1. Uniportal VATS: The Exipirience from Bosnia and Herzegovina
Krdžalic Goran, Mušanović Nermin, Krdžalić Alisa, Kešetović Amar
University Clinical Center Tuzla
Bosnia and Herzegovina

2. 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.

3. Introduction
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 Oct;6(suppl 6).S650-5.

4. Patients and methods Visit to UCC Ljubljana in Avgust 2015.
August and February 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

5. 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

6. 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

7. Camera in the upper part of incision
Suction device under scope

8. Camera in upper part and
2 instruments under the camera

9. Closing the wound
Chest tube inserted in the same incision

10. Chest tube at the posterior part of the incision

11. Results Uniportal VATS No pat. Drainage (days) Hospital stay (days)
Bullectomy-pleurodesis
Wedge resection
Pleura biopsy
Thymectomy
Schwanoma resection
Mediastinum biopsy
Mean overall value ± ±4.3

12. Results The median operation time was 85 minutes
range 25 min for wedge resection up to 140 minutes for giant bulla resection
Hystology
- Emphysema pulmonum et bullosum
- Thymus
- Paravertebral thoracic Schwanoma tumor
- Mesothelioma pleurae
- Hodgin lymphoma
- Tumor epiteloides hystiocytoides malignum
- Carcinoma adenoides cysticum infiltrativum pulmonis

13. 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

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

15. AP X-ray after uniportal VATS resection

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

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

18. Results Postoperative Morbidity - excessive postoperative effusion
- prolonged air laek
- wound infection
one conversion and one revision
- Conversion in case of giant bullae when incision was enlarged
- Revision due to postoperative excessive effusion in patient with wedge resections
- mini-thoracotomy with double chest draiange was performed

19. 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 4.6±2.1 days
- The mean hospital stay was 5.8±4.3 days

20. 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
- Think this is a beging of nice story