Uniportal Video-Assisted Thoracic Surgery for the Treatment of Lung Cancer

A Consensus Report From Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS) and Chinese Association of Thoracic Surgeons (CATS)

Dingpei Han; Yuqin Cao; Han Wu; Haifeng Wang; Lei Jiang; Deping Zhao; Feng Yao; Shuben Li; Chong Zhang; Bin Zheng; Junqiang Fan; Yongde Liao; Bin Qiu; Fengwei Tan; Chun Chen; Yuming Zhu; Shugeng Gao; Hecheng Li

Disclosures

Transl Lung Cancer Res. 2020;9(4):971-987. 

In This Article

Abstract and Introduction

Abstract

Uniportal video-assisted thoracoscopic surgery (UniVATS) has been widely adopted in China, where several ultra-high volume thoracic surgical and training centers are located. The objective of this consensus from Chinese experts was to summarize the current application and give reference for the future development of UniVATS in the treatment of lung cancer. A panel of 41 experts from 21 Chinese hospitals was invited to join this project. The Delphi method was used in this consensus consisting of two rounds of voting. The questionnaire was based on the current clinical evidence. Forty (97.6%) experts completed the 2 rounds of questionnaires. The experts' experience was relatively similar. We defined the UniVATS as monitor-dependent surgery, no use of rib-spreading and single incision less than 4 cm. Tumor with stage of T1–T3 and N0–N2 is considered amenable to UniVATS. Other consensus was reached on several points outlining the safety and feasibility, surgical skills, learning curve, short-term and long-term outcomes for lung cancer, and current application of subxiphoid and nonintubated UniVATS approach. This consensus statement represents a collective agreement among Chinese experts to suggest that UniVATS is an effective alternative to multi-portal approach, although high-level evidence is expected in the future. Some agreements can be referred in the training of young surgeons.

Introduction

It has been more than a decade since uniportal video-assisted thoracoscopic surgery (UniVATS) was applied in thoracic surgery.[1] Compared with the multi-portal video-assisted thoracoscopic surgery (VATS), UniVATS was related to less invasion and a vertical vision similar to open surgery.[2] The first UniVATS lung cancer resection was described in 2010.[3] With the development of surgical skills and instruments, many complex thoracic procedures were reported to be performed by UniVATS approach.[4–6]

Nowadays, UniVATS has been widely accepted and adopted in China but is less prevalent in Western countries, lack of high-quality evidence might be one of the reasons.[7] In 2019, the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS) has published a consensus report on UniVATS for lobectomy,[8] aiming to define and standardize the procedures, to optimize the indications and perioperative management, and to provide advice for future training. However, the largest quantity of UniVATS is performed in China, where several ultra-high volume thoracic surgical centers are located.[9] Therefore, a consensus from Chinese experts will have a significance of reference in summarizing the current application of UniVATS in lung cancer. In this consensus, not only lobectomy, but also segmentectomy, subxiphoid and nonintubated approach were included. The recommendations from the experts will be helpful for the future development of UniVATS.

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