Preface on Advanced Uniportal VATS

Uniportal video-assisted thoracic surgery (VATS) constitutes one of the less invasive approaches within minimally invasive thoracic surgery (MITS). Since the initial publications in 2004 (1), and especially after the first report of anatomical pulmonary resection with uniportal VATS in 2011 (2), the technique has become increasingly common worldwide.

There has been an increasing interest in uniportal VATS, as it provides multiple advantages for surgeons and patients. The technique offers a simpler combination of visualization and instrument handling compared to multiportal VATS and limits surgical trauma to a single intercostal space, which can decrease postoperative pain and promote faster recovery. Also contributing to this increased interest are improvements in surgical visualization systems, new endostapler technologies, advanced energy devices, and the proliferation of surgical instruments designed specifically for uniportal VATS. New initiatives to improve teaching and reduce the learning curve for uniportal VATS by more media-active surgeons have likewise promoted adoption of this technique by surgeons at all stages of their careers.

Despite its being widely used for conventional procedures such as lobectomies or simple segmentectomies, there is still concern about the use of uniportal VATS for complex procedures—such as bronchial/vascular sleeve resections, complex segmentectomies, lung cancer with chest wall involvement—and how to handle intraoperative bleeding and other unexpected complications through a single incision. There are several strategies for skill development in uniportal VATS, which vary from educational resources such as masterclasses, surgical videos with technical tips and tricks, illustrative textbooks, and technical publications by experienced surgeons to more practical tools such as simulation devices, animal training, surgical proctorships or even fellowships in reference centers.

This special series in Advanced Uniportal VATS aims to provide less experienced surgeons or surgeons without prior experience with technical reviews written by well-known surgeons with high expertise in the approach.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Video-Assisted Thoracic Surgery for the series “Advanced Uniportal VATS”. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://vats.amegroups.com/article/view/10.21037/vats-24-17/coif). The series “Advanced Uniportal VATS” was commissioned by the editorial office without any funding or sponsorship. C.G.M. and P.A.U.F. served as the unpaid Guest Editors of the series. P.A.U.F. is a speaker of AstraZeneca and Medtronic and receives payments from both companies. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg 2004;77:726-8. [Crossref] [PubMed]
2. Gonzalez-Rivas D, de la Torre M, Fernandez R, et al. Single-port video-assisted thoracoscopic left upper lobectomy. Interact Cardiovasc Thorac Surg 2011;13:539-41. [Crossref] [PubMed]

Carlos Galvez Munoz

Paula A. Ugalde Figueroa