Background: Rigid-angle bronchial blockers (BBs) have been routinely applied in thoracic operations for less invasiveness on airways. However, few reports exist regarding the application of BBs in uniportal video-assisted thoracoscopic surgery (VATS), which is more difficult to be performed without satisfactory lung collapse. BBs may associate with necessity of readjustment to achieve satisfactory operation fields for ipsilateral location with intraoperative manipulations especially for anatomical resections. In this investigation, we hypothesized that the efficiency will be reduced if BBs prolong the operation time. We compared the operation time of either wedge or anatomical resections (involving hilar manipulations such as segmentectomy or lobectomy) by employing uniportal VATS with BBs or double-lumen tubes (DLTs). Operation sides (right and left) were further analyzed, especially for operations involving the right upper lobes.
Methods: We retrospectively enrolled patients receiving intubated uniportal VATS from March to May 2019. Patient factors (including sex, body weight, and BMI), anesthetic factors (BBs or DLTs), and surgical factors (including wedge or anatomical resection, tumor size, number of lymph nodes sampled, pathological results and whether the right upper lobe involved) were collected. Univariate and backward multivariable linear regression analyses were performed to determine the effect of various factors on surgical time.
Results: A total of 317 patients who received uniportal VATS (right-side, 52.4%; left-side, 47.6%) were included. Wedge resections accounted for 70.7% and anatomical resections accounted for 29.3%. BBs were applied for left- and right-side (85.6% and 78.7%, respectively) wedge resections and left- and right-side (74.1% and 56.4%, respectively) anatomical resections. After univariate and multivariate analysis on factors affecting operation time in either-side VATS, surgical factors such as operation procedures (P < .01), number of lymph nodes sampled (P < .001), and size of tumors (P < .01) were found to significantly affect operation time, but patient factors (e.g., body weight, sex, BMI), operation sides, and involvement of the right upper lobes, BBs, or DLTs did not significantly affecting operation time.
Conclusions: Despite less preference for right-side uniportal anatomical resections, BBs are feasible for more than half of uniportal VATSs. Application of BBs is not inferior in efficiency for both wedge and anatomical uniport resections for right and left side operations.
Clinical Registration Number: Approval was obtained from the Research Ethics Committee of National Taiwan University Hospital, No. 201906015RINB.