Technical Aspects And Early Results of Uniportal Video-Assisted Thoracoscopic Complex Segmentectomy: A 30 Case-Series Study

Abstract Background. With the advantages of better cosmetic incision and faster recovery, uniportal video-assisted thoracoscopic surgery (UP-VATS) has developed rapidly worldwide in recent decades and indications for UP-VATS were further expanded as those for conventional VATS. Complex segmentectomy that makes several, or intricate intersegmental planes, with more a complex procedure, continues to be a difficulty in minimally invasive techniques. However, there are few reports as yet on UP-VATS complex segmentectomy. In this report, we describe the perioperative clinical data and operative techniques and present our early results of UP-VATS complex segmentectomy in our hospital. Methods. The records of a total of 30 patients who underwent UP-VATS complex segmentectomy by a single surgeon between January 2021 and June 2021 were retrospectively reviewed. We defined cases as complex segmentectomy if they required resection of segment 9, 10, combined segmentectomy, segmentectomy+subsegmentectomy, subsegmentectomy, or combined subsegmentectomy. Results. The mean age was 52.8±9.9 years old; mean nodule size was 0.84±0.36 cm; the mean margin width was 2.307±0.309 cm; median operative time was 229.0±58.06 minutes; mean operative hemorrhage was 56.60±17.95 mL; 5.58±1.74 lymph nodes dissected had not metastasized; mean duration of postoperative chest tube drainage was 4.7±1.4 days; and mean postoperative hospital stay was 6.5±3.0 days. Although 1 patient experienced a prolonged air leak, the other 29 recovered uneventfully. Another patient failed to reach the 2cm safe margins who received completion lobectomy later. Conclusions. UP-VATS complex segmentectomy is a safe and effective procedure in the treatment of lung cancers, sparing more pulmonary parenchyma and ensuring safe margins, the disadvantage being lengthy operative times during early acquisition of skills.