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Ebook Operative thoracic surgery (6/E): Part 2

(BQ) Part 2 book “Operative thoracic surgery” has contents: Combined bronchial and pulmonary artery sleeve resections, superior sulcus tumors , lung volume reduction surgery, lung transplantation, pleural space problems, outpatient thoracic surgery, outpatient thoracic surgery, and other contents. | 17 Uniportal video-assisted thoracoscopic surgery (VATS) GAETANO ROCCO INTRODUCTION Single-port (uniportal) video-assisted thoracoscopic surgery (VATS) represents an evolution of traditional VATS principles and, at the same time, a formidable return to the geometric configuration of classic open thoracotomies.1–3 In a way, the uniportal concept is the center of a star system whose satellites exchange technical aspects with the other known thoracic surgical approaches (see Figure 17.1). The main feature of the uniportal VATS approach consists of targeting, through a caudocranial (sagittal) plane, any area of surgical interest inside the chest (see Figure 17.2). Two advantages result from such a perspective: (1) the procedure allows for a similar approach as is used for open surgery and (2) the reacquisition of the depth of visualization lost with conventional three-port VATS.3 The latter is based on the 17.1  Uniportal VATS seen as the fulcrum of the armamentarium of the modern thoracic surgeon. 17.2  Caudocranial approach (i.e., sagittal plane) for uniportal VATS. 206   Uniportal video-assisted thoracoscopic surgery (VATS) 17.3  Schematic of the simultaneous insertion of the development of a transversal latero-lateral (or anteroposterior) plane, along which the operative instruments are deployed to address the target area.3 With the current 2-D technology, the surgical maneuvers impede in-depth visualization through a centrally located videothoracoscope because of the torsion angle created by the operative instruments (see Figure 17.3).3,4 As a result, traditional three-port VATS demands an extent of hand–eye coordination to overcome the geometrical obstacle originating from this torsion angle (see Figure 17.4a).4 This hand–eye coordination represents an added difficulty, especially during hilar dissection during VATS lobectomy, and this has possibly undermined the more universal acceptance of the procedure, which is otherwise appealing. Conversely, in the .