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Correspondence

Reply

Department of Thoracic Surgery and Oncology, Division of Thoracic Surgery, National Cancer Institute, Pascale Foundation, Via M Semmola, 81, 80131 Naples, Italy

(Email: gaetano.rocco{at}btopenworld.com).

To the Editor:

Dr Rocco discloses that he has a financial relationship with Covidien.

 

Assouad and colleagues [1] should be commended for rightfully raising the point of how to expand the practice of uniportal videoscopic assisted thoracic surgery (VATS). However, although the indications for single-port VATS to manage pleural disease (ie, single incision VATS to obtain diagnosis and divide loculations) have been known since the inception of thoracoscopic surgery, operative uniportal VATS (ie, single incision VATS pulmonary resection) often requires interchangeability of the reciprocal position of the necessary instrumentation to address different areas in the chest cavity [2]. Accordingly, in the description of the original technique of uniportal VATS pulmonary resection [2], the use of a trocar was not contemplated to avoid space impediments.

In this setting, the single-incision laparoscopic surgical (SILS) port (Covidien, Mansfield, MA) is a U.S. Food and Drug Administration-approved device for laparoscopic use that enables the surgeon to perform single-port laparoscopic procedures while establishing and maintaining the pneumoperitoneum. Once again, thoracic surgeons should rely on laparoscopic instruments adapted for thoracic surgical use. Indeed, the adaptation of this laparoscopic soft port duplicates the idea of introducing more instruments though a single incision introduced by operative uniportal VATS [2]. Along with flexing the patient's trunk by increasing the intercostal space width, SILS could represent an additional protective factor against intercostal nerve injury—the latter significantly reduced compared with the traditional 3-port VATS if the uniportal VATS technique is carefully adhered to [3]—but I suspect it may also hinder maneuverability [4].

I am convinced Assouad and colleagues' contribution will help clarify this issue in a future report of a larger institutional experience with SILS where more details about stapler introduction and specimen removal through SILS will be given. In the meantime, I would envisage the use of SILS in uniportal VATS to avoid or reduce tedious blood dripping on the thoracoscope lens, which is common if no port is used.

In conclusion, I agree with Assouad and coworkers that specific instruments for operative uniportal VATS should be devised because the operative uniportal VATS technique is based on a totally different intrathoracic approach to the target lesion in the chest compared with conventional 3-port VATS [2–4]. Moreover, unlike 3-port operative VATS, the contribution of articulating instrumentation is fundamental for operative uniportal VATS [2–4]. In this setting, it is important to define a clear-cut distinction between uniportal operative vs diagnostic VATS, with the latter certainly benefitting from the use of SILS.

	References

Top References

 

1. Assouad J, Vignes S, Nakad J, Grunenwald D. Single incision video-assisted thoracic surgery using a laparoscopic port (letter) Ann Thorac Surg 2011;91:2020-2021.[Free Full Text]
2. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections Ann Thorac Surg 2004;77:726-728.[Abstract/Free Full Text]
3. Jutley RS, Khalil MW, Rocco G. Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: comparison of post-operative pain and residual paraesthesia Eur J Cardiothorac Surg 2005;28:43-46.[Abstract/Free Full Text]
4. Rocco G, Romano V, Accardo R, et al. Awake single-access (uniportal) video-assisted thoracoscopic surgery for peripheral pulmonary nodules in a complete ambulatory setting Ann Thorac Surg 2010;89:1625-1627.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Gaetano Rocco Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rocco, G. Search for Related Content PubMed PubMed Citation Articles by Rocco, G. Related Collections Lung - other Related Article