intralobar pulmonary sequestration. Interact Cardiovasc Thorac Surg, 2015, 21(4): 542-544.
14.	刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
15.	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.
16.	Richards JM, Dunning J, Oparka J, et al. Video-assisted thoracoscopic lobectomy: the Edinburgh posterior approach. Ann Cardiothorac Surg, 2012, 1(1): 61-69.

1. Shen Y, Feng M, Tan L, et al. Thoracoscopic esophagectomy in prone versus decubitus position: ergonomic evaluation from a randomized and controlled study. Ann Thorac Surg, 2014, 98(3): 1072-1078.
2. Lin Z, Xu S, Wang Q. Uniportal video-assisted thoracoscopic surgery right upper lobectomy with systematic lymphadenectomy in a semiprone position. J Thorac Dis, 2014, 6(12): 1840-1842.
3. 蒋伟, 奚俊杰, 汪灏, 等. 全胸腔镜肺叶切除术治疗临床早期非小细胞肺癌的疗效评价. 中国胸心血管外科临床杂志, 2012, 19(2): 120-124.
4. 林宗武, 徐松涛, 王群. 半俯卧位单孔胸腔镜肺叶切除术的初步探讨. 中国临床医学, 2015, 22(2): 159-164.
5. Lin Z, Xi J, Xu S, et al. Uniportal video-assisted thoracic surgery lobectomy in semiprone position: primary experience of 105 cases. J Thorac Dis, 2015, 7(12): 2389-2395.
6. 林宗武, 奚俊杰, 蒋伟, 等. 无抓持整块纵隔淋巴结清扫在单孔胸腔镜肺癌手术中的应用. 中华胸心血管外科杂志, 2015, 31(11): 645-648.
7. 刘伦旭, 刘成武, 朱云柯, 等. 胸腔镜无抓持整块纵隔淋巴结切除. 中国胸心血管外科临床杂志, 2015, 22(1): 1-3.
8. Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg, 2015, 15: 38.
9. Gonzalez D, Paradela M, Garcia J, et al. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg, 2011, 12(3): 514-515.
10. Shen Y, Wang H, Feng M, et al. Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study? Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i48-i53.
11. Xie D, Wang H, Fei K, et al. Single-port video-assisted thoracic surgery in 1063 cases: a single-institution experience. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i31-36.
12. Guo C, Liu C, Lin F, et al. Intrathoracic vertical overhanging approach for placement of an endo-stapler during single-port video-assisted thoracoscopic lobectomy? Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i84-i86.
13. Lin Z, Xu S, Wang Q. Uniportal video-assisted thoracic lobectomy in a semiprone position for the treatment of a huge intralobar pulmonary sequestration. Interact Cardiovasc Thorac Surg, 2015, 21(4): 542-544.
14. 刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
15. 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.
16. Richards JM, Dunning J, Oparka J, et al. Video-assisted thoracoscopic lobectomy: the Edinburgh posterior approach. Ann Cardiothorac Surg, 2012, 1(1): 61-69.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Posterior approach for uniportal video-assisted thoracic surgery right upper lobectomy in the semiprone position

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