Uniportal Thoracoscopic Wedge Resections of Lung by Use of a Spinal Needle to Replace a Grasper.

SESSION TYPE: Thoracic Surgery Posters IIPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: Thoracoscopic wedge resection using three ports is the technique of choice for spontaneous pneumothorax or other lung lesions needed tissue confirmation. A few publications describing the uniportal thoracoscopic surgery an alternative to conventional three-port surgery have been reported. We herein introduce uniportal thoracoscopic wedge resection technique using a spinal needle.METHODS: Between March 2011 and March 2012, 56 patients were enrolled. Only one incision (1.5~2.0 cm long) is placed in mid-axillary line of 5th~7th intercostal space according to the location of target lesions. A 5 mm 30° thoracoscope and a 5 mm grasper to hold target lesions were inserted into pleural cavity through the incision. And then a 20 gauge spinal needle bended about 90° was inserted into pleural cavity through mid- or anterior axillary line of 3rd~5th intercostal space. The target lesion was hooked by spinal needle and grasper was taken out of pleural cavity. The wedge resection was performed with roticulating stapler (endo-GIA, Covidien). We covered apex including the stapled line with fibrin glue and Neoveil® sheet additionally in patients with spontaneous pneumothorax. A 24 French chest tube was positioned through the incision.RESULTS: Patients included 35 men and 21 women with mean age of 37 years (range 15~72). The surgical indications were 34 patients of primary spontaneous pneumothorax and 22 patients of other disease (primary lung cancer 5, metastatic lung cancer 3, interstitial lung disease 3, organizing pneumonia 2, fibrotic granuloma 2, tuberculosis 2, septic emboli 1, pulmonary sarcoidosis 1, chondroid hamartoma 1 and intrapulmonary LN 1). The mean operative time was 38 minutes (range 20~90). Neither mortality nor major morbidity was observed. The median chest drain duration and hospital stay were 2 days (range 1~3) and 3 days (range 2~5) in 35 patients with primary spontaneous pneumothorax.CONCLUSIONS: Only 5 mm scope and stapler are inserted through a 1.5~2.0 cm incision during stapling in uniportal thoracoscopic wedge technique by use of a spinal needle to replace a grasper. We suggest that this technique is simple and easy to perform and may applicable to both spontaneous pneumothorax and other peripheral lung lesions needed tissue confirmation.CLINICAL IMPLICATIONS: Uniportal thoracoscopic wedge resections of lung by use of a spinal needle is a simple, easy and cosmetic technique applicable to both spontaneous pneumothorax and other peripheral lung lesions needed tissue confirmation.DISCLOSURE: The following authors have nothing to disclose: Cheonwoong Choi, Dae Hyun KimNo Product/Research Disclosure InformationKyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.