Uniportal VATS Left lower Lobectomy

Since late 1990s video-assisted thoracic surgery (VATS) lobectomy has demonstrated to be safe and with similar oncologic results as open lobectomies . It has provided advantages for patients including shorter recovery and less pain. In early 2011 a new form of VATS lobectomy was reported. The Uni-portal or Uni-incisional VATS (uVATS) lobectomy initially described by Gonzales-Rivas has since become a very popular technique. The technique allows for placement of the camera and instruments using a single incision (approx 4 cm) without the use of trocars and provides outstanding visualization and versatility in order to perform lobectomies. 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 uVATS left lower lobectomy.

Steps to complete the 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 w Vascular Endostapler (45mm)
5. Complete the fissure if not complete
6. Removal of Inter lobar lymph nodes to expose PA (Station 11)
7. Exposure of 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, test bronchial stump under water and complete mediastinal lymph node dissection (not showed 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.