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. 2024 Jun 25;19(6):e0300632.
doi: 10.1371/journal.pone.0300632. eCollection 2024.

Lu's approach for video-assisted thoracoscopic surgery

Baofeng Wang  1   2 , Jiang Wang  2 , Tongyu Sun  2 , Yilin Ding  2 , Shasha Li  3 , Hengxiao Lu  2
Affiliations

Lu's approach for video-assisted thoracoscopic surgery

Baofeng Wang et al. PLoS One. .

Abstract

Objectives: Lu's approach for video-assisted thoracoscopic surgery (LVATS), which derives from UVATS, is a novel surgical approach for VATS and carries out micro-innovation for lung cancer resection. The objective of this study is to elucidate the safety, feasibility, and efficacy of this novel surgical approach.

Methods: The clinical data of patients with non-small cell lung cancer (NSCLC) who underwent a curative thoracoscopic lobectomy between Mar. 2021 and Mar. 2022, were retrospectively collected, and analyzed. According to whether applied Lu's approach during the VATS operation, patients were divided into the LVATS group and the UVATS group. The propensity score (PS) matching method was used to reduce selection bias by creating two groups. After generating the PSs, 1:1 ratio and nearest-neighbor score matching was completed. Perioperative variables, including the operation time, intraoperative blood loss, lymph node stations dissected, total drainage volume, drainage duration, postoperative hospital stay, pain score (VAS, Visual Analogue Scale) on the postoperative first day (POD1) and third day (POD3), and incidence of postoperative complications, were compared between the two groups. The data were analyzed statistically with P<0.05 defined as statistically significant.

Results: A total of 182 patients were identified, among whom 86 patients underwent LVATS and 96 UVATS. Propensity matching produced 62 pairs in this retrospective study. There were no deaths during perioperative period. Patients in the LVATS group experienced a shorter operation time (88 (75, 106) VS 122 (97, 144)min, P <0.001), less intraoperative blood loss(20 (20, 30) VS 25 (20, 50)ml, P = 0.021), shorten incision length (2.50 (2.50, 2.50) VS 3.00 (3.00, 3.50)cm, P <0.001), and more drainage volume (460 (310, 660) VS 345 (225, 600)ml, P = 0.041) than patients in the UVATS group. There was not significant difference in the lymph node stations dissected(5 (4, 5) VS 5 (4, 5), P = 0.436), drainage duration (3 (3, 4) VS 3 (3, 4)days, P = 0.743), length of postoperative hospital stay (4 (4, 5) VS 4 (4, 6)days, P = 0.608), VAS on the POD1(4 (4, 4) VS 4 (4, 4), P = 0.058)and POD3 (3 (3, 4) VS 4 (3, 4), P = 0.219), and incidence of postoperative complications (P = 0.521) between the two groups.

Conclusions: Lu's approach is a safe and feasible approach for video-assisted thoracoscopic surgery for the lobectomy of NSCLC. This approach can shorten surgical time, reduce incision length and intraoperative blood loss.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Surgical set up for Lu’s approach for video-assisted thoracoscopic surgery (LVATS).
a The right-handed energy instrument approach in left-sided lung surgery, the electric hook was introduced by a 5 mm trocar hole that was used as a drainage port after surgery, and the surgical instruments such as aspirator was introduced by the main operation port. The surgeon and camera holder were positioned on the ventral side and the assistant was positioned on the dorsal side of the patient. b In the right-sided lung surgery, the energy instrument in the right hand was introduced by the main operation port and the surgical instrument with a diameter of less than 5 mm such as aspirator was introduced by the 5 mm trocar hole. The intraoperative position of the surgeon was the same as for left-sided lung surgery. c The surgical instruments in LVATS.
Fig 2
Fig 2. The contrast between the angles formed by two surgical instruments in the UVATS and LVATS, maintaining a large angle between the two instruments can reduce collisions between instruments and facilitate the surgeon ’s operation.
a the angle between the electric hook and the aspirator during the dissection of the left hilus in UVATS. b the angle between the electric hook and the aspirator during the dissection of the left hilus in LVATS. c the angle between the electric hook and the aspirator during the dissection of the right hilus in UVATS. d the angle between these two instruments during the dissection of the righ lung fissure in LVATS.
Fig 3
Fig 3. LVATS can bring convenience to the placement of cutting closure device during surgery.
a the aspirator introduced through the drainage port can assist the separation of bronchus of the right upper lobe in LVATS. b the aspirator introduced through the drainage port can assist placing the cutting closure device to cut and close the bronchi of the right upper lobe in LVATS. c the aspirator assisted separating the artery of the right upper lobe in LVATS. d the aspirator assisted placing the cutting closure device to cut and close the artery of the right upper lobe in LVATS. e the aspirator assisted separating the vein of the right upper lobe in LVATS. f the aspirator assisted placing the cutting closure device to cut and close the vein of the right upper lobe in LVATS.
Fig 4
Fig 4. Appearance of the LVATS incisions.
a details of surgical incision and the 5 mm trocar was introduced in LVAST. b the 5mm drain port achieved low thoracic drainage postoperatively in LVATS.
See this image and copyright information in PMC

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Grants and funding

The author(s) received no specific funding for this work.