Title : Benefits of modified uniportal VATS for management of complex thoracic cases
Abstract:
Uniportal Video Assisted Thoracoscopic Surgeries (UVATS) have advantage of making Thoracic Surgery minimally invasive without compromising on outcome. VATS was initially performed through multiple ports but in patients with dense adhesions and complex locations many times accurate visibility is hindered making surgery difficult. The advent of Uniportal VATS in last decade simplified Thoracoscopic Surgeries and has several advantages but sometimes dense adhesions may necessitate conversion to open thoracotomy. We have modified the Uniportal VATS technique to further facilitate complex Thoracic Surgeries.
Patients and Methods: This modified UVATS technique has further improved the direct visibility by specially designed retractors. We also utilise anterior as well as posterior approach f through a single 3 to 4 cm incision which is later used for intercostal drains placement after completion of the procedure.
This has been utilised to perform 164 wide range of thoracoscopic procedures like Segmental Resection for Mucormycosis / Aspergillomas (16), removal of foreign bodies trapped in airways(1), Endocystectomy for Pulmonary Hydatidosis((9), Lung injuries/ clotted Hemothorax(11), simple or Giant Bullectomies(19), Decortications(90) and release of trapped lung, removal of Bronchogenic cysts (subcarinal -2,cervicomediastinal-1), removal of Mediastinal Goiter (1), Thymectomies (4) ,Epicardial lead insertion (2) ,as well as for several advanced Thoracic malignancies(12).
Result: Majority of patients were extubated on table,mobilised on first post operative day and mean hospital stay was3.5 days. The advantages of this unique technique are that it improves exposure for surgeons with direct visualisation similar to that of Open Thoracotomy. At the same time, it is less painful, less costly for patient, facilitates complex procedures with reduced hospital stay and early return to normal activity apart from being cost effective.
This technique has a shorter learning curve, is less expensive and can be utilised to perform all kinds of complex thoracoscopic procedures without need for convertion to open technique.
