Tag: uniportal surgery

16th National Continuing Education Forum in General Thoracic Surgery

Report from the recent 16th National Forum on Thoracic Surgery in Shanghai, China.

Shanghai Pulmonary Hospital, Tongji University

Shanghai, China

October 18th – 19th, 2013

Dr. Gonzalez Rivas demonstrates the single port technique during a live surgery presentation
Dr. Gonzalez Rivas (second from the left) demonstrates the single port technique during a live surgery presentation

As readers know, we strive to feature information about thoracic surgery from around the world.  This report on the 16th National Continuing Education Forum in General Thoracic Surgery comes from featured speaker, Dr. Diego Gonzalez Rivas of Coruna, Spain.

Some of the biggest names in thoracic surgery were in attendance, to present their research and surgical techniques to a crowd of over 600 Chinese thoracic surgeons. The lectures (and live surgery) were also broadcast across China.

World-renown thoracic surgeons at the 16th National Forum in Shanghai, China
World-renown thoracic surgeons at the 16th National Forum in Shanghai, China

Invited International Speakers included:

Dr. G. Alexander Patterson, thoracic surgeon/ lung transplant from the Washington School of Medicine in St. Louis, Mo. (USA).  Dr. Patterson gave a lecture on clinical experiences and advances in Lung Transplantation.  He also lectured on pancoast tumors.

Dr. Claude Deschamps, French Canadian thoracic surgeon and Chair of Surgery at the Mayo Clinic, Rochester, MN (USA). Dr. Deschamps talked about the use of anti-reflux surgery.

Dr. Gaetano Rocco, of the National Cancer Institute in Naples, Italy.  Dr. Rocco talked about advances in chest wall reconstruction.  He gave another lecture on uniport surgery.

Dr. Alan Sihoe from the University of Hong Kong discussed management of air leaks.

Surgeons from Taiwan and mainland China presented on a variety of topics including tracheal surgery, management of empyema, sympathectomy for hyperhidrosis and surgical treatment of tuberculosis.  (The full list of speakers and topics presented is available here*.)

Conference Spotlight: Single port surgery 

But the focal point of the forum was single port (uniportal) surgery.  Saturday (the 19th) was devoted to lectures and demonstrations of the single port thoracoscopic technique, including live surgical demonstrations performed by Dr. Diego Gonzalez Rivas.  His live surgery presentation was viewed by 500 surgeons at the conference as well as hundreds of other surgeons via a live feed.

Dr. Gonzalez Rivas demonstrates the uniport technique in Shanghai, China
Dr. Gonzalez Rivas demonstrates the single port (uniport) technique in Shanghai, China

Thank you to Dr. Gonzalez Rivas for his submission.  We welcome reports, photographs and discussions on recent and upcoming thoracic surgery conferences.  If you have a meeting, paper or presentation to share, please contact us at k.eckland@gmail.com

*Information is translated from Mandarin using google software with some obvious translational errors, particularly names of several of the Chinese surgeons.

SITS: That’s Single Incision Thoracoscopic Surgery

the development and application of single-port thoracoscopic surgery, (or the lack there of.)

Right now, single incision scopic surgery (laparoscopic, generally*) is in all the literature. This is a minimally invasinve technique using only one port (or incision) for access to the surgical area (usually the abdomen).

I’ve seen it performed by several general surgeons as part of my travels for BogotaSurgery.org and read the literature surrounding it, but hadn’t heard much about it’s close kin, single port thoracoscopic surgery, though I’d seen it performed during a trip to Cartagena early last year. At the time, I immediately noticed the difference in technique in the operating room (it’s not something you miss) but the surgeon performing the procedure just sort of shrugged, and went back to work, a “Yeah, well.. I do this all the time sort of thing.”

Since that trip, I’ve talked to several thoracic surgeons about this technique, and they all agreed; that due to limited visibility and maneverability, it was a procedure with “limited applications”. But it didn’t sound like any of them had attempted it, or knew much on the subject.
Since ‘limited applications’ describes many surgical techniques, I decided to go to the literature, and see what has been published on the topic.

Hmm.. Not much.

An article from two Spanish surgeons dating to 2009. It’s a well written article with a decent amount of subjects (24) for the treatment of spontaneous pneumothorax. They mention one of the adaptations required is use of the Coviden multi-station system to hold instruments – this is a silly piece of equipment that costs about a thousand dollars. I know that in general surgery, several surgeons have adapted a sterile surgical glove for the same purpose. Since use of this costly but specialized piece of rubber also requires an even bigger incision – I hope these surgeons have since moved on to the sterile glove technique. In this study, length of stay and amount of post-operative pain were not greatly reduced, which was a little surprising.

Jutley, Khalil and Rocco published a paper in 2005 in the European Journaol of Cardiothoracic Surgery on the same technique for spontaneous pneumothorax with 16 patients having uniport surgery (versus 19 in the standard three port group) with positive findings of reduced pain, and less residual neuralgias.

An Italian group reported similar positive findings (compared to Jutley, et. al) in 2008 on a similar sized group/ population (28 patients uniport versus 23 ‘traditional’ 3 port). They also reported a minimum of problems with the uniport technique.

So, three published studies (there are probably more, but this is what I could find over at Pubmed) with minimum of fuss or problems… So, why isn’t there more single incision thoracoscopic surgery? Where are the surgeons performing this technique? Maybe I’m just not talking to enough thoracic surgeons, or the right thoracic surgeons..

I’ll get back to you on this.

* This laparoscopic technique goes by the anacronym: SILS for single-incision laparoscopic surgery. It is also called uni-port (uniportal) laparoscopy and it has both it’s champions and detractors.