Uniportal VATS Left lower Lobectomy

Since the late 1990s video-assisted thoracic surgery (VATS) lobectomy has been demonstrated to be safe and to provide similar oncologic results as those achieved via open lobectomy . The approach has provided advantages for patients, including shorter recovery times and less pain. In early 2011 a new form of VATS lobectomy was reported. The uniportal or uni-incisional VATS (uVATS) lobectomy initially described by Gonzales-Rivas has since become a very popular technique. The technique allows for the placement of the camera and instruments using a single incision (approx 4 cm) without the use of trocars, and provides outstanding visualization and versatility. The technique allows for parallel instrumentation that can mimic the motions of an open operation using an anterior approach.

The following is a 7 minute video demonstrating the basic/critical steps for a uVATS left lower lobectomy.

The steps to complete a uVATS left lower lobectomy include:

1. 4 cm incision usually in the 5th intercostal space and anterior axillary line.
2. Placement of soft tissue retractor (keep camera in the apex of incision).
3. Dissection of the inferior pulmonary ligament and station 9 lymph nodes.
4. Exposure of the inferior pulmonary vein and transection with vascular endostapler (45mm).
5. Completion of the fissure if not complete.
6. Removal of inter lobar lymph nodes to expose PA (station 11).
7. Exposure of the pulmonary artery branches to left lower lobe (segmental branches).
8. Transection of the pulmonary artery branches using vascular endostapler (45mm).
9. Exposure of the left lower lobe bronchus and transection with endostapler thick tissue (60mm).
10. Removal of specimen, the testing of the bronchial stump under water, and completion of the mediastinal lymph node dissection (not shown in video).
11. Intercostal nerve block (4-6 levels) and placement of chest tube using same incision (24-28Fr).

References

1. Bourdages-Pageau E, Vieira A, Lacasse Y, Figueroa PU. Outcomes of Uniportal vs Multiportal Video-Assisted Thoracoscopic Lobectomy. Semin Thorac Cardiovasc Surg. 2020 Spring;32(1):145-151. doi: 10.1053/j.semtcvs.2019.05.021. Epub 2019 May 29. PMID: 31150825.
2.  Dziedzic DA, Zbytniewski M, Gryszko GM, Cackowski MM, Langfort R, Orlowski TM. Video-assisted versus open thoracotomy lobectomy: comparison on lymphadenectomy and survival in early stage of lung cancer. J Thorac Dis. 2021;13(1):101-112. doi:10.21037/jtd-20-2251
3. Gonzalez-Rivas D, Fieira E, Delgado M, Mendez L, Fernandez R, de la Torre M. Uniportal video-assisted thoracoscopic lobectomy. J Thorac Dis. 2013;5 Suppl 3(Suppl 3):S234-S245. doi:10.3978/j.issn.2072-1439.2013.07.30
4. McKenna RJ Jr. The current status of video-assisted thoracic surgery lobectomy. Chest Surg Clin N Am. 1998 Nov;8(4):775-85, viii; discussion 787-8. PMID: 9917925.
5. McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2006 Feb;81(2):421-5; discussion 425-6. doi: 10.1016/j.athoracsur.2005.07.078. PMID: 16427825.

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