Double-sleeve and carinal resections using the uniportal VATS technique: a single centre experience

Background: Video-assisted thoracic surgery (VATS) double-sleeve lobectomy and carinal resections are two of the most complex procedures in thoracic surgery. The uniportal approach provides an advantage for performing these procedures successfully; however, knowledge of the important technical details is required. This study describes the experience of implementing these procedures by Russian specialists. Methods: Six patients (one woman; mean age, 57.3 +/- 3.6 years) who underwent a uniportal VATS double sleeve and carinal resections were consecutively included in this study. A 5-to 6-cm incision was made at the fifth intercostal space on the middle axillary line. Results: Double sleeve left upper lobectomy was completed in four cases. One case of the right sleeve carinal pneumonectomy and one case of the right sleeve carinal upper lobectomy were completed. The mean operation time was 280 +/- 13 minutes. There was no conversion to thoracotomy. The mean postoperative hospital stay was 10.8 +/- 0.8 days. There was no postoperative mortality. In one case of double-sleeve lobectomy, postoperative pneumonia developed. The postoperative diagnoses of the four uniportal double-sleeve cases were as follows: T2aN2M0 in one case, T3N1M0 in two cases, and T2aN0M0 in one case. The postoperative diagnoses of the two uniportal totally carinal resections were as follows: T4N0M0 and T3N0M0. Conclusions: This study results suggest that a uniportal VATS approach might be a feasible option for complex sleeve resections with acceptable postoperative outcomes in the advanced stages of lung cancer. To further evaluate the feasibility, safety, and efficacy of this technique, more experience would be required.