VATS Uniportal, masterclass Guatemala / VATS Uniportal, masterclass Guatemala

En las dos últimas décadas la evolución de la cirugía mínimamente invasiva del tórax ha transmutado de un abordaje de tres puertos, siguiendo dos puertos hasta llegar a puerto único, conocido también como VATS Uniportal, procurando un confort mucho mejor para el paciente y resultados quirúrgicos similares. Objetivos. Presentar la técnica quirúrgica de VATS Uniportal en un hospital nacional, efectuadas por un experto internacional en este campo. Pacientes y Métodos. Se presentan dos casos clínicos quirúrgicos: El de una paciente con Miastenia Gravis a quien se le realizó timectomía por abordaje sub-xifoideo y otra paciente, a quien se le completó una lobectomía inferior derecha por hallazgos de patología posterior a la resección de un nódulo pulmonar solitario, reportado como cáncer primario de pulmón. Conclusiones. La técnica de cirugía mínimamente invasiva, VATS Uniportal, ofrece grandes beneficios para el paciente, tanto estéticos como funcionales y su aprendizaje es posible con la transmisión de conocimientos y experiencias directa con la presencia del experto o indirectas a través de la información publicada. (AU)

In the last two decades, the evolution of minimally invasive chest surgery has transmuted from a three-port approach, following two ports until reaching a single port, also known as VATS Uniportal, seeking much better comfort for the patient and similar surgical results. Objective. Present the VATS Uniportal surgical technique in a national hospital, performed by an international expert in this field. Patients and Methods. Two surgical clinical cases are presented: that of a patient with Myasthenia Gravis who underwent thymectomy through the sub-xiphoid approach and another patient, who underwent a right lower lobectomy due to findings of pathology after the resection of a pulmonary nodule. solitary, reported as primary lung cancer. Conclusions. The minimally invasive surgery technique, VATS Uniportal, offers great benefits for the patient, both aesthetic and functional and its learning is possible with the transmission of knowledge and experiences directly with the presence of the expert or indirectly through published information. (AU)

Single-port video-assisted thoracic surgery (VATS)-advanced procedures & update.

The uniportal approach for major pulmonary resections began in 2010, with the first case being reported by D González-Rivas and colleagues in La Coruña, Spain. Since then, in different countries, thoracic surgeons had been performing hundreds of cases, with more advanced and complex procedures. Nowadays, there are reports of uniportal tracheal resection and reconstruction, carinal resection, bronchoplastic procedures, lobectomies with en bloc chest wall excision, and vascular reconstruction with optimal outcomes. The development of technologies and the potential benefits of a direct view, anatomic instrumentation, better cosmesis, and, potentially, less postoperative pain have led uniportal video-assisted thoracic surgery to grow exponentially worldwide.

Technological aids in uniportal video-assisted thoracoscopic surgery.

With the evolution of uniportal video-assisted thoracoscopic surgery (VATS), the technological aids have come to help skill surgeons to improve the results in thoracic surgery and feasible to perform a complex surgery. The technological aids are divided into three important groups, which make surgical steps easy to perform, besides reducing surgical time and surgical accidents in the hands of experienced surgeons. The groups are: (I) conventional thoracoscopic instruments; (II) sealing devices using in uniportal VATS; (III) high definition cameras, robotic arms prototype and the future robotic aids for uniportal VATS surgery. Uniportal VATS is an example of the continuing search for methods that aim to provide the patient a surgical cure of the disease with the lowest morbidity. That is the reason companies are creating more and new technologies, but the surgeon have to choose properly and to know how, when and where is the moment to use each new aids to avoid mistakes. The future of the thoracic surgery is based on evolution of surgical procedures and innovations to try to reduce even more the surgical and anesthetic trauma. This article summarizes the technological aids to improve and help a thoracoscopics surgeons perform a uniportal VATS feasible and safe.

Multiportal video-assisted thoracic surgery, uniportal video-assisted thoracic surgery and minimally invasive open chest surgery-selection criteria.

Thoracic surgery started the path to minimally invasive surgery over a hundred years ago, with the first thoracoscopic procedure performed by Jacobeus in 1910. Interestingly, these first procedures were performed using a single port approach and were used for diagnostic and minor procedures only. For a long period of time, the progress for minimally invasive thoracic surgery was considerably slow until the early 90s, when video assisted thoracic surgery started to be used for major pulmonary resections. Since then, video-assisted thoracic surgery (VATS) had a widespread use around the world and an ongoing search for a less invasive procedures evolved into uniportal VATS. Now, thoracic surgeons have a variety of choices for minimally invasive thoracic surgery and must be trained in these approaches to keep up with the evolution of the specialty and be up to date with the recommended treatments for diseases needing surgical intervention. The approach chosen by each surgeon is a matter of preference, while keeping in mind certain characteristics specific to the pathology and patient to be treated, the level of training of the surgeon, and the healthcare resources available. As more evidence is collected, the choice for video-assisted procedures, which have currently been proven safe, effective, less invasive and, in general, show good results, will prevail.

Uniportal video-assisted thoracoscopic surgery, Argentinian experience.

The acceptance of uniportal video-assisted thoracoscopic surgery (VATS) for minor and major thoracic procedures is growing in South America. This study presents the experience with uniportal VATS in Buenos Aires, Argentina. In a retrospective study, 181 patients were operated with uniportal VATS technique between December 2013 and October 2016. Uniportal procedures included minor and major procedures. Uniportal VATS were analyzed en terms of morbidity, mortality, conversion rate, hospital stay. A total of 181 patients were analyzed. 59% were males and 41% females. The mean age was 58.7. The uniportal VATS procedures included pneumothorax 30, interstitial lung 5, complicated pleural effusion 35, pleurectomy biopsy pleurodesis 40, pericardial effusion 10, mediastinal tumor (posterior) 5, wedge resection 30, anatomical segment resection 6, and lobectomy 20. There were 2 conversions in major resection procedures due to technical difficulties. There was 1 revision for postoperative hemothorax. The mean hospital stay was 4.9 days for the whole group. Uniportal VATS is a safe technique in thoracic surgery. Maintains the oncological principles of traditional open procedures. There are lower, few general complications, lower pain level, lower postoperative morbidity and mortality. Reduces surgical trauma, and reduces the postoperative hospital stay.

First uniportal video assisted thoracic surgery masterclass in Ecuador.

Currently video-assisted thoracic surgery (VATS) and the evolution Uniportal VATS have a worldwide acceptance and Ecuador is not exception when we decided invited to Dr. Diego Gonzalez-Rivas pioneer surgeon in the world of single-port video-assisted thoracoscopic procedures, with the aim to provide a faster recovery of the patients compared to those who received a conventional thoracotomy. We thanks the opportunity to present a report to the first Masterclass in Uniportal VATS with live surgery, performed on February 23rd to 24th of 2017 at the Luis Vernaza Hospital in Guayaquil-Ecuador. In addition to demonstrate the efficacy and safety of the uniportal VATS technique we presented a video of uniportal VATS left lower lobectomy performed by Dr. Diego Gonzalez-Rivas during the first uniportal masterclass in Guayaquil, Ecuador.

Subxiphoid approach for a combined right upper lobectomy and thymectomy through a single incision.

The subxiphoid uniportal video assisted thoracoscopic surgery (VATS) is a new interesting approach for the resection of anterior mediastinal masses and lung resections. For this reason in cases with both pathologies is an ideal approach to perform both procedures at the same time without multiple incisions. The evolution in the surgery of thymoma is getting less invasive, from the transsternal thymectomy to the minimally invasive Thoracic surgery improving the recovery of the patients and with satisfactory postoperative results, otherwise the anatomical view of the main structures and the recognition of the vascular anatomy, and his variants is feasible. In those cases with synchronic masses, the Subxiphoid approach is an ideal option in hands of experienced surgeons. In this video, we present the case of a right upper lobectomy and a thymectomy by subxiphoid approach in which the anatomical variations of the thymic artery are well recognized, and both procedures were completed without complications.

Uniportal video assisted thoracic surgery right main sparing lung bronchial resection: live surgery in Sao Paulo.

We report the first uniportal right main sparing bronchial resection in Brazil. The procedure was performed live at Hospital Alemão Oswaldo Cruz, São Paulo during the II Brazil uniportal video assisted thoracic surgery (VATS) advanced masterclass. Another uniportal VATS right upper lobectomy with bronchoplasty, uniportal VATS S6 left segmentectomy and a subxiphoid uniportal VATS mediastinal tumor, were performed as well. This VATS program was conducted in São Paulo for the first time in 2016. We hope to extend the course to other centers around the country in the next year.

Bilateral uniportal video-assisted thoracic surgery segmentectomy S3: an unusual case.

When talking about lung cancer, it is important to recognize this as the first cause of death of neoplastic origin. The detection of this in early stages has made the emergence of ground glass opacity (GGO) more frequent due to the establishment of lung cancer screening programs, allowing the reduction of morbidity and mortality caused by the same and achieving a curative treatment of it. The management of multiple GGOs depends much on the characteristics of these, however, being multiple and contralateral should be considered surgical resection, always taking into account the stage of the dominant lesion. In this article, we present a case of a 60 years old woman with a bilateral GGO lesions located in segment 3 on both sides. A bilateral uniportal video-assisted thoracic surgery (VATS) anatomic segmentectomy S3 of both lesions was performed in a single stage surgery. The postoperative course of the patient was uneventful.

The evolution of uniportal video assisted thoracic surgery in Costa Rica.

Video-assisted thoracic surgery (VATS) has become one of the most important advances in thoracic surgery in this generation. It has evolved continuously into a less invasive approach, being uniportal VATS the last step in this evolution. Since the first uniportal VATS lobectomy was performed in La Coruña in 2010, the procedure has suffered and exponential growth that has allowed it to widespread around the world, expanding the indications from initially early stage lung cancer cases to complex advance cases nowadays. In Costa Rica, uniportal VATS started to be used for major pulmonary resection in June 2014, thanks to the tutoring from Dr. Gonzalez-Rivas. In our center, uniportal VATS is the standard approach for minimally invasive procedures, and major pulmonary resections had only been done through the single port approach. In order to evolve and progress in the experience of the procedure, and to expand the indications in which it was being performed, a "uniportal VATS master class" was held in Rafael Angel Calderón Guardia Hospital in San José, Costa Rica, from September 16 to September 18 2015. The master class was led by Dr. Diego Gonzalez-Rivas and it counted with the contribution of Dr. Li Wentao and Dr. Yang Yang, from Shanghai Pulmonary Hospital. The course attracted almost every thoracic surgeon in our country and participants also included anesthesiologists, pulmonologists, nurses and medical students. Three uniportal VATS were performed during the course, a left lower and a right upper lobectomy and a wedge resection that was the first non-intubated VATS procedure ever performed in our country.

Uniportal video-assisted thoracoscopic major pulmonary resections.

Uniportal thoracic surgery is being continuously adopted by thoracic units around the world. Growing interest in the procedure is demonstrated by numerous workshops and training programs along every continent. The success of the technique lies in that it does not compromise oncologic principles and be carried out safely when proper training is acquired. For a surgeon to be able to perform a uniportal lobectomy successfully and safely proper steps must be ensuring. Multiple key maneuver and tricks are inherent to the uniportal approach. This article summarizes the equipment and key steps necessary to do a uniportal lobectomy.

Uniportal video-assisted thoracic surgery course in Mexico-first experience.

"The First Minimally Invasive Thoracic Surgery Uniportal Course" in Mexico was held from July 13th to 15th in Mexico City, at the National Institute of Respiratory Diseases (INER). Thoracic surgeons from around Mexico assisted the course. The special guests were the Spanish doctor Diego González-Rivas and the Brasilian doctor Joao Carlos das Neves-Pereira. The course included live surgery and wet lab. Demonstration of the uniportal video-assisted thoracic surgery (VATS) technique was done. The course was a success and Mexican thoracic surgeons were ready to adopt this technique.

First non-intubated uniportal video-assisted pulmonary lobectomy in America.

The first video-assisted thoracic lobectomy in non-intubated patient in America was performed on 27th of September 2014 in Bogotá Colombia, The National Cancer Institute in Bogotá received Dr. Diego González-Rivas to make possible this kind of procedure in a 53-year-old man, with a history of papillary thyroid cancer treated with surgery and Iodine therapy, in whom two pulmonary nodules were found in the monitoring tomography. We resected the nodule located at the right upper lobe previously marked by scintigraphy, the other one required a lobectomy because it was a deep nodule with malignant radiologic appearance inside of the middle lobe. The procedure discoursed in a non-intubated patient without technical difficulties or complications, very short recovery time, minimum pain and a quiet and usual postoperative evolution. This procedure, the first reported in America was replicated after others with similar results in several countries thanks to the collaboration between surgeons, anesthesiologists, radiologists, nurses and therapists, because especially in such interventions teamwork is essential. We believe that given the benefits in terms of recovery for the patient and anesthetic time, we could go on replicating the experience in selected patients.

Uniportal video-assisted thoracoscopic right upper sleeve lobectomy.

BACKGROUND: The development of minimally invasive thoracic surgery in recent years is undeniable, VATS has evolved from the conventional three-port technique to an uniportal approach, without compromising the type of cases that can be operated successfully. METHODS: Thanks to the continuous progress of uniportal video-assisted thoracoscopic surgery (VATS) the complexity of cases performed by this approach has improved remarkably since the first procedures were made, recent advances in surgical thoracoscopic technology had made feasible to achieve vascular and bronchial sleeve lobectomies. Anatomic variants in patients can increase the technical difficulty of the procedure making the process more challenging. RESULTS: In this case the sleeve right upper lobectomy was performed by uniportal VATS despite the obstruction of the right pulmonary artery (PA) for the bronchial anastomosis. CONCLUSIONS: In the hands of experienced surgeons in uniportal VATS with background in thoracoscopic suturing, sleeve lobectomies are feasible and safe to perform even when anatomic variants increase the complexity of the case.