Krdžalic Goran, Mušanović Nermin, Kešetović Amar

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Krdžalic Goran, Mušanović Nermin, Kešetović Amar Uniportal video assisted thoracic surgery in the diagnosis and treatment of mediastinal tumors Krdžalic Goran, Mušanović Nermin, Kešetović Amar University Clinical Center Tuzla Bosnia and Herzegovina

Introduction Implementation of uniportal VATS techinique for various intrathoracic procedures is increasing especially in Asia and Europa It is spreading very fast and the results are very promising and encouraging We reveal the our first expirience on uniportal VATS in Bosnia and Herezegovina Ng CSH. Uniportal video-assisted surgery: a look into the future. Eur J Cardiothorac Surg 2016;49:i1-12.

Introduction 1998. the first description of Uniportal VATS technique for six patients in Japan 2003. Gaetano Rocco the National Cancer Institute Naples Italy mainly pioneered the first progress of Uniportal VATS 2010. Gonzalez-Rivas Coruña University Hospital – Spain made the first Uniportal VATS lobectomy for non small cell cancer 2015. Štupnik Tomaž University Clinical Center Ljubljana perforemed the first uniportal VATS lobectomy in our region Ismail M, Gonzales Rivas D, et all. Uniportal VATS: the first German expirience.J Thorac Dis. 2014 Oct;6(suppl 6).S650-5.

Patients and methods Visit to UCC Ljubljana in Avgust 2015. August 2015. and February 2016. - 11 adult patients underwent Uniportal VATS one female and ten male patients mean age 39.9±20.53 years range 20y - 83y Department of Thoracic Surgery - UCC Tuzla – B&H Our thoracic team is well expirienced in - open lung and oesophageal cancer surgery - conventional minor and intermediate VATS - laparoscopic surgery - Nuss procedure (MIRPE) and sternal surgery

Surgical technique - patents are placed in a right or left sided position as in PL thoracotomy - general anaestesia with singl lung ventilation - 4-5 cm incision in the 5th intercostal space - no rib spreading - 10mm 30º scope camera in upper part of incision - incision allowed introduction two instruments under the camera - no additional scin incision - instruments from laparoscopic procedure and open lung surgery - Harmonic ACE shears and staplers - Ethicon Inc. Johnson & Johnson Co. - in all patinets tube drainage was inserted in the incision - have no special instruments for uniportal VATS

Righ side incision The incision placed in the 5th intercostal space Scope in the upper part of incision and instrument under Display in the background

Camera in the upper part of incision Suction device under scope

Camera in upper part and 2 instruments under the camera

Closing the wound Chest tube inserted in the same incision

Chest tube at the posterior part of the incision

Results Uniportal VATS No pat. Drainage (days) Hospital stay (days) Thymectomy 1 2 3 Schwanoma resection 1 2 3 Mediastinum biopsy 3 12 15 Mean overall value 3.2 5.2

Results The median operation time was 58 minutes range 25 min for Hodgin lymphoma biopsy up to 90 minutes for thymectomy Hystology - Thymus - Paravertebral thoracic Schwanoma tumor - Hodgin lymphoma 2 - Mediastinal cyst

chest CT scan shows righ paravertebral tumor 4cm in diameter A case of 22 years old boy chest CT scan shows righ paravertebral tumor 4cm in diameter

The same patient preoperative AP x-ray with right thoracic paravertebral tumor

AP X-ray after uniportal VATS resection

The same boy two months after uniportal VATS resection Hystology - Schwannoma tumor

The lady with MG - 2 months after right uniportal VATS thymectomy It was the first uniportal VATS thymectomy in B&H

Results Postoperative Morbidity - prolonged air laek No one conversion or revision, no mortality

Results Postoperative management - Mobilisation and physotherapy began on the operation day - x-ray was performed on the operation day and the first postoperative day - Thoracic drainage was removed after 12 hours clamping with normal x ray and secretion volume below 150ml - Postoperative lung air leak was treated conservatively - The mean thoracic drainage was 3.2 days - The mean hospital stay was 4.2 days

Conclusion - The procedure can be optimally learned under supervision of expirienced surgeons - The development of uniportal VATS program requires previous general VATS expirience - Could be performed by thoracic surgeon expirienced in PL thoracotomy - The results of this emerging technique are very promisisng and encouraging for the diagnosis and therapy of mediastinal tumors