RECENT ADVANCES IN UNIPORTAL VATS Diego Gonzalez-Rivas, MD, FECTS Thoracic Surgery and Lung Transplantation Department Minimally Invasive Thoracic Surgery Unit (UCTMI),Coruña, Spain Shanghai Pulmonary Hospital, Tongi University, Shanghai, China Yunan cancer hospital, Kunming, China www.diegogonzalezrivas.com
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RECENT ADVANCES IN UNIPORTAL VATS
Diego Gonzalez-Rivas, MD, FECTS Thoracic Surgery and Lung Transplantation DepartmentMinimally Invasive Thoracic Surgery Unit(UCTMI),Coruña, SpainShanghai Pulmonary Hospital, Tongi University, Shanghai, China Yunan cancer hospital, Kunming, China
www.diegogonzalezrivas.com
Learning VATS ?
Begining (2007)
Double port technique
First Uniportal lobectomyApril 2009
First reported Uniportal VATS lobectomyJune 2010
“In our experience, this technique is possible for lowerlobes. For upper lobes, the hilar dissection is possible viaone incision but there are difficulties stapling the uppervein, mediastinal trunk and the bronchus. Probably, thedevelopment of new technologies (angled optics, angledand curved staplers) will lead to single-port upper lobectomiesbecoming possible in experienced VATS groups”
Published in journals, atlas, textbook, etcData and survival
Gonzalez-Rivas D et al. Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small celllung cancer? J Thorac Dis 2014 May 22. doi: 10.3978/j.issn.2072-1439.2014.05.17
Abbreviations used: ND = no difference; CPKmax = maximum postop level of creatine phosphokinase; CRPmax = maximum postop level of C-reactive protein
Uniportal VATS Conventional VATS
Operation times (mins) 170179
191208
Blood loss (ml) 5356
9578
Nodes dissected 2728
2225
Operation
Operation
Pain
Pain
Recovery
Chin Med J 2015;128:2731-5
Recovery
Wu C,Fernandez R, De la torre M, Delgado M, Fieira E, Wu C, Hsieh M, Paradela M, Liu Y, Gonzalez-Rivas D. Mid-Term Survival Outcome of Single Port Video Assisted Thoracoscopic Anatomic LungResection: Two Center Experience. EJCTS 2018. In Press. DOI 10.1093/ejcts/ezy067
• Teaching around the world• The concept of “Advanced instrumentation” and “ultradvanced
instrumentation”• Complex hilum (lymph nodes or fibrosis)• Complex segmentectomies and lobectomies• Sleeve broncho-vascular procedures, carinal• Radical lymph node dissection• Bleeding control• Non intubated lobectomy• Subxiphoid and subcostal resections• Unisurgeon assisted with robotic arm• High volume Training courses
RECENT ADVANCES IN UNIPORTAL VATS
• Symposia
• Workshops
• Visiting (Observer)
• wetlabs
• Videos
• Training courses (2 weeks)
➢ Train the Team !!!
Correct Training!!
Uniportal LUL and chest wall resection
Gonzalez-Rivas D, Xie B, Yang Y, Jiang G. Uniportal video-assisted thoracoscopiclobectomy with en bloc chest wall resection. J Vis Surg 2015;1:7.
Vascular reconstruction
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Direct suture Patch Sleeve anastomosis
Bronchial sleeve
Uniportal bronchial sleeve
Gonzalez-Rivas D et al. Uniportal video-assisted thoracoscopic bronchovascular, trachealand carinal sleeve resections . Eur J Cardiothorac Surg 2015; doi:10.1093/ejcts/ezv410
Right carinal sleeve pneumonectomy
RUL and carinal resectionHigh frequency ventilation jet
Gonzalez-Rivas D et al. Advances in Uniportal video-assisted thoracoscopic surgery: pushing the envelope.Thoracic Surgery Clinics 2016. DOI: http://dx.doi.org/10.1016/j.thorsurg.2015.12.007
Gonzalez-Rivas D. Double sleeve uniportal video-assisted thoracoscopic lobectomy for non-small cell lung cancer. Ann Cardiothorac Surg 2014 Apr 11. doi: 10.3978/j.issn.2225-319X.2014.03.13
Gonzalez-Rivas D, Bonome C, Fieira E, Aymerich H, Fernandez R, Delgado M et al.Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg 2015; doi:10.1093/ejcts/ezv136.
Non intubated Uniportal VATS lobectomy
Non intubated Uniportal carinal resection
Jiang L, Liu J, Gonzalez-Rivas D et al. Thoracoscopic Surgery for Tracheal and CarinalResection and Reconstruction under Spontaneous Ventilation. JTCVS 2018. In press. DOI: https://doi.org/10.1016/j.jtcvs.2017.12.153