Abstract：Objective To explore the feasibility and short-term efficacy of uniportal video-assisted thoracoscopic surgery (U-VATS) single-direction anatomical right upper lung lobectomy.Methods The retrospective cohort study was conducted. Clinical data of 60 patients with primary upper lobe lung cancer(ⅠA2-Ⅲ B period) in the Xuzhou Central Hospital, between January 2016 and July 2018 were collected, including 42 males and 18 females, with age of (62.2±9.0) years. These patients were divided into single-direction U-VATS group and conventional U-VATS group according to surgical procedures, with 30 cases in each group. The resection sequence in conventional U-VATS group was as follows: fissure,posterior ascending branch, pulmonary vein, anterior and apical branches, upper brouchus. On the contrary, the resection sequence in single-direction U-VATS group was as follows: anterior apical branch of pulmonary artery, right upper bronchus, posterior ascending branch of pulmonary artery, pulmonary vein and fissure. There were no significant differences between the groups in terms of age, gender and T staging of the tumors (all P values＞0.05), except that of body mass index (t=2.264, P＜0.05). The operation time, blood loss during the surgery, dissected lymph nodes, postoperative chest drainage, complications, visual analogue pain scale and postoperative hospital stay of the two groups were compared, respectively.Results There was no conversion to thoracotomy or short-term mortality, followed by tumor-negative surgical margin. Three cases of artery branch injury were indicated in conventional U-VATS group, and one of them was converted to two-port VATS. The operation time of single-direction U-VATS group was (63.5±13.1) min, which was shorter than the conventional U-VATS group of (75.2±15.7) min, with a statistical difference (t=3.131, P＜0.01). Meanwhile, the blood loss in single-direction U-VATS group was (83.3±40.1) mL, which was less than that in the conventional U-VATS of (150.0±107.5) mL, showing a statistical difference (t=3.183, P＜0.01). In addition, the pain scores in single-direction U-VATS group on the first and third day after the surgery were (5.4±1.3) and (4.1±1.1), respectively, both of which were less than the conventional group of (6.4±1.3) and (5.1±1.3), with a statistical difference respectively (t=2.878, 3.362, all P values＜0.01). Both groups had no differences in terms of incision length, stations and numbers of the dissected lymph nodes, chest drainage time , the amount of liquid discharged, operation-related complications, and postoperative stay, respectively (all P values＞0.05).Conclusions Single-direction U-VATS anatomical lobectomy is feasible and effective, which also has certain advantages compared with conventional U-VATS.
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Zhao Tian, Zhang Miao, Wu Wenbin, Liu Dong, Pan Xuefeng, Zhang Hui, Hu Zhengqun, Yang Dunpeng. Clinical analysis on uniportal thoracoscopic single-direction anatomical right upper lung lobectomy. Chinese Journal of Anatomy and Clinics, 2019, 24(2): 176-181.
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