Is video-assisted thoracoscopic lobectomy a unified approach? (original) (raw)
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European Journal of Cardio-Thoracic Surgery, 2013
OBJECTIVES: Video-assisted thoracoscopic surgery (VATS) lobectomy is associated with improved short-term outcomes compared with thoracotomy. Definition of the hilar structures is crucial to safe VATS lobectomy. Several VATS approaches have been described. We report the effect of three surgeons in our institution undertaking standardized anterior approach (SAA) training on the proportion of isolated lobectomies subsequently completed by VATS. Predictors of successful VATS lobectomy were analysed.
Annals of the American Thoracic Society, 2016
Rationale: There is a paucity of data regarding the optimal surgical approach for lung lobectomy. Lobectomy performed by videoassisted thoracoscopic surgery (VATS) has been associated with lower morbidity as compared with lobectomy performed by thoracotomy. However, no multicenter studies have shown improved mortality with VATS lobectomy compared with open surgical lobectomy. Objectives: We used data from the United States Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2009 to 2012 to compare VATS with open lobectomy for in-hospital mortality and other short-term outcomes. Methods: We used International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes to identify the patients undergoing lobectomy. We used 1:1 ratio propensity matching with the nearest neighbor method without replacement to generate matched pairs. Measurements and Main Results: Over the 4-year period, 27,451 patients underwent lobectomy. The majority of these procedures were performed by thoracotomy (65%) as compared with VATS (35%). A total of 9,393 matched pairs were created. VATS lobectomy was associated with significantly lower in-hospital mortality when compared with thoracotomy (1.3% vs. 2.5%, P , 0.001). A shorter length of hospital stay was observed for those undergoing VATS lobectomy (6.21 vs. 8.75 d, P , 0.001). The overall rate of perioperative complications was low, with those undergoing VATS being less likely to have any perioperative morbidity. Conclusions: In recent years, the use of VATS for lobectomy has increased relative to thoracotomy. This trend has coincided with increased survival and shorter length of stay for VATS lobectomy compared with thoracotomy. Further studies are needed to identify comorbidities that identify ideal candidates for VATS lobectomy.
2010
Data regarding the benefits for the complete video-assisted thoracic surgery (c-VATS) lobectomy over the open lobectomy are numerous. This article describes the experience of introducing this technique in a training hospital, the first reported cohort in The Netherlands. From March 2006 to November 2008, all patients operated on for proven or suspected lung cancer were analyzed. Prospective data from these patients were evaluated. A subgroup analysis for the c-VATS lobectomy is presented. A total of 184 operations were performed on 172 patients. In 122 (66.3%) of the operations the resection ended in a lobectomy of which 70 were done by complete thoracoscopic procedure. For the c-VATS lobectomy the mean operating time was 179 min, with a mean blood loss of 444 ml. The median hospital stay was four days. Complications were present in 10% of c-VATS lobectomies. No mortality was seen in the c-VATS group. After thorough evaluation and training, c-VATS lobectomy is a safe procedure that can be performed in a relatively low volume hospital. It has exceptional short-term benefits. For training purposes all operations must start thoracoscopically. All patients must be operated according the intention to treat method.
Video-assisted thoracoscopic surgery lobectomy using "the caudal approach": results and evolution
Journal of visualized surgery, 2017
Background Video-assisted thoracoscopic surgery (VATS) has become a common surgical approach in the diagnosis and treatment of lung and mediastinal diseases. In this study, we reported our current experience of thoracoscopic surgery using a new caudal position technique for anatomical lung resections and compared it with the standard anterior VATS technique. Methods From January 2016 to October 2017, 92 consecutive patients with lung cancer underwent VATS lobectomy. Among these, 34 patients were treated by conventional anterior three portal VATS lobectomy, and 58 patients were treated using the caudal three port VATS lobectomy. The mean operative time, conversion rate, hospital stay, post-operative drainage, reoperation, post operative pain were compared between each group. Results No differences between the two groups are showed in terms of surgical time, post-operative drainage, incidence of prolonged air leaks and post-operative pain. Conclusions The caudal approach to major pulm...
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2019
OBJECTIVES Our goal was to report the results of the first consensus paper among international experts in uniportal video-assisted thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi process, the objective of which was to define and standardize the main procedural steps, optimize its indications and perioperative management and identify elements to assist in future training. METHODS The 40 members of the working group were convened and organized on a voluntary basis by the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). An e-consensus finding exercise using the Delphi method was applied to require 75% agreement for reaching consensus on each question. Repeated iterations of anonymous voting continued for 3 rounds. RESULTS Overall, 31 international experts from 18 countries completed all 3 rounds of questionnaires. Although a technical quorum was not achieved, most of the responders agreed that the maximum size of a UniVATS in...
Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases
European Journal of Cardio-thoracic Surgery, 2011
Objective: To analyse the evolution of the video-assisted thoracoscopic (VATS) approach for lobectomy and results during the first 3 years of program. Methods: From 1 st July-2007 to 31 th July-2010 we carried out 200 lobectomies by VATS. In February 2009 we started performing VATS lobectomies with only 2 incisions .We have analyzed both annual and overall outcomes regarding type of approach, conversion rate, surgical time, lymphadenectomy and overall survival. Results: Distribution of the cases per year were as follows: first-year 32, second-year 65, thirdyear 103. Overall conversion rate was 14,5% (first-year 25%, second-year 20%, third-year 7.8%; p = 0.017). Surgical approach was: 4 ports (1 case), 3 ports (99 cases, 100% in first-year), 2 ports (99 cases, 80% in third-year), single-port (1 case, third-year) Mean surgical time in successful VATS was 193.8 min (210.8 first-year, 207.9 second-year, 181.1 third-year; p = 0.011), mean number of lymph nodes were 11.9 (9.3 first-year, 10.1 second-year, 13.9 third-year; p = 0.003) and mean explored stations was 4.2 (3.6 first-year, 3.8 second-year, 4.5 third-year; p < 0.001). Globally median chest tube duration was 3 days. Median length of stay was 4 days. The disease-free survival at 30 months was 85% for Stage I patients and 62% for non-stage I patients. Conclusions: As we gain more experience over time, with more cases performed each year and less invasive approaches, results improve in terms of less surgical time and more extended lymphadenectomies. Furthermore, we have observed a clear evolution in our surgical approach to a less invasive 2-port approach. In selected cases we have implemented the singleport lobectomy #
Journal of thoracic disease, 2018
The expertise curve of video-assisted thoracoscopic surgery (VATS) lobectomies still stirs debate and controversy both because of the number of procedures to carry out and of the evaluation of the learning threshold. The purpose of our study was the examination of the variables related to the learning curve of the video-assisted approach, to establish what may be an expression of the technical maturity of the surgeon. The National Register for VATS lobectomy built in 2013 was used to collect data from 65 Thoracic Surgery Units. Out of more than 3,700 patients enrolled, only information from Units with ≥100 VATS lobectomies were retrospectively analysed. Unpaired Student's -tests, Fisher's exact tests, Pearson's χ were applied as needed. Cumulative summative analysis and one-way ANOVA were used to identify the expertise curve of VATS lobectomy. Ten institutions contributed a total of 1,679 patients, who were divided into three uniform groups according to the chronological...
Video-assisted thoracic surgery lobectomy: results in lung cancer
Journal of Thoracic …, 2011
The first thoracoscopy was performed in 1910, when Hans Christian Jacobaeus inserted a rigid cystoscope into the pleural cavity (1); since then, the technique has undergone far-reaching changes that could not have been foreseen by the earliest practitioners. Major advances both in endoscopic material and in visualisation techniques, together with the use of single-lung ventilation, enabled Landreneau et al to lay the technical and strategic foundations for modern video-assisted thoracic surgery (VATS) in 1992 (2). Over the last fifteen years, major pulmonary section using VATS has been shown to be both safe and technically-feasible, and to offer a number of advantages over conventional surgery (3,4,5,6,7). Nevertheless, its adoption as a standard technique is proving slow; VATS is not routinely performed in most hospitals, and tends to be used mainly in highly-specialised centres. Recent reviews of the outcomes obtained in large patient series highlight the importance of training surgeons in this complex technique (5,6). Our Department has been performing major pulmonary resections by VATS since 1993, making it one of the pioneering groups in Europe. The Department also runs a twice-yearly training programme in advanced thoracoscopic surgery at the MINIMALLY INVASIVE SURGERY CENTRE JESUS USON in Caceres (Spain) www. ccmijesususon.com. Available data suggest that the proportion of lobectomies performed using VATS in Spain is still very small, even below the European average, although widespread interest has been expressed in the adoption of this technique in the country's leading hospitals. The present paper reports on the VATS lobectomy technique in use at this institution, on the surgeons' experience with the technique and on the outcomes obtained over a 16-year period. Material and methods This descriptive, retrospective review included all patients un