Video-Assisted Thoracoscopic Surgery

(Section 1) Video-Assisted Thoracoscopic Surgery has evolved significantly over the last twenty years and is increasingly becoming the preferred method for lung resection. It has and continues to be refined and improved with an increasing body of evidence to support it over open surgery.

(Section 2) In this chapter, the author defines and briefly describes Mini-Uniportal VATS (Uni-VATS).

The introduction of Video-assisted thoracic surgery (VATS) via a short (Mini) Single skin incision and a port (trocar) provides an alternative to already established access to the thoracic cavity and a novel surgical approach to pulmonary operations.

There has been a debate about the definition of “Uni- VATS” and how short in extent characterizes the adjective “mini”? Many surgeons define “uniportal” as a VATS operation performed through an incision of 4-8 cm, others believe that when the skin exceeds 2 cm the name should be mini-thoracotomy. We define Uni-VATS an operation in which the operation in the chest is performed when a port (trocar) is introduced via a minimal skin incision of 2-3 cm, whereas when a larger incision is made, the operation should be called single–incision-video assisted-mini thoracotomy.

Uni- VATS for lung cancer has been successfully used to perform a range of pulmonary operations from wedge excision to pneumonectomy and more sophisticated procedures. Double lumen tube and controlled ventilation is the preferred method to carry out Uni-VATS, but more recently, the feasibility of non-intubated normal breathing method has also been explored in selected patients undergoing major lung resection. Although the first uniportal lobectomy was performed almost 10 years ago, there have only been a few retrospective comparative studies and only one prospective randomized trial between single-port and multi-port lobectomy.

With the advance in technology and imaging devices matched by experience and surgical expertise, one may speculate that within a decade uniportal computer-assisted, instrument-controlled surgery will open up a new horizon, allowing Uni- VATS to become a routine practice for surgical treatment of lung cancer.

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Keywords: Lung cancer, Minimally invasive thoracic surgery, Minimal incision, NSCLC, Single port, Single trocar, Uniportal, VATS, Video-Assisted Thoracoscopic Surgery.