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Uniportal VATS lobectomy in the treatment of NSCLC lung cancer

Background

Uniportal Video-Assisted Thoracic Surgery (uniportal VATS) lobectomy represents the pinnacle of evolution for minimally invasive techniques in surgical management of lung cancer. Growing evidence suggest that Uniportal VATS procedures are technically feasible and safe with immediate outcomes comparable to traditional VATS approach. Uniportal approach has demonstrated equivalent disease-free survival, at intermediate follow-up for patients with early stage NSCLC, compared to conventional VATS. It represents a less invasive approach, and offers the advantage of minimizing the extent of the surgical access trauma thus resulting in postoperative pain reduction, muffled inflammatory response, early recovery and better cosmesis. Some authors described minimal changes in pulmonary function after uniportal surgery in patients with poor cardio-respiratory function. Here we present our experiences with uniportal VATS lobectomies for NSCLC.

Key words: Uniportal, VATS, lobectomy, NSCLC

Materials and methods

Between October 2015. and March 2016. twenty-four (24) patients with non-small lung cancer (NSCLC) underwent uniportal VATS lobectomy and mediasitnal lymph node dissection. Surgical access was performed through a 4-5 cm long utilitarian incision at the 5th intercostal space in the anterior axillary line. Anatomical resection of veins, arteries, bronchi and mediastinal lymph nodes followed established oncological principals. Once the operation was completed a single chest tube was inserted in the anterior part of the incision for uniportal VATS.

Results

Fifteen male and nine female patients with an average age of 62.6 years (49-76) were enrolled in the study. Average procedural time was 108 minutes (75min-154min). None of the patients required blood transfusion after the procedure or during the rest of their hospital stay. Average duration of chest drainage was 3.6 days (2-8) and mean hospital stay was 6.3 days (3-10). There were 14 patients with adenocarcinoma and 10 with squamous cell carcinoma. Two patients had prolonged air leak and were treated conservatively. There was no perioperative mortality.

Conclusions

Our initial experiences with Uniportal VATS lobectomy is encouraging as it demonstrated benefits to patients due minimal surgical stress, faster recovery, reduced postoperative pain and shorter hospital stay.

Krnic D., Juricic J., Ilic N., Orsulic D., Simundza I., Urlic M.
Department of Thoracic Surgery, University Hospital Split, Split, Croatia

Corresponding presenting author's e-mail: joskojuricic123@gmail.com

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