• Journal of Chest Surgery
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• v.47 no.4
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• pp.384-388
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• 2014

Background: Recently, single-port video-assisted thoracic surgery (VATS) has been proposed as an alternative to the conventional three-port VATS for primary spontaneous pneumothorax (PSP). The aim of this study is to evaluate the early outcomes of the single-port VATS for PSP. Methods: VATS was performed for PSP in 52 patients from March 2012 to March 2013. We reviewed the medical records of these 52 patients, retrospectively. Nineteen patients underwent the conventional three-port VATS (three-port group) and 33 patients underwent the single-port VATS (single-port group). Both groups were compared according to the operation time, number of wedge resections, amount of chest tube drainage during the first 24 hours after surgery, length of chest tube drainage, length of hospital stay, postoperative pain score, and postoperative paresthesia. Results: There was no difference in patient characteristics between the two groups. There was no difference in the number of wedge resections, operation time, or amount of drainage between the two groups. The mean lengths of chest tube drainage and hospital stay were shorter in the single-port group than in the three-port group. Further, there was less postoperative pain and paresthesia in the single-port group than in the three-port group. These differences were statistically significant. The mean size of the surgical wound was 2.10 cm (range, 1.6 to 3.0 cm) in the single-port group. Conclusion: Single-port VATS for PSP had many advantages in terms of the lengths of chest tube drainage and hospital stay, postoperative pain, and paresthesia. Single-port VATS is a feasible technique for PSP as an alternative to the conventional three-port VATS in well-selected patients.

• Journal of Chest Surgery
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• v.48 no.6
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• pp.387-392
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• 2015

Background: The aim of this study was to evaluate the feasibility of single-port video-assisted thoracic surgery (VATS) in the treatment of secondary spontaneous pneumothorax (SSP). Methods: Twenty-four patients who were scheduled to undergo single-port VATS for SSP were studied. The medical records of the patients were retrospectively reviewed. The mean follow-up duration was $26.1{\pm}19.8$ months. In order to evaluate the feasibility of single-port VATS for SSP, the postoperative results of single-port VATS (n=15) in patients with emphysema were compared with those of emphysematous patients who underwent three-port VATS (n=15) during the study period. Results: Single-port VATS was feasible in 19 of 24 patients (79.2%), while an additional port was needed in five patients. In the single-port VATS patients, the median operation time, duration of chest tube drainage, and hospital stay were 84.0 minutes, one day, and two days, respectively. Postoperative complications included prolonged chest tube drainage for more than five days (n=1), wound infection (n=1), and vocal fold palsy (n=1). No recurrence of pneumothorax was observed during the follow-up period. The median operation time, duration of chest tube drainage, and hospital stay of the emphysematous patients who underwent single-port VATS were shorter than those who underwent three-port VATS group (p<0.05 for all parameters). Conclusion: Single-port VATS proved to be a feasible procedure in the treatment of patients with secondary spontaneous pneumothorax.

• Journal of Chest Surgery
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• v.46 no.4
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• pp.299-301
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• 2013

Video-assisted thoracic surgery (VATS) is a minimally invasive technique that has many advantages in postoperative pain and recovery time. Because of its advantages, VATS is one of the surgical techniques widely used in patients with lung cancer. Most surgeons perform VATS for lung cancer with three or more incisions. As the technique of VATS has evolved, single-port VATS for lung cancer has been attempted and its advantages have been reported. We describe our experiences of VATS for lung cancer with a single incision in this report.

• Journal of Chest Surgery
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• v.54 no.4
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• pp.314-318
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• 2021

In this paper, I present the technique of subxiphoid single-port video-assisted thoracic surgery (VATS) thymectomy for thoracic surgeons to perform this procedure safely. This procedure is indicated for all anterior mediastinal masses and may be extended to lung cancer. The patient is placed in the lithotomy position, and the operator should be on the midline. Below the xiphoid process, a skin incision is made 4-5 cm horizontally at a single thumb's width down. Under two-lung ventilation, CO₂ is insufflated, maintaining 10 mm Hg. The fat tissue and thymic tissue are all resected from the sternum and pericardium between both phrenic nerves using an articulated grasper and an energy device. After retrieval of the mass with a wrap bag, a Jackson-Pratt drain is inserted instead of a chest tube. One of the advantages of this procedure is less postoperative pain than intercostal VATS. The subxiphoid approach can be used for bilateral pneumothorax, bilateral pulmonary metastasectomy, and simple lobectomy for both upper lobes and the right middle lobe.

• Journal of Chest Surgery
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• v.47 no.4
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• pp.327-332
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• 2014

Single-port video-assisted thoracic surgery (VATS) has slowly established itself as an alternate surgical approach for the treatment of an increasingly wide range of thoracic conditions. The potential benefits of fewer surgical incisions, better cosmesis, and less postoperative pain and paraesthesia have led to the technique's popularity worldwide. The limited single small incision through which the surgeon has to operate poses challenges that are slowly being addressed by improvements in instrument design. Of note, instruments and video-camera systems that are narrower and angulated have made single-port VATS major lung resection easier to perform and learn. In the future, we may see the development of subcostal or embryonic natural orifice translumenal endoscopic surgery access, evolution in anaesthesia strategies, and cross-discipline imaging-assisted lesion localization for single-port VATS procedures.

• Journal of Chest Surgery
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• v.46 no.5
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• pp.388-390
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• 2013

With advancement of the technique of video-assisted thoracic surgery (VATS), some surgeons have made great efforts to reduce the number of incisions in the conventional three- or four-port approach. Several studies on cases treated by single-incision VATS and their short-term outcomes were reported. Here, we present our experience with single-incision VATS for the treatment of benign mediastinal diseases.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.339-345
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• 2017

Background: In recent years, single-port video-assisted thoracoscopic surgery (VATS) for lobectomy in non-small cell lung cancer (NSCLC) patients has become increasingly common. The objective of this study was to compare the feasibility and safety of single-port and triple-port VATS lobectomy. Methods: A total of 73 patients with NSCLC who underwent VATS lobectomy from December 2011 to August 2016 were retrospectively reviewed, including 47 in the triple-port group and 26 in the single-port group. Statistical analysis was performed after propensity score matching. Patients were matched on a 1-to-1 basis. Results: Operative time and intraoperative blood loss in the triple-port group and the single-port group were similar ($189.4{\pm}50.8minutes$ vs. $205.4{\pm}50.6minutes$, p=0.259; $286.5{\pm}531.0mL$ vs. $314.6{\pm}513.1mL$, p=0.813). There were no cases of morbidity or mortality. No significant differences in complications or the total number of dissected lymph nodes were found between the 2 groups. In the single-port group, more mediastinal lymph nodes were dissected than in the triple-port group ($1.7{\pm}0.6$ vs. $1.2{\pm}0.5$, p=0.011). Both groups had 1 patient with bronchopleural fistula. Chest tube duration and postoperative hospital stay were shorter in the single-port group than in the triple-port group ($8.7{\pm}5.1days$ vs. $6.2{\pm}6.6days$, p=0.130; $11.7{\pm}6.1days$ vs. $9.5{\pm}6.4days$, p=0.226). However, the differences were not statistically significant. In the single-port group, the rate of conversion to multi-port VATS lobectomy was 11.5% (3 of 26). The rates of conversion to open thoracotomy in the triple-port and single-port groups were 7.7% and 3.8%, respectively (p=1.000). Conclusion: In comparison with the triple-port group, single-port VATS lobectomy showed similar results in safety and efficacy, indicating that single-port VATS lobectomy is a feasible and safe option for lung cancer patients.

• Journal of Chest Surgery
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• v.48 no.2
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• pp.155-155
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• 2015

• Journal of Chest Surgery
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• v.50 no.3
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• pp.190-196
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• 2017

Background: The feasibility of single-port video-assisted thoracic surgery (SPVATS) for primary lung cancer is not well understood. In this study, we compared SP and multi-port (MP) VATS for the surgical treatment of patients with primary lung cancer. Methods: Surgical treatment was performed in 181 patients with primary lung cancer at Inje University Haeundae Paik Hospital between June 2012 and December 2015. A propensity-matched analysis was used to compare the postoperative outcomes and to evaluate the comparative feasibility and safety of SPVATS and MPVATS. Results: There were 37 patients in the SPVATS group and 67 patients in the MPVATS group. Propensity matching produced 32 pairs. The operation time (210 minutes versus 200 minutes, p=0.11), volume of the estimated blood loss (170 mL versus 160 mL, p=0.19), duration of chest tube drainage (5 days versus 6 days, p=0.66), and length of hospital stay (9 days versus 10 days, p=0.89) were similar between the 2 groups. Conclusion: In our study, SPVATS for primary lung cancer was safe and feasible in well selected patients. A prospective, randomized study with a large group and long-term follow-up is necessary to evaluate the clinical feasibility and the advantages of SPVATS for primary lung cancer.

• Journal of Chest Surgery
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• v.50 no.3
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• pp.184-189
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• 2017

Background: The benefits of video-assisted thoracoscopic surgery (VATS) have been demonstrated over the past decades; as a result, VATS has become the gold-standard treatment for primary spontaneous pneumothorax (PSP). Due to improvements in surgical technique and equipment, single-port VATS (s-VATS) is emerging as an alternative approach to conventional three-port VATS (t-VATS). The aim of this study was to evaluate s-VATS as a treatment for PSP by comparing operative outcomes and recurrence rates for s-VATS versus t-VATS. Methods: Between March 2013 and December 2015, VATS for PSP was performed in 146 patients in Kyungpook National University Hospital. We retrospectively reviewed the medical records of these patients. Results: The mean follow-up duration was $13.4{\pm}6.5$ months in the s-VATS group and $28.7{\pm}3.9$ months in the t-VATS group. Operative time (p<0.001), the number of staples used for the operation (p=0.001), duration of drainage (p=0.001), and duration of the postoperative stay (p<0.001) were significantly lower in the s-VATS group than in the t-VATS group. There was no difference in the overall recurrence-free survival rate between the s-VATS and t-VATS groups. Conclusion: No significant differences in operative outcomes and recurrence rates were found between s-VATS and t-VATS for PSP. Therefore, we cautiously suggest that s-VATS may be an appropriate alternative to t-VATS in the treatment of PSP.