A prospective study comparing three-port video-assisted thoracoscopy with the single-incision laparoscopic surgery (SILS) port and instruments for the video thoracoscopic approach: a pilot study
A prospective study comparing three-port video-assisted thoracoscopy with the single-incision laparoscopic surgery (SILS) port and instruments for the video thoracoscopic approach: a pilot study
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DOI：
10.1007/s00464-012-2782-6
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发表时间：
2013-07-01
影响因子：
3.1
通讯作者：
Molins, Laureano
中科院分区：
文献类型：
--
作者：
Mier, Jose M.;Chavarin, Abraham;Molins, Laureano
单切口腹腔镜手术（锡尔斯）已在几种手术中证明了其优势，主要是住院时间更短，美容效果更好，术后疼痛更少。作者已将该入路用于多例胸外科手术，本前瞻性研究比较了20例标准三孔电视胸腔镜手术（VATS）和使用标准腹部锡尔斯系统的单切口入路。在两组中，术后镇痛提供了15毫升的布比卡因0.5%，在3小时的时间间隔，通过椎旁导管。记录住院时间和胸腔引流持续时间（小时）以及使用模拟视觉疼痛量表（AVPS）的术后疼痛。对所有门诊患者进行电话调查。采用Mann-Whitney U检验进行统计学分析，该研究包括20例手术，包括11例肺活检，6例气胸手术，2例纵隔囊肿切除术和1例月经气胸手术。两组之间的住院时间或胸腔引流持续时间无统计学显著差异。然而，锡尔斯组（AVPS，4.40）24小时的术后疼痛显著低于VATS组（AVPS，6.20）（p = 0.035）。锡尔斯组报告了2例轻微手术伤口并发症和1例不需要引流的月经性气胸复发。VATS组报告了1例不明原因的皮疹。在胸外科手术中使用锡尔斯输液港可减少术后疼痛。这与输液港对骨膜和肋间神经的保护作用有关，使其免于与手术器械直接接触。然而，研究结果显示锡尔斯输液港的手术伤口并发症发生率较高，这可能是由于输液港周围皮肤和软组织压力增加，以及该切口用于放置胸腔引流管，从而增加了并发症风险。
Single-incision laparoscopic surgery (SILS) has proved its advantages in several procedures, mainly a shorter hospital stay, improved aesthetic results, and less postoperative pain. The authors have used this approach for several thoracic surgical procedures.This prospective study compared 20 cases between standard three-port video-assisted thoracic surgery (VATS) and the single-incision approach using a standard abdominal SILS system. In both groups, postsurgical analgesia was provided with 15 ml of bupivacaine 0.5% at 3 h intervals via a paravertebral catheter. The hospital length of stay and chest drain duration (in hours) were recorded as well as postoperative pain using an analogic visual pain scale (AVPS). A telephone survey was conducted for all the outpatients. The Mann-Whitney U test was used for statistical analysis.This study of 20 procedures included 11 lung biopsies, 6 pneumothorax procedures, 2 mediastinic cystectomies, and 1 catamenial pneumothorax procedure. No statistically significant difference was reported in hospital length of stay or chest drain duration between the two groups. However, postoperative pain at 24 h was significantly less in the SILS group (AVPS, 4.40) than in the VATS group (AVPS, 6.20) (p = 0.035). The SILS group reported two minor surgical wound complications and one catamenial pneumothorax recurrence that did not require drainage. The VATS group reported one case of skin rash with no identifiable cause.The use of the SILS port in thoracic surgery results in less postoperative pain. This is related to the port's protective effect over the periostium and the intercostal nerve, relieving them of direct contact with surgical instruments. However, the findings showed a higher incidence of surgical wound complications with the SILS port, which can be attributed to increased pressure on the skin and soft tissues surrounding the port and to the fact that this same incision was used for chest drain placement, thus increasing the risk for complications.