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Thorac Cardiovasc Surg 2024; 72(02): 146-155
DOI: 10.1055/s-0042-1758825
Original Thoracic

Design Appropriate Incision Length for Uniportal Video-Assisted Thoracoscopic Lobectomy: Take into Account Safety and Minimal Invasiveness

Chen-ye Shao   *
1   Department of Cardiothoracic Surgery, Nanjing Hospital of Chinese Medicine, Nanjing, People's Republic of China
,
Can-hui Liu   *
1   Department of Cardiothoracic Surgery, Nanjing Hospital of Chinese Medicine, Nanjing, People's Republic of China
,
Qian-he Ren   *
2   Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
,
Xiao-long Liu
3   Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
,
Guo-hua Dong
1   Department of Cardiothoracic Surgery, Nanjing Hospital of Chinese Medicine, Nanjing, People's Republic of China
,
Sheng Yao 
1   Department of Cardiothoracic Surgery, Nanjing Hospital of Chinese Medicine, Nanjing, People's Republic of China
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Abstract

Background There is no criterion on the length of the uniportal video-assisted thoracoscopic surgery (UVATS) incision when performing lobectomy. We aimed to develop a nomogram to assist surgeons in designing incision length for different individuals.

Methods A cohort consisting of 290 patients were enrolled for nomogram development. Univariate and multivariate logistic regression analyses were performed to identify candidate variables among perioperative characteristics. C-index and calibration curves were utilized for evaluating the performance of the nomogram. Short-term outcomes of nomogram-predicted high-risk patients were compared between long incision group and conventional incision group.

Results Of 290 patients, 150 cases (51.7%) were performed incision extension during the surgery. Age, tumor size, and tumor location were identified as candidate variables related with intraoperative incision extension and were incorporated into the nomogram. C-index of the nomogram was 0.75 (95% confidence interval: 0.6961–0.8064), indicating the good predictive performance. Calibration curves presented good consistency between the nomogram prediction and actual observation. Of high-risk patients identified by the nomogram, the long incision group (n = 47) presented shorter duration of operation (p = 0.03), lower incidence of total complications (p = 0.01), and lower incidence of prolonged air leak (p = 0.03) compared with the conventional incision group (n = 55).

Conclusion We developed a novel nomogram for predicting the risk of intraoperative incision extension when performing uniportal video-assisted thoracoscopic lobectomy. This model has the potential to assist clinicians in designing the incision length preoperatively to ensure both safety and minimal invasiveness.

Keywords

lobectomy - minimally invasive surgery - uniportal video-assisted thoracoscopic surgery

Note

Written informed consent was obtained from all individual participants included in the study.


Authors' Contribution

Conception and design: X.L.L., C.Y.S., G.H.D., S.Y. Administrative support: X.L.L., G.H.D., S.Y. Provision of study materials or patients: C.H.L., Q.H.R., C.Y.S. Collection and assembly of data: C.H.L., Q.H.R., C.Y.S., X.L.L. Data analysis and interpretation: X.L.L., C.Y.S., Q.H.R. Manuscript writing: All authors. Final approval of manuscript: All authors.


* These authors contributed equally to this work.




Publication History

Received: 27 June 2022

Accepted: 18 October 2022

Article published online:
29 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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