SlideShare a Scribd company logo

Single port lobectomy gtsc 2016 tucson - v6

•Download as PPTX, PDF•
•
Sebastien Gilbert MD
Sebastien Gilbert MD

Single Port lobectomy

Science
1 of 64
Sebastien Gilbert MD Associate Professor of Surgery Chief, Division of Thoracic Surgery The Ottawa Hospital University of Ottawa Uniportal Anatomic Pulmonary Resection General Thoracic Surgical Club Tucson, USA Mar 10-13, 2016
Disclosures  None
Outline Background Review Technical Aspects Share Early Experience Case Videos
Reducing Chest Wall Trauma Thoracic Operations
Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Non-Rib Spreading (VATS)
Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Postero- lateral Muscle sparing, Anterior, “French window” Non-Rib Spreading (VATS)
Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Postero- lateral Muscle sparing, Anterior, “French window” Non-Rib Spreading (VATS) Multi-port Single-port
Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Postero- lateral Muscle sparing, Anterior, “French window” Non-Rib Spreading (VATS) Multi-port Single-port Intercostal Access Minimal or No Intercostal Access
Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Postero- lateral Muscle sparing, Anterior, “French window” Non-Rib Spreading (VATS) Multi-port Single-port Intercostal Access Minimal or No Intercostal Access Subxyphoid, Subcostal*, Cervical* *May include one 5 mm intercostal port
Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Postero- lateral Muscle sparing, Anterior, “French window” Non-Rib Spreading (VATS) Multi-port Single-port Intercostal Access Minimal or No Intercostal Access Subxyphoid, Subcostal*, Cervical* *May include one 5 mm intercostal port
Is VATS superior to OPEN?  Common answer = “Yes”  Equivalent oncologic outcomes1,3  Similar chest tube drainage, LOS, pain2  Similar pneumonia, air leak, arrhythmia, mortality3 1. Sugi et al. WJS 2000; 24, 27–31 2. Kirby et al. JCTVS 1995;109:997-1002 3. Yan et al. JCO 2009; 27:2553-2562
Transition from OPEN to VATS  How far have we come? Limited adoption of VATS lobectomy: STS data = 28-35%1-2 of cases ESTS data = 11%3 of cases Why? 1. Boffa et al. JTCVS 2008; 135:247-54 2. Ceppa et al. Ann Surg 2012; Sep;256(3):487-93 3. Begum et al. JTD 2014; 6 Suppl 2:S203-10
Single-port or Uniportal VATS  Early publications: 2000: Migliore M 2004: Rocco G 2011: Gonzalez-Rivas D  Popular topic: Last 10 years: 1000 cases reported Last 6 months: >400 cases reported
 Only 3 retrospective comparisons: n≈200 cases Early outcomes are similar Is Multi-port superior to Single-Port? 1. Mu et al. Chin Med J 2015;128:2731-5 2. Shen et al. EJCTS 2016; 49 (suppl 1): i48-i53 3. French et al. Ann Cardiothorac Surg 2016 (in press)
Planning the Transition  Focus on Patient Safety  Maintain Surgical Quality  Preserve/Enhance Educational Experience
Port Placement
Technical Aspects Posterior axillary Anterior axillary
Single Port: Anterior Hilar Dissection Camera Head Controls at 12 o’clock Camera Post at 6 o’clock “30o up”Retracting Hand (Surgeon or Assistant) Operating Hand Additional Operating Hand (Optional) Surgeon
Single Port: Posterior Hilar Dissection Camera Head and Post at 12 o’clock “30o down” Retracting Hand (Surgeon or Assistant) Operating Hand Additional Operating Hand (Optional) Surgeon
Incision Plane Camera Line of Sight Instruments Camera Post facing Surgeon
Incision Plane Camera Line of Sight Instruments Camera Post facing Surgeon
Incision Plane Camera Line of Sight Instruments Camera Post facing Surgeon
Incision Plane Camera Line of Sight Instruments Camera Post away from Surgeon
Ergonomics
Ergonomics Camera Instruments Instruments Camera
VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Median [interquartile range] University of Ottawa: Early Experience
VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 Median [interquartile range] University of Ottawa: Early Experience
VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Median [interquartile range] University of Ottawa: Early Experience
VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Smokers 38 (76%) 38 (76%) 1.000 Median [interquartile range] University of Ottawa: Early Experience
VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Smokers 38 (76%) 38 (76%) 1.000 Charlson Score 2 [1-3] 2 [1-3] 0.615 Median [interquartile range] University of Ottawa: Early Experience
VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Smokers 38 (76%) 38 (76%) 1.000 Charlson Score 2 [1-3] 2 [1-3] 0.615 FEV1% 85 [69-101] 79 [69-89] 0.072 Median [interquartile range] University of Ottawa: Early Experience
VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Smokers 38 (76%) 38 (76%) 1.000 Charlson Score 2 [1-3] 2 [1-3] 0.615 FEV1% 85 [69-101] 79 [69-89] 0.072 DLCO% 74 [63-85] 73 [64-81] 0.958 Median [interquartile range] University of Ottawa: Early Experience
VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Smokers 38 (76%) 38 (76%) 1.000 Charlson Score 2 [1-3] 2 [1-3] 0.615 FEV1% 85 [69-101] 79 [69-89] 0.072 DLCO% 74 [63-85] 73 [64-81] 0.958 Tumor Size (cm) 2.8 [1.8-3.8] 2.5 [1.6-3.5] 0.332 Median [interquartile range] University of Ottawa: Early Experience
Operations Performed Operations VATS (n=50) S-VATS (n=50) p Lobectomy 42 (84%) 39 (78%) 0.764
Operations Performed Operations VATS (n=50) S-VATS (n=50) p Lobectomy 42 (84%) 39 (78%) 0.764 Bilobectomy 0 1 (2%)
Operations Performed Operations VATS (n=50) S-VATS (n=50) p Lobectomy 42 (84%) 39 (78%) 0.764 Bilobectomy 0 1 (2%) Segmentectomy 8 (16%) 10 (20%) 0.603
Operations Performed Operations VATS (n=50) S-VATS (n=50) p Lobectomy 42 (84%) 39 (78%) 0.764 Bilobectomy 0 1 (2%) Segmentectomy 8 (16%) 10 (20%) 0.603 Laterality (right:left) 23:27 26:24 0.548
Intraoperative Outcomes Outcome VATS (n=50) S-VATS (n=50) p R0 Resection 50 (100%) 50 (100%) 1.000
Intraoperative Outcomes Outcome VATS (n=50) S-VATS (n=50) p R0 Resection 50 (100%) 50 (100%) 1.000 Conversion to Open 1 (2%) 2 (4%) 0.558
Intraoperative Outcomes Outcome VATS (n=50) S-VATS (n=50) p R0 Resection 50 (100%) 50 (100%) 1.000 Conversion to Open 1 (2%) 2 (4%) 0.558 Operating Time (min) 146 [121-178] 154 [142-175] 0.081
Intraoperative Outcomes Outcome VATS (n=50) S-VATS (n=50) p R0 Resection 50 (100%) 50 (100%) 1.000 Conversion to Open 1 (2%) 2 (4%) 0.558 Operating Time (min) 146 [121-178] 154 [142-175] 0.081 Staplers 8 [6-10] 9 [8-10] 0.577
Intraoperative Outcomes Outcome VATS (n=50) S-VATS (n=50) p R0 Resection 50 (100%) 50 (100%) 1.000 Conversion to Open 1 (2%) 2 (4%) 0.558 Operating Time (min) 146 [121-178] 154 [142-175] 0.081 Staplers 8 [6-10] 9 [8-10] 0.577 Chest Tube(s) 1 2 <0.001
Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 LOS (days) 4 [3-7] 4 [3-7] 0.992 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 LOS (days) 4 [3-7] 4 [3-7] 0.992 Complications:‡ None 32 (64%) 30 (60%) 0.680 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 LOS (days) 4 [3-7] 4 [3-7] 0.992 Complications:‡ None 32 (64%) 30 (60%) 0.680 Grade I-II 13 (26%) 9 (18%) 0.334 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 LOS (days) 4 [3-7] 4 [3-7] 0.992 Complications:‡ None 32 (64%) 30 (60%) 0.680 Grade I-II 13 (26%) 9 (18%) 0.334 Grade III 4 (8%) 8 (16%) 0.357 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 LOS (days) 4 [3-7] 4 [3-7] 0.992 Complications:‡ None 32 (64%) 30 (60%) 0.680 Grade I-II 13 (26%) 9 (18%) 0.334 Grade III 4 (8%) 8 (16%) 0.357 Grade IV 1 (2%) 2 (4%) 0.558 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
Post-Operative Pain Outcomes VATS (n=50) S-VATS (n=50) p Time on PCA (days) 3 [3-3] 3 [2-3] 0.559
Post-Operative Pain Outcomes VATS (n=50) S-VATS (n=50) p Time on PCA (days) 3 [3-3] 3 [2-3] 0.559 Total PCA Dose (mg) 3.4 [2.6-8.0] 5.4 [1.6-8.0] 0.209
Post-Operative Pain Outcomes VATS (n=50) S-VATS (n=50) p Time on PCA (days) 3 [3-3] 3 [2-3] 0.559 Total PCA Dose (mg) 3.4 [2.6-8.0] 5.4 [1.6-8.0] 0.209 VAS @ 1 hour 3 [0-4] 1 [0-3] 0.009
Post-Operative Pain Outcomes VATS (n=50) S-VATS (n=50) p Time on PCA (days) 3 [3-3] 3 [2-3] 0.559 Total PCA Dose (mg) 3.4 [2.6-8.0] 5.4 [1.6-8.0] 0.209 VAS @ 1 hour 3 [0-4] 1 [0-3] 0.009 VAS @ 24 hours 4 [2-5] 4 [3-5] 0.625
Post-Operative Pain Outcomes VATS (n=50) S-VATS (n=50) p Time on PCA (days) 3 [3-3] 3 [2-3] 0.559 Total PCA Dose (mg) 3.4 [2.6-8.0] 5.4 [1.6-8.0] 0.209 VAS @ 1 hour 3 [0-4] 1 [0-3] 0.009 VAS @ 24 hours 4 [2-5] 4 [3-5] 0.625 Satisfied with Pain Control @ 24 hours 48 (96%) 47 (94%) 0.743
Comparing Approaches Multiport Single Port MIS training/experience Important ?
Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes
Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes
Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace
Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required
Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required Dividing PA before vein Optional Required
Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required Dividing PA before vein Optional Required Clipping PA Optional Recommended
Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required Dividing PA before vein Optional Required Clipping PA Optional Recommended Wound protector Optional Recommended
Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required Dividing PA before vein Optional Required Clipping PA Optional Recommended Wound protector Optional Recommended Special instrumentation Optional Optional
Summary Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required Dividing PA before vein Optional Required Clipping PA Optional Recommended Wound protector Optional Recommended Special instrumentation Optional Optional Assistant 1 0-1
Thank You!

Recommended

Anthro and bmi
Anthro and bmiAnthro and bmi
Anthro and bmiSM Lalon
 
Sequelae & Complications of Pneumonectomy
Sequelae & Complications of PneumonectomySequelae & Complications of Pneumonectomy
Sequelae & Complications of Pneumonectomycairo1957
 
Thoracic surgeries
Thoracic surgeriesThoracic surgeries
Thoracic surgeriesKrishna Priya
 
Surgical persrective in lung cancer
Surgical persrective in lung cancerSurgical persrective in lung cancer
Surgical persrective in lung cancerHarilal Nambiar
 
Pulmonary resection
Pulmonary resectionPulmonary resection
Pulmonary resectionAbdulsalam Taha
 
Emergency Thoracotomy
Emergency ThoracotomyEmergency Thoracotomy
Emergency ThoracotomySCGH ED CME
 
Thoracostomy indications and options
Thoracostomy indications and optionsThoracostomy indications and options
Thoracostomy indications and optionsSCGH ED CME
 
Thoracotomy
ThoracotomyThoracotomy
Thoracotomyacox27
 

Recommended

Anthro and bmi
Anthro and bmiAnthro and bmi
Anthro and bmiSM Lalon
 
Sequelae & Complications of Pneumonectomy
Sequelae & Complications of PneumonectomySequelae & Complications of Pneumonectomy
Sequelae & Complications of Pneumonectomycairo1957
 
Thoracic surgeries
Thoracic surgeriesThoracic surgeries
Thoracic surgeriesKrishna Priya
 
Surgical persrective in lung cancer
Surgical persrective in lung cancerSurgical persrective in lung cancer
Surgical persrective in lung cancerHarilal Nambiar
 
Pulmonary resection
Pulmonary resectionPulmonary resection
Pulmonary resectionAbdulsalam Taha
 
Emergency Thoracotomy
Emergency ThoracotomyEmergency Thoracotomy
Emergency ThoracotomySCGH ED CME
 
Thoracostomy indications and options
Thoracostomy indications and optionsThoracostomy indications and options
Thoracostomy indications and optionsSCGH ED CME
 
Thoracotomy
ThoracotomyThoracotomy
Thoracotomyacox27
 
Critical care aspects of GI surgery by Professor Lars Lundell
Critical care aspects of GI surgery by Professor Lars LundellCritical care aspects of GI surgery by Professor Lars Lundell
Critical care aspects of GI surgery by Professor Lars LundellSMACC Conference
 
14.54 krajcer global experience with tri vascular
14.54 krajcer global experience with tri vascular14.54 krajcer global experience with tri vascular
14.54 krajcer global experience with tri vascularSalutaria
 
Speiser B - AIMRADIAL 2014 - Nursing workload
Speiser B - AIMRADIAL 2014 - Nursing workloadSpeiser B - AIMRADIAL 2014 - Nursing workload
Speiser B - AIMRADIAL 2014 - Nursing workloadInternational Chair on Interventional Cardiology and Transradial Approach
 
Bienert I - AIMRADIAL 2015 - Exposure
Bienert I - AIMRADIAL 2015 - ExposureBienert I - AIMRADIAL 2015 - Exposure
Bienert I - AIMRADIAL 2015 - ExposureInternational Chair on Interventional Cardiology and Transradial Approach
 
Emerging factors predicting outcome after kidney transplantation
Emerging factors predicting outcome after kidney transplantationEmerging factors predicting outcome after kidney transplantation
Emerging factors predicting outcome after kidney transplantationMaarten Naesens
 
Jolly SS et al
Jolly SS et alJolly SS et al
Jolly SS et alInternational Chair on Interventional Cardiology and Transradial Approach
 
Rib Fractures in the Elderly (Dr. Francis Ali-Osman)
Rib Fractures in the Elderly (Dr. Francis Ali-Osman)Rib Fractures in the Elderly (Dr. Francis Ali-Osman)
Rib Fractures in the Elderly (Dr. Francis Ali-Osman)honorhealth
 
Ruzsa Z - AIMRADIAL 2015 - Carotid stenting learning curve
Ruzsa Z - AIMRADIAL 2015 - Carotid stenting learning curveRuzsa Z - AIMRADIAL 2015 - Carotid stenting learning curve
Ruzsa Z - AIMRADIAL 2015 - Carotid stenting learning curveInternational Chair on Interventional Cardiology and Transradial Approach
 
malas savs 2015
malas savs 2015malas savs 2015
malas savs 2015Salutaria
 
Gilchrist IC 201305
Gilchrist IC 201305Gilchrist IC 201305
Gilchrist IC 201305International Chair on Interventional Cardiology and Transradial Approach
 
Does the physical work capacity of subjects with early osteoarthritis of hip ...
Does the physical work capacity of subjects with early osteoarthritis of hip ...Does the physical work capacity of subjects with early osteoarthritis of hip ...
Does the physical work capacity of subjects with early osteoarthritis of hip ...SaxionZorgWelzijn
 
Seto A - AIMRADIAL 2013 - RAUST trial
Seto A - AIMRADIAL 2013 - RAUST trialSeto A - AIMRADIAL 2013 - RAUST trial
Seto A - AIMRADIAL 2013 - RAUST trialInternational Chair on Interventional Cardiology and Transradial Approach
 
Omer Goktekin - TransradialApproach is Better
Omer Goktekin - TransradialApproach is BetterOmer Goktekin - TransradialApproach is Better
Omer Goktekin - TransradialApproach is BetterEuro CTO Club
 
MATTHIAS HONL SilentHip TM inventor
MATTHIAS HONL SilentHip TM inventorMATTHIAS HONL SilentHip TM inventor
MATTHIAS HONL SilentHip TM inventorMatthias Honl
 
Saturday 1050 – tsuchikane – try to stay intimal
Saturday 1050 – tsuchikane – try to stay intimalSaturday 1050 – tsuchikane – try to stay intimal
Saturday 1050 – tsuchikane – try to stay intimalEuro CTO Club
 
Kshivets O. Cardioesophageal Cancer Surgery
Kshivets O. Cardioesophageal Cancer SurgeryKshivets O. Cardioesophageal Cancer Surgery
Kshivets O. Cardioesophageal Cancer SurgeryOleg Kshivets
 
Dharma S - AIMRADIAL 2014 - Nitroglycerin and radial artery occlusion
Dharma S - AIMRADIAL 2014 - Nitroglycerin and radial artery occlusion Dharma S - AIMRADIAL 2014 - Nitroglycerin and radial artery occlusion
Dharma S - AIMRADIAL 2014 - Nitroglycerin and radial artery occlusionInternational Chair on Interventional Cardiology and Transradial Approach
 
Clinical Database
Clinical DatabaseClinical Database
Clinical DatabaseRobert Chen
 
03 Wainstein aimradial20170922 Compression device
03 Wainstein aimradial20170922 Compression device03 Wainstein aimradial20170922 Compression device
03 Wainstein aimradial20170922 Compression deviceInternational Chair on Interventional Cardiology and Transradial Approach
 
Erik Witvrouw - Hamstring Injuries
Erik Witvrouw - Hamstring InjuriesErik Witvrouw - Hamstring Injuries
Erik Witvrouw - Hamstring InjuriesMuscleTech Network
 
Human genetics..........................pptx
Human genetics..........................pptxHuman genetics..........................pptx
Human genetics..........................pptxSilpa
 
Proteomics: types, protein profiling steps etc.
Proteomics: types, protein profiling steps etc.Proteomics: types, protein profiling steps etc.
Proteomics: types, protein profiling steps etc.Silpa
 

More Related Content

Similar to Single port lobectomy gtsc 2016 tucson - v6

Critical care aspects of GI surgery by Professor Lars Lundell
Critical care aspects of GI surgery by Professor Lars LundellCritical care aspects of GI surgery by Professor Lars Lundell
Critical care aspects of GI surgery by Professor Lars LundellSMACC Conference
 
14.54 krajcer global experience with tri vascular
14.54 krajcer global experience with tri vascular14.54 krajcer global experience with tri vascular
14.54 krajcer global experience with tri vascularSalutaria
 
Emerging factors predicting outcome after kidney transplantation
Emerging factors predicting outcome after kidney transplantationEmerging factors predicting outcome after kidney transplantation
Emerging factors predicting outcome after kidney transplantationMaarten Naesens
 
Rib Fractures in the Elderly (Dr. Francis Ali-Osman)
Rib Fractures in the Elderly (Dr. Francis Ali-Osman)Rib Fractures in the Elderly (Dr. Francis Ali-Osman)
Rib Fractures in the Elderly (Dr. Francis Ali-Osman)honorhealth
 
malas savs 2015
malas savs 2015malas savs 2015
malas savs 2015Salutaria
 
Does the physical work capacity of subjects with early osteoarthritis of hip ...
Does the physical work capacity of subjects with early osteoarthritis of hip ...Does the physical work capacity of subjects with early osteoarthritis of hip ...
Does the physical work capacity of subjects with early osteoarthritis of hip ...SaxionZorgWelzijn
 
Omer Goktekin - TransradialApproach is Better
Omer Goktekin - TransradialApproach is BetterOmer Goktekin - TransradialApproach is Better
Omer Goktekin - TransradialApproach is BetterEuro CTO Club
 
MATTHIAS HONL SilentHip TM inventor
MATTHIAS HONL SilentHip TM inventorMATTHIAS HONL SilentHip TM inventor
MATTHIAS HONL SilentHip TM inventorMatthias Honl
 
Saturday 1050 – tsuchikane – try to stay intimal
Saturday 1050 – tsuchikane – try to stay intimalSaturday 1050 – tsuchikane – try to stay intimal
Saturday 1050 – tsuchikane – try to stay intimalEuro CTO Club
 
Kshivets O. Cardioesophageal Cancer Surgery
Kshivets O. Cardioesophageal Cancer SurgeryKshivets O. Cardioesophageal Cancer Surgery
Kshivets O. Cardioesophageal Cancer SurgeryOleg Kshivets
 
Clinical Database
Clinical DatabaseClinical Database
Clinical DatabaseRobert Chen
 
Erik Witvrouw - Hamstring Injuries
Erik Witvrouw - Hamstring InjuriesErik Witvrouw - Hamstring Injuries
Erik Witvrouw - Hamstring InjuriesMuscleTech Network
 

Similar to Single port lobectomy gtsc 2016 tucson - v6 (20)

Critical care aspects of GI surgery by Professor Lars Lundell
Critical care aspects of GI surgery by Professor Lars LundellCritical care aspects of GI surgery by Professor Lars Lundell
Critical care aspects of GI surgery by Professor Lars Lundell
 
14.54 krajcer global experience with tri vascular
14.54 krajcer global experience with tri vascular14.54 krajcer global experience with tri vascular
14.54 krajcer global experience with tri vascular
 
Speiser B - AIMRADIAL 2014 - Nursing workload
Speiser B - AIMRADIAL 2014 - Nursing workloadSpeiser B - AIMRADIAL 2014 - Nursing workload
Speiser B - AIMRADIAL 2014 - Nursing workload
 
Bienert I - AIMRADIAL 2015 - Exposure
Bienert I - AIMRADIAL 2015 - ExposureBienert I - AIMRADIAL 2015 - Exposure
Bienert I - AIMRADIAL 2015 - Exposure
 
Emerging factors predicting outcome after kidney transplantation
Emerging factors predicting outcome after kidney transplantationEmerging factors predicting outcome after kidney transplantation
Emerging factors predicting outcome after kidney transplantation
 
Jolly SS et al
Jolly SS et alJolly SS et al
Jolly SS et al
 
Rib Fractures in the Elderly (Dr. Francis Ali-Osman)
Rib Fractures in the Elderly (Dr. Francis Ali-Osman)Rib Fractures in the Elderly (Dr. Francis Ali-Osman)
Rib Fractures in the Elderly (Dr. Francis Ali-Osman)
 
Ruzsa Z - AIMRADIAL 2015 - Carotid stenting learning curve
Ruzsa Z - AIMRADIAL 2015 - Carotid stenting learning curveRuzsa Z - AIMRADIAL 2015 - Carotid stenting learning curve
Ruzsa Z - AIMRADIAL 2015 - Carotid stenting learning curve
 
malas savs 2015
malas savs 2015malas savs 2015
malas savs 2015
 
Gilchrist IC 201305
Gilchrist IC 201305Gilchrist IC 201305
Gilchrist IC 201305
 
Does the physical work capacity of subjects with early osteoarthritis of hip ...
Does the physical work capacity of subjects with early osteoarthritis of hip ...Does the physical work capacity of subjects with early osteoarthritis of hip ...
Does the physical work capacity of subjects with early osteoarthritis of hip ...
 
Seto A - AIMRADIAL 2013 - RAUST trial
Seto A - AIMRADIAL 2013 - RAUST trialSeto A - AIMRADIAL 2013 - RAUST trial
Seto A - AIMRADIAL 2013 - RAUST trial
 
Omer Goktekin - TransradialApproach is Better
Omer Goktekin - TransradialApproach is BetterOmer Goktekin - TransradialApproach is Better
Omer Goktekin - TransradialApproach is Better
 
MATTHIAS HONL SilentHip TM inventor
MATTHIAS HONL SilentHip TM inventorMATTHIAS HONL SilentHip TM inventor
MATTHIAS HONL SilentHip TM inventor
 
Saturday 1050 – tsuchikane – try to stay intimal
Saturday 1050 – tsuchikane – try to stay intimalSaturday 1050 – tsuchikane – try to stay intimal
Saturday 1050 – tsuchikane – try to stay intimal
 
Kshivets O. Cardioesophageal Cancer Surgery
Kshivets O. Cardioesophageal Cancer SurgeryKshivets O. Cardioesophageal Cancer Surgery
Kshivets O. Cardioesophageal Cancer Surgery
 
Dharma S - AIMRADIAL 2014 - Nitroglycerin and radial artery occlusion
Dharma S - AIMRADIAL 2014 - Nitroglycerin and radial artery occlusion Dharma S - AIMRADIAL 2014 - Nitroglycerin and radial artery occlusion
Dharma S - AIMRADIAL 2014 - Nitroglycerin and radial artery occlusion
 
Clinical Database
Clinical DatabaseClinical Database
Clinical Database
 
03 Wainstein aimradial20170922 Compression device
03 Wainstein aimradial20170922 Compression device03 Wainstein aimradial20170922 Compression device
03 Wainstein aimradial20170922 Compression device
 
Erik Witvrouw - Hamstring Injuries
Erik Witvrouw - Hamstring InjuriesErik Witvrouw - Hamstring Injuries
Erik Witvrouw - Hamstring Injuries
 

Recently uploaded

Human genetics..........................pptx
Human genetics..........................pptxHuman genetics..........................pptx
Human genetics..........................pptxSilpa
 
Proteomics: types, protein profiling steps etc.
Proteomics: types, protein profiling steps etc.Proteomics: types, protein profiling steps etc.
Proteomics: types, protein profiling steps etc.Silpa
 
Reboulia: features, anatomy, morphology etc.
Reboulia: features, anatomy, morphology etc.Reboulia: features, anatomy, morphology etc.
Reboulia: features, anatomy, morphology etc.Silpa
 
Atp synthase , Atp synthase complex 1 to 4.
Atp synthase , Atp synthase complex 1 to 4.Atp synthase , Atp synthase complex 1 to 4.
Atp synthase , Atp synthase complex 1 to 4.Silpa
 
Cyanide resistant respiration pathway.pptx
Cyanide resistant respiration pathway.pptxCyanide resistant respiration pathway.pptx
Cyanide resistant respiration pathway.pptxSilpa
 
Role of AI in seed science Predictive modelling and Beyond.pptx
Role of AI in seed science Predictive modelling and Beyond.pptxRole of AI in seed science Predictive modelling and Beyond.pptx
Role of AI in seed science Predictive modelling and Beyond.pptxArvind Kumar
 
TransientOffsetin14CAftertheCarringtonEventRecordedbyPolarTreeRings
TransientOffsetin14CAftertheCarringtonEventRecordedbyPolarTreeRingsTransientOffsetin14CAftertheCarringtonEventRecordedbyPolarTreeRings
TransientOffsetin14CAftertheCarringtonEventRecordedbyPolarTreeRingsSérgio Sacani
 
Chemistry 5th semester paper 1st Notes.pdf
Chemistry 5th semester paper 1st Notes.pdfChemistry 5th semester paper 1st Notes.pdf
Chemistry 5th semester paper 1st Notes.pdfSumit Kumar yadav
 
Zoology 5th semester notes( Sumit_yadav).pdf
Zoology 5th semester notes( Sumit_yadav).pdfZoology 5th semester notes( Sumit_yadav).pdf
Zoology 5th semester notes( Sumit_yadav).pdfSumit Kumar yadav
 
Cyathodium bryophyte: morphology, anatomy, reproduction etc.
Cyathodium bryophyte: morphology, anatomy, reproduction etc.Cyathodium bryophyte: morphology, anatomy, reproduction etc.
Cyathodium bryophyte: morphology, anatomy, reproduction etc.Silpa
 
FAIRSpectra - Enabling the FAIRification of Analytical Science
FAIRSpectra - Enabling the FAIRification of Analytical ScienceFAIRSpectra - Enabling the FAIRification of Analytical Science
FAIRSpectra - Enabling the FAIRification of Analytical ScienceAlex Henderson
 
module for grade 9 for distance learning
module for grade 9 for distance learningmodule for grade 9 for distance learning
module for grade 9 for distance learninglevieagacer
 
Genetics and epigenetics of ADHD and comorbid conditions
Genetics and epigenetics of ADHD and comorbid conditionsGenetics and epigenetics of ADHD and comorbid conditions
Genetics and epigenetics of ADHD and comorbid conditionsbassianu17
 
Dr. E. Muralinath_ Blood indices_clinical aspects
Dr. E. Muralinath_ Blood indices_clinical aspectsDr. E. Muralinath_ Blood indices_clinical aspects
Dr. E. Muralinath_ Blood indices_clinical aspectsmuralinath2
 
300003-World Science Day For Peace And Development.pptx
300003-World Science Day For Peace And Development.pptx300003-World Science Day For Peace And Development.pptx
300003-World Science Day For Peace And Development.pptxryanrooker
 
LUNULARIA -features, morphology, anatomy ,reproduction etc.
LUNULARIA -features, morphology, anatomy ,reproduction etc.LUNULARIA -features, morphology, anatomy ,reproduction etc.
LUNULARIA -features, morphology, anatomy ,reproduction etc.Silpa
 
biology HL practice questions IB BIOLOGY
biology HL practice questions IB BIOLOGYbiology HL practice questions IB BIOLOGY
biology HL practice questions IB BIOLOGY1301aanya
 
Selaginella: features, morphology ,anatomy and reproduction.
Selaginella: features, morphology ,anatomy and reproduction.Selaginella: features, morphology ,anatomy and reproduction.
Selaginella: features, morphology ,anatomy and reproduction.Silpa
 
Use of mutants in understanding seedling development.pptx
Use of mutants in understanding seedling development.pptxUse of mutants in understanding seedling development.pptx
Use of mutants in understanding seedling development.pptxRenuJangid3
 
Genome sequencing,shotgun sequencing.pptx
Genome sequencing,shotgun sequencing.pptxGenome sequencing,shotgun sequencing.pptx
Genome sequencing,shotgun sequencing.pptxSilpa
 

Recently uploaded (20)

Human genetics..........................pptx
Human genetics..........................pptxHuman genetics..........................pptx
Human genetics..........................pptx
 
Proteomics: types, protein profiling steps etc.
Proteomics: types, protein profiling steps etc.Proteomics: types, protein profiling steps etc.
Proteomics: types, protein profiling steps etc.
 
Reboulia: features, anatomy, morphology etc.
Reboulia: features, anatomy, morphology etc.Reboulia: features, anatomy, morphology etc.
Reboulia: features, anatomy, morphology etc.
 
Atp synthase , Atp synthase complex 1 to 4.
Atp synthase , Atp synthase complex 1 to 4.Atp synthase , Atp synthase complex 1 to 4.
Atp synthase , Atp synthase complex 1 to 4.
 
Cyanide resistant respiration pathway.pptx
Cyanide resistant respiration pathway.pptxCyanide resistant respiration pathway.pptx
Cyanide resistant respiration pathway.pptx
 
Role of AI in seed science Predictive modelling and Beyond.pptx
Role of AI in seed science Predictive modelling and Beyond.pptxRole of AI in seed science Predictive modelling and Beyond.pptx
Role of AI in seed science Predictive modelling and Beyond.pptx
 
TransientOffsetin14CAftertheCarringtonEventRecordedbyPolarTreeRings
TransientOffsetin14CAftertheCarringtonEventRecordedbyPolarTreeRingsTransientOffsetin14CAftertheCarringtonEventRecordedbyPolarTreeRings
TransientOffsetin14CAftertheCarringtonEventRecordedbyPolarTreeRings
 
Chemistry 5th semester paper 1st Notes.pdf
Chemistry 5th semester paper 1st Notes.pdfChemistry 5th semester paper 1st Notes.pdf
Chemistry 5th semester paper 1st Notes.pdf
 
Zoology 5th semester notes( Sumit_yadav).pdf
Zoology 5th semester notes( Sumit_yadav).pdfZoology 5th semester notes( Sumit_yadav).pdf
Zoology 5th semester notes( Sumit_yadav).pdf
 
Cyathodium bryophyte: morphology, anatomy, reproduction etc.
Cyathodium bryophyte: morphology, anatomy, reproduction etc.Cyathodium bryophyte: morphology, anatomy, reproduction etc.
Cyathodium bryophyte: morphology, anatomy, reproduction etc.
 
FAIRSpectra - Enabling the FAIRification of Analytical Science
FAIRSpectra - Enabling the FAIRification of Analytical ScienceFAIRSpectra - Enabling the FAIRification of Analytical Science
FAIRSpectra - Enabling the FAIRification of Analytical Science
 
module for grade 9 for distance learning
module for grade 9 for distance learningmodule for grade 9 for distance learning
module for grade 9 for distance learning
 
Genetics and epigenetics of ADHD and comorbid conditions
Genetics and epigenetics of ADHD and comorbid conditionsGenetics and epigenetics of ADHD and comorbid conditions
Genetics and epigenetics of ADHD and comorbid conditions
 
Dr. E. Muralinath_ Blood indices_clinical aspects
Dr. E. Muralinath_ Blood indices_clinical aspectsDr. E. Muralinath_ Blood indices_clinical aspects
Dr. E. Muralinath_ Blood indices_clinical aspects
 
300003-World Science Day For Peace And Development.pptx
300003-World Science Day For Peace And Development.pptx300003-World Science Day For Peace And Development.pptx
300003-World Science Day For Peace And Development.pptx
 
LUNULARIA -features, morphology, anatomy ,reproduction etc.
LUNULARIA -features, morphology, anatomy ,reproduction etc.LUNULARIA -features, morphology, anatomy ,reproduction etc.
LUNULARIA -features, morphology, anatomy ,reproduction etc.
 
biology HL practice questions IB BIOLOGY
biology HL practice questions IB BIOLOGYbiology HL practice questions IB BIOLOGY
biology HL practice questions IB BIOLOGY
 
Selaginella: features, morphology ,anatomy and reproduction.
Selaginella: features, morphology ,anatomy and reproduction.Selaginella: features, morphology ,anatomy and reproduction.
Selaginella: features, morphology ,anatomy and reproduction.
 
Use of mutants in understanding seedling development.pptx
Use of mutants in understanding seedling development.pptxUse of mutants in understanding seedling development.pptx
Use of mutants in understanding seedling development.pptx
 
Genome sequencing,shotgun sequencing.pptx
Genome sequencing,shotgun sequencing.pptxGenome sequencing,shotgun sequencing.pptx
Genome sequencing,shotgun sequencing.pptx
 

Single port lobectomy gtsc 2016 tucson - v6

  • 1. Sebastien Gilbert MD Associate Professor of Surgery Chief, Division of Thoracic Surgery The Ottawa Hospital University of Ottawa Uniportal Anatomic Pulmonary Resection General Thoracic Surgical Club Tucson, USA Mar 10-13, 2016
  • 4. Reducing Chest Wall Trauma Thoracic Operations
  • 5. Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Non-Rib Spreading (VATS)
  • 6. Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Postero- lateral Muscle sparing, Anterior, “French window” Non-Rib Spreading (VATS)
  • 7. Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Postero- lateral Muscle sparing, Anterior, “French window” Non-Rib Spreading (VATS) Multi-port Single-port
  • 8. Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Postero- lateral Muscle sparing, Anterior, “French window” Non-Rib Spreading (VATS) Multi-port Single-port Intercostal Access Minimal or No Intercostal Access
  • 9. Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Postero- lateral Muscle sparing, Anterior, “French window” Non-Rib Spreading (VATS) Multi-port Single-port Intercostal Access Minimal or No Intercostal Access Subxyphoid, Subcostal*, Cervical* *May include one 5 mm intercostal port
  • 10. Reducing Chest Wall Trauma Thoracic Operations Rib Spreading Postero- lateral Muscle sparing, Anterior, “French window” Non-Rib Spreading (VATS) Multi-port Single-port Intercostal Access Minimal or No Intercostal Access Subxyphoid, Subcostal*, Cervical* *May include one 5 mm intercostal port
  • 11. Is VATS superior to OPEN?  Common answer = “Yes”  Equivalent oncologic outcomes1,3  Similar chest tube drainage, LOS, pain2  Similar pneumonia, air leak, arrhythmia, mortality3 1. Sugi et al. WJS 2000; 24, 27–31 2. Kirby et al. JCTVS 1995;109:997-1002 3. Yan et al. JCO 2009; 27:2553-2562
  • 12. Transition from OPEN to VATS  How far have we come? Limited adoption of VATS lobectomy: STS data = 28-35%1-2 of cases ESTS data = 11%3 of cases Why? 1. Boffa et al. JTCVS 2008; 135:247-54 2. Ceppa et al. Ann Surg 2012; Sep;256(3):487-93 3. Begum et al. JTD 2014; 6 Suppl 2:S203-10
  • 13. Single-port or Uniportal VATS  Early publications: 2000: Migliore M 2004: Rocco G 2011: Gonzalez-Rivas D  Popular topic: Last 10 years: 1000 cases reported Last 6 months: >400 cases reported
  • 14.  Only 3 retrospective comparisons: n≈200 cases Early outcomes are similar Is Multi-port superior to Single-Port? 1. Mu et al. Chin Med J 2015;128:2731-5 2. Shen et al. EJCTS 2016; 49 (suppl 1): i48-i53 3. French et al. Ann Cardiothorac Surg 2016 (in press)
  • 15. Planning the Transition  Focus on Patient Safety  Maintain Surgical Quality  Preserve/Enhance Educational Experience
  • 18. Single Port: Anterior Hilar Dissection Camera Head Controls at 12 o’clock Camera Post at 6 o’clock “30o up”Retracting Hand (Surgeon or Assistant) Operating Hand Additional Operating Hand (Optional) Surgeon
  • 19. Single Port: Posterior Hilar Dissection Camera Head and Post at 12 o’clock “30o down” Retracting Hand (Surgeon or Assistant) Operating Hand Additional Operating Hand (Optional) Surgeon
  • 20. Incision Plane Camera Line of Sight Instruments Camera Post facing Surgeon
  • 21. Incision Plane Camera Line of Sight Instruments Camera Post facing Surgeon
  • 22. Incision Plane Camera Line of Sight Instruments Camera Post facing Surgeon
  • 23. Incision Plane Camera Line of Sight Instruments Camera Post away from Surgeon
  • 26. VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Median [interquartile range] University of Ottawa: Early Experience
  • 27. VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 Median [interquartile range] University of Ottawa: Early Experience
  • 28. VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Median [interquartile range] University of Ottawa: Early Experience
  • 29. VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Smokers 38 (76%) 38 (76%) 1.000 Median [interquartile range] University of Ottawa: Early Experience
  • 30. VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Smokers 38 (76%) 38 (76%) 1.000 Charlson Score 2 [1-3] 2 [1-3] 0.615 Median [interquartile range] University of Ottawa: Early Experience
  • 31. VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Smokers 38 (76%) 38 (76%) 1.000 Charlson Score 2 [1-3] 2 [1-3] 0.615 FEV1% 85 [69-101] 79 [69-89] 0.072 Median [interquartile range] University of Ottawa: Early Experience
  • 32. VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Smokers 38 (76%) 38 (76%) 1.000 Charlson Score 2 [1-3] 2 [1-3] 0.615 FEV1% 85 [69-101] 79 [69-89] 0.072 DLCO% 74 [63-85] 73 [64-81] 0.958 Median [interquartile range] University of Ottawa: Early Experience
  • 33. VATS (n=50) S-VATS (n=50) p Gender (M:F) 11:39 15:35 0.362 Age (years) 67 67 0.820 BMI 27 [24-30] 27 [22-30] 0.844 Smokers 38 (76%) 38 (76%) 1.000 Charlson Score 2 [1-3] 2 [1-3] 0.615 FEV1% 85 [69-101] 79 [69-89] 0.072 DLCO% 74 [63-85] 73 [64-81] 0.958 Tumor Size (cm) 2.8 [1.8-3.8] 2.5 [1.6-3.5] 0.332 Median [interquartile range] University of Ottawa: Early Experience
  • 34. Operations Performed Operations VATS (n=50) S-VATS (n=50) p Lobectomy 42 (84%) 39 (78%) 0.764
  • 35. Operations Performed Operations VATS (n=50) S-VATS (n=50) p Lobectomy 42 (84%) 39 (78%) 0.764 Bilobectomy 0 1 (2%)
  • 36. Operations Performed Operations VATS (n=50) S-VATS (n=50) p Lobectomy 42 (84%) 39 (78%) 0.764 Bilobectomy 0 1 (2%) Segmentectomy 8 (16%) 10 (20%) 0.603
  • 37. Operations Performed Operations VATS (n=50) S-VATS (n=50) p Lobectomy 42 (84%) 39 (78%) 0.764 Bilobectomy 0 1 (2%) Segmentectomy 8 (16%) 10 (20%) 0.603 Laterality (right:left) 23:27 26:24 0.548
  • 38. Intraoperative Outcomes Outcome VATS (n=50) S-VATS (n=50) p R0 Resection 50 (100%) 50 (100%) 1.000
  • 39. Intraoperative Outcomes Outcome VATS (n=50) S-VATS (n=50) p R0 Resection 50 (100%) 50 (100%) 1.000 Conversion to Open 1 (2%) 2 (4%) 0.558
  • 40. Intraoperative Outcomes Outcome VATS (n=50) S-VATS (n=50) p R0 Resection 50 (100%) 50 (100%) 1.000 Conversion to Open 1 (2%) 2 (4%) 0.558 Operating Time (min) 146 [121-178] 154 [142-175] 0.081
  • 41. Intraoperative Outcomes Outcome VATS (n=50) S-VATS (n=50) p R0 Resection 50 (100%) 50 (100%) 1.000 Conversion to Open 1 (2%) 2 (4%) 0.558 Operating Time (min) 146 [121-178] 154 [142-175] 0.081 Staplers 8 [6-10] 9 [8-10] 0.577
  • 42. Intraoperative Outcomes Outcome VATS (n=50) S-VATS (n=50) p R0 Resection 50 (100%) 50 (100%) 1.000 Conversion to Open 1 (2%) 2 (4%) 0.558 Operating Time (min) 146 [121-178] 154 [142-175] 0.081 Staplers 8 [6-10] 9 [8-10] 0.577 Chest Tube(s) 1 2 <0.001
  • 43. Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
  • 44. Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 LOS (days) 4 [3-7] 4 [3-7] 0.992 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
  • 45. Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 LOS (days) 4 [3-7] 4 [3-7] 0.992 Complications:‡ None 32 (64%) 30 (60%) 0.680 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
  • 46. Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 LOS (days) 4 [3-7] 4 [3-7] 0.992 Complications:‡ None 32 (64%) 30 (60%) 0.680 Grade I-II 13 (26%) 9 (18%) 0.334 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
  • 47. Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 LOS (days) 4 [3-7] 4 [3-7] 0.992 Complications:‡ None 32 (64%) 30 (60%) 0.680 Grade I-II 13 (26%) 9 (18%) 0.334 Grade III 4 (8%) 8 (16%) 0.357 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
  • 48. Post-Operative Outcomes Outcomes VATS (n=50) S-VATS (n=50) p Chest tube drainage (days) 3 [3-5] 3 [2-5] 0.394 LOS (days) 4 [3-7] 4 [3-7] 0.992 Complications:‡ None 32 (64%) 30 (60%) 0.680 Grade I-II 13 (26%) 9 (18%) 0.334 Grade III 4 (8%) 8 (16%) 0.357 Grade IV 1 (2%) 2 (4%) 0.558 ‡Ottawa TMM system (https://ottawatmm.org) Seely AJE et al. Ann Thor Surg 2010;90(3):936-42
  • 49. Post-Operative Pain Outcomes VATS (n=50) S-VATS (n=50) p Time on PCA (days) 3 [3-3] 3 [2-3] 0.559
  • 50. Post-Operative Pain Outcomes VATS (n=50) S-VATS (n=50) p Time on PCA (days) 3 [3-3] 3 [2-3] 0.559 Total PCA Dose (mg) 3.4 [2.6-8.0] 5.4 [1.6-8.0] 0.209
  • 51. Post-Operative Pain Outcomes VATS (n=50) S-VATS (n=50) p Time on PCA (days) 3 [3-3] 3 [2-3] 0.559 Total PCA Dose (mg) 3.4 [2.6-8.0] 5.4 [1.6-8.0] 0.209 VAS @ 1 hour 3 [0-4] 1 [0-3] 0.009
  • 52. Post-Operative Pain Outcomes VATS (n=50) S-VATS (n=50) p Time on PCA (days) 3 [3-3] 3 [2-3] 0.559 Total PCA Dose (mg) 3.4 [2.6-8.0] 5.4 [1.6-8.0] 0.209 VAS @ 1 hour 3 [0-4] 1 [0-3] 0.009 VAS @ 24 hours 4 [2-5] 4 [3-5] 0.625
  • 53. Post-Operative Pain Outcomes VATS (n=50) S-VATS (n=50) p Time on PCA (days) 3 [3-3] 3 [2-3] 0.559 Total PCA Dose (mg) 3.4 [2.6-8.0] 5.4 [1.6-8.0] 0.209 VAS @ 1 hour 3 [0-4] 1 [0-3] 0.009 VAS @ 24 hours 4 [2-5] 4 [3-5] 0.625 Satisfied with Pain Control @ 24 hours 48 (96%) 47 (94%) 0.743
  • 54. Comparing Approaches Multiport Single Port MIS training/experience Important ?
  • 55. Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes
  • 56. Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes
  • 57. Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace
  • 58. Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required
  • 59. Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required Dividing PA before vein Optional Required
  • 60. Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required Dividing PA before vein Optional Required Clipping PA Optional Recommended
  • 61. Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required Dividing PA before vein Optional Required Clipping PA Optional Recommended Wound protector Optional Recommended
  • 62. Comparing Approaches Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required Dividing PA before vein Optional Required Clipping PA Optional Recommended Wound protector Optional Recommended Special instrumentation Optional Optional
  • 63. Summary Multiport Single Port MIS training/experience Important ? Viewing angle similar to open No Yes Alignment No Yes Access incision 4th interspace 5th interspace Articulating staplers Optional Required Dividing PA before vein Optional Required Clipping PA Optional Recommended Wound protector Optional Recommended Special instrumentation Optional Optional Assistant 1 0-1