Overview of uniportal video-assisted thoracic surgery pulmonary segmentectomy—the movement of minimally invasive surgery

Uniportal video-assisted thoracic surgery (uVATS) for wedge resection has been firstly introduced by Rocco and colleagues in 2004 (1). Subsequently, Gonzalez-Rivas and colleagues reported uVATS lobectomy in 2012, which was the first report describing anatomic pulmonary resection via single skin incision (2). After these introductions, uVATS has extended worldwide as general thoracic surgeons strive for minimally invasive approach which can ensure better postoperative quality of life in patients. Several reports described the superior perioperative results of uVATS for patients with primary lung cancer undergoing lobectomy with systemic lymphadenectomy compared with multiportal VATS (mVATS) (3). Moreover, Gonzalez-Rivas and colleagues showed successful results of uVATS broncho-angioplasty or carinal reconstruction, which indicated that these complex procedures are no longer contraindications via around 40 mm single skin incision (4).

Pulmonary segmentectomy has also extended worldwide as the movement of minimally invasive surgery. Although this type of sublobar resection can be adopted as an intentional or an (unintentional) palliative treatment, intentional segmentectomy is being focused more because small-sized peripheral lung cancer is more frequently detected accompanied with the improvement of computed tomographic imaging. Suzuki and colleagues recently described that the perioperative results of pulmonary segmentectomy for early-staged non-small cell lung cancer was equivalent to those of lobectomy except more air leakage in the prospective randomized trial (5). This group will demonstrate whether pulmonary segmentectomy can lead to the superior pulmonary function and noninferiority in overall survival compared to lobectomy in near future. In addition, our group demonstrated the equivalent perioperative results between common and uncommon segmentectomies via thoracoscopic approach although uncommon pulmonary segmentectomy is considered having more technical difficulties compared to common segmentectomy, which indicated that such a complex type of segmentectomy can be achieved via a thoracoscopic approach (6). These positive results will facilitate pulmonary segmentectomy to become widespread.

Although uVATS and pulmonary segmentectomy are considered less invasive treatments as we described them above, the aspects of “less invasive” are different. While uVATS focuses on “approach”, segmentectomy does on “preservation of the lung”. However, we expect that combination of those less invasive treatments might be standard for thoracic disease including lung cancer in the future based on the movement of minimally invasive surgery. Therefore, thoracic surgeons should have technical skills to perform this type of surgery appropriately. In this focused issue, the surgical techniques to achieve uVATS segmentectomy appropriately and the tips of several types of uVATS segmentectomy are introduced by experts in this field. The goal is for this focused issue to help thoracic surgeons to overcome the technical difficulties in uVATS segmentectomy due to limited angulation and interference of any surgical instrument via a single incision.

Acknowledgments

Funding: None.

Footnote

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

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/vats-2019-uvs-07). The series “Uniportal VATS Segmentectomy” was commissioned by the editorial office without any funding or sponsorship. HI served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Video-Assisted Thoracic Surgery from Apr 2019 to Mar 2021. MK has 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

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