Atlas of Uniportal Video Assisted Thoracic Surgery

Contents

Part I: General Aspects & Background

The Evolution of Video Assisted Thoracic Surgery

Evolution: The Cornerstone of Surgical Progress

The Early History of VATS

The Evolution of VATS Outcomes Assessment

Birth: Defining the Technique

Infancy: Safety and Feasibility

Childhood: Crude Benefit

Adolescence: Objective, Quantifiable Benefit

Adulthood: Treatment Efficacy

The Evolution of VATS Technique

Early Three-Port VATS

Modified Three-Port VATS

Robot-Assisted Thoracic Surgery

Needlescopic VATS

Two-Port VATS

Uniportal VATS

Implications of Evolution on Technique

Step-wise Learning: Manual Skills, Then Visual

Instruments: Try Before You Buy

Coping Without the Posterior Port

Troubleshooting

Peri-operative Care

Implications of Evolution on the Future of VATS

Trial by Evidence

Training in VATS

Technology and Technique

Conclusion

References

The New Era of Uniportal VATS

Introduction

What Made Uniportal VATS Easier

Scope Technologies

Instrumental Design

Image-Guided VATS for Tiny Pulmonary Nodules

What Has Been Made Possible by Uniportal VATS?

Non-intubated VATS Lung Resection

Alternative Surgical Access

Robotic Uniportal VATS

Summary

References

Room Set Up and Instrumentation

Introduction

Perioperative Preparation

Patient Positioning and Incision Marking

Staff Positioning

Instrumentation

Intraoperative Tips and Tricks

Immediate Postoperative Care

Conclusion

References

Anaesthesia for Uniportal VATS

Introduction

Preoperative Evaluation

Monitoring

Airway Management

Pain Management

Conclusion

References

Geometric Considerations in Uniportal VATS

Introduction

A Bird Fly on Plane Geometry Concepts

Geometrical Characteristics of Uniportal VATS

Conclusions

References

Modified Uniportal Approach

Introduction

Surgical Technique

Discussion

Conclusion

References

Part II: Uniportal VATS in Pleural and Mediastinal Diseases

Uniportal Video-Assisted Thoracoscopic Surgery for the Management of Pleural Effusions, Empyema and Pleural Biopsy

Uniportal Video-Assisted Thoracoscopic Surgery (Vats) for Pleural Effusions and Pleural Biopsy

Uniportal Video-Assisted Thoracoscopic Surgery (Vats) for Empyema

References

Uniportal Approach to Pericardial Window and Sympathectomy

Pericardial Window

Introduction

Patient Selection and Preoperative Planning

Uniportal VATS Pericardial Window

Sympathectomy

Introduction

VATS Sympathectomy

Patient Selection

Technical Consideration of Sympathectomy

Uniportal Thoracic Endoscopic Sympathectomy

Nonintubated Uniportal Sympathectomy

Embryonic Natural Orificial Transumbilical Endoscopic Surgery (ENOTES)

Subxiphoid Uniport Technique

Conclusion

References

Uniport Anterior Mediastinal Surgery

Introduction

Operation Preparation (Fig. 1)

Creation of the Wound (Fig. 1)

Detaching the Anterior Mediastinal Tissue from the Pericardium (Fig. 2)

Ligating the Thymic Vein, Retrieving the Bilateral Horns of Thymus (Fig. 3)

Extracting the Anterior Mediastinal Tumor (Fig. 4)

How to Deal with Visceral Pleural Adhesion and Bleeding Episode (Fig. 5)

Case Demonstration

Discussion

References

Uniportal Posterior Mediastinal Surgery

Anatomy

Incidence and Pathophysiology

Clinical Manifestation and Diagnosis

Surgical Technique

Patients Position

Incision Placement

Surgical Technique (Video 1)

Discussion

References

Subxiphoid Mediastinal Resections

Introduction

Operative Technique of Subxiphoid Single-Port Thymectomy

Instruments for Subxiphoid Single-Port Thymectomy

Patient Selection

Anesthesia Management

Operative Positioning

Surgical Technique (Video 1)

Tips for Surgery

Managing Hemorrhage

Subxiphoid Thymectomy (Dual-Port Thymectomy)

Postoperative Management

Results

Discussion

Conclusions

References

Part III: Parenchymal Lung Diseases

Uniportal Treatment for Spontaneous Pneumothorax

History

Principles

Anesthesia

Surgical Technique

Outcome

Conclusion

References

Uniportal Bullectomy for Emphysematous Bullous Lung Disease

Introduction and a Brief Historical Remark

Terminology and Basic Pathophysiology

Clinical Manifestations and Evolution

Surgical Indications and Preoperative Assessment

Surgical Treatment: Options Overview

Surgical Treatment: General Considerations About Giant Bullectomy

The Uniportal VATS Approach for Bullectomy

Results and Outcomes

Summary and Conclusion

References

Hookwire Localization of Pulmonary Nodules in Uniportal VATS

Introduction

Technique

Indication and Efficiency of Hookwire Localization

Complications

Technical Limitations

Ways to Improve the Technique

Trajectory Guidance System for Centesis

Decreasing the Rate of Dislodgement

Dual Localization

Simultaneous Localization and Resection

Initial Results of Hookwire Placement in a Hybrid OR

Conclusions

References

Intraoperative Ultrasound Guidance in Pulmonary Nodule Localization in Uniportal VATS

Technique (Videos)

References

Videoendoscopic Uniportal Resection of Solitary Peripheral Lung Nodule

Introduction

Indications

Contraindications

Anaesthetic Considerations

Positioning

Port Placement

Preference Card

Results and Discussion

References

Part IV: Uniportal Major Lung Resections

Right Lower Lobe

Introduction

General Aspects

Operative Techniques

Fissure Complete

Completion

References

Left Lower Lobe Resection

Introduction

Operative Technique

Results

Conclusions

References

Right Middle Lobe

Uniportal Video-Assisted Thoracoscopic Right Upper Lobectomy

General Aspects

Operative Technique

How to Select the Proper Angle for Stapler Insertion

Uniportal Right Upper Lobectomy

Introduction

VATS Evolution: From Multiportal to Uniportal

Indications for Uniportal Lobectomy

Contraindications for Uniportal Lobectomy

Preoperative Planning

Uniportal Right Upper Lobe Technique for Lung Cancer

Patient Positioning, Uniportal Access, and Lobectomy Overview

Ligation of the Pulmonary Artery Anterior Trunk

Dissection of the Right Upper Lobe Bronchus

Dissection of Right Upper Lobe Vein

Completion of the Fissure

Lymphadenectomy

Final Steps

Postoperative Care

References

Left Upper Lobectomy

Introduction

Indications and Preoperative Preparation

Anesthesia and Analgesia

Positioning

Incision and Instrumentation

Thoracic Exploration

Left Upper Lobectomy

“Single Direction” Left Upper Lobectomy

Management of the Truncus Apicoanterior Branch

Management of the Superior Pulmonary Vein

Management of the Posterior Arterial Branches

Management of the Left Upper Bronchus

Management of the Fissure and the Lingular Arterial Branch

Hybrid Approach Left Upper Lobectomy

Other Procedure

Conclusions

References

Left VATS Upper Lobectomy

Patient Positioning

Port Position

Procedural Steps

Further Reading

Uniportal Video-Assisted Thoracoscopic Segmentectomy

Introduction

Indication and Preoperative Evaluation

Operative Technique

Lingula-Sparing Left Upper Lobectomy

Lingulectomy

Superior Segmentectomy (Video 2)

Basilar Segmentectomy

Upper Lobe Posterior Segmentectomy (LUL-RUL)

Left Posterior Segmentectomy (It Is Uncommon, Usually in the Left Side the S1+2 Are Removed Together)

Right Posterior Segmentectomy

Right Upper Lobe Apical-Posterior Segmentectomy

Right Upper Lobe Apical Segmentectomy

References

Segmental Resection

Introduction

Localization Technique

Localization Techniques for Small Pulmonary Nodules

Percutaneous Localization

Intraoperative Localization

Identification of the Intersegmental Plane

Operative Techniques

Right and Left Upper Lobe Apical and Posterior Segments (Fig. 4)

Right and Left Lower Lobe Superior Segments (Fig. 5)

Right and Left Lower Lobe Basilar Segments (Fig. 6)

Left Upper Divisional Segment (Tri-segment) (Fig. 7)

Left Lingular Segment (Fig. 8)

Results

Conclusions

References

Left Uniportal VATS Pneumonectomy

Pre-operative Considerations

Operative Strategy

Postoperative Care

References

Right Pneumonectomy

Indications

Contraindications

Historical Review

Patient Selection

Surgical Technique

Discussion

References

Uniportal Lymphadenectomy

Introduction

Operative Techniques

The Material

The Technical Aspects in Mediastinal Lymph Node Dissection

Right Paratracheal Space

Left Paratracheal Space

Right Subcarinal Lymphadenectomy

Left Subcarinal Lymphadenectomy

Aortopulmonary Window Space

Para-oesophageal and Pulmonary Ligament Lymph Nodes

Hiliar and Interlobar Lymph Nodes

Comments

References

Part V: Advanced Uniportal Techniques

Uniportal Video-Assisted Thoracoscopic Sleeve Resections

Introduction

Preoperative Planning

Surgical Thoracoscopic Technique

Sleeve Bronchoplasty

Vascular Reconstruction

RUL Sleeve Lobectomy (Videos 1, 2)

Right Lower Lobe Sleeve Resection (Middle Lobe Bronchus to Intermediate Bronchus Sleeve) (Video 4)

Right Upper Sleeve Bilobectomy (Video 5)

Left Upper Lobe (LUL) Sleeve Resection (Video 6)

Left Lower Sleeve Resection (Video 7)

Bronchial Sleeve Resection (Lung Sparing)

Sleeve Segmental Procedures (Video 8)

Tracheal and Carinal Resection Reconstruction (Video 9)

Literature Review and Discussion

Conclusions

References

Sleeve Resection

Introduction

Operative Technique

Results

Conclusions

References

Tracheal and Carina Resection/Reconstruction

Introduction

Preoperative Preparation

Induction of Anesthesia

Position and Incision Selection

Surgical Technique

Post-operative Care

Conclusion

References

Uniportal VATS Chest Wall and Diaphragm Resection and Reconstruction

Introduction

Discussion

Incidence

Staging and Prognosis

The Role of VATS

Surgery

Anesthesia

Positioning

Technique

Lobectomy with Chest Wall Resection

Lobectomy with Diaphragm Resection and Reconstruction

References

Troubleshooting: Management of Bleeding

Introduction

Bleeding During VATS Lobectomies

References

Uniportal Minimally Invasive Esophagectomy

Introduction

Patient Selection

Surgical Anatomy for Esophagus and Regional Lymph Nodes

Operative Methods

Incision and Access

Surgical Exposure Under Uniportal Thoracoscopy

Mobilization and Dissection of Esophagus

Mediastinal Lymphadenectomy

Gastric Mobilization Under Uniportal Laparoscopy

Completion of Procedure

Tri-incision

Ivor-Lewis

Discussion

References

Part VI: The Future of Uniportal VATS

Non-intubated Uniportal VATS Major Pulmonary Resections

Introduction

Alternative or Recommendation: Advantages of Thoracic Surgery Without Intubation

Anesthesia Management for Non-intubated Thoracic Surgery: From Theory to Practice

Monitoring

Ventilation

Sedation

Regional Anesthesia Techniques

Local Anesthesia and Intercostal Blockade

Paravertebral Blockade

Epidural Anesthesia

Vagus Nerve

Conversion to General Anesthesia

Conclusions

References

Subxiphoid Uniportal Video-Assisted Thoracoscopic Surgery

Introduction

General Principles

Patients Selection and Preoperative Assessment

Operative Technique

Anesthesia Considerations

Positioning

Creating the Wound and the Working Channel

Basics of Instrumentation

Subxiphoid Technique for Lobectomy

Right Upper Lobectomy (Video 2)

Right Middle Lobectomy (Video 3)

Right Lower Lobectomy (Video 4)

Left Upper Lobectomy (Video 5)

Left Lower Lobectomy (Video 6)

Thymectomy and Anterior Mediastinal Mass Resection (Video 7)

Specimen Removal

Mediastinal and Hilar Lymph Nodes Dissection

Closure of the Wound

References

Natural-Orifice Uniport VATS for Lung Resection

Introduction

Historical Background

Transvesical Approach

Transgastric Approach

Transesophageal Approach

Transtracheal Approach

Transoral Approach

Transumbilical Approach

Potential Future Direction

References

Natural Orifice Transluminal Endoscopic Surgery (NOTES) Uniportal VATS for Sympathectomy

Inclusion and Exclusion Criteria

Inclusion Criteria

Exclusion Criteria

Special Instruments and Equipments/Materials

Surgical Procedures

Postoperative Treatment and Care

Surgical Experience and Recommendation

Umbilical Incision

Diaphragm Incision

Intrathoracic Operation

Advantages and Disadvantages of This Surgery

Prospect

References

Image-Guided Uniportal VATS in the Hybrid Operating Room

Hybrid Theater and Its Preclinical Data

Structure of Hybrid Theater

Image-Guided ENB Diagnostic/Marking Procedure

Image-Guided Metallic Implantation

Conclusions

References

Development of 3D VATS

Introduction and Development

Current Status

Surgery

Teaching

Issues and Concerns

One Step Ahead Glasses-Free 3D VATS

Future

References

Future Development and Technologies

Introduction

Thoracoscopes

Uniportal Platforms

Advanced Multimodality Image-Guided Operating Room

Conclusion

References