Video-assisted thoracoscopic surgery (VATS) offers great advantages: less long-term postoperative pain, better functional recovery, lower immunological damage and complication rate, better cosmetic outcome and early discharge.
Since 2010, we have developed single-incision thoracoscopic surgery for lung cancer (Uniportal VATS). This allows us to perform more complex bronchial and vascular reconstruction surgeries and avoid total lung removal.
Since 2014, we have gone one step further: lung surgery with the patient without intubation, under sedation and maintaining spontaneous ventilation. Thanks to this less aggressive option, complications are reduced, oxygenation and hemodynamic conditions are improved, the patient has greater postoperative comfort, admission to intensive care is avoided, the patient returns home in the shortest possible time and costs are significantly reduced. These techniques should only be performed by surgeons with extensive experience.
Another innovation is the uniportal subxiphoid approach for major lung surgery. The advantage is that the thorax is not opened and the incidence of postoperative pain is very low. From the subxiphoid space we can perform thymectomies in myasthenic patients, resection of mediastinal tumors, surgery of both lungs and pulmonary lobectomies. For this type of interventions the surgeon must have a great experience in the uniportal technique.
Upcoming technological advances such as single-incision robotic surgery, the development of new, thinner and more angulable endographers or the use of wireless cameras facilitate the adoption of single-port thoracic surgery by a large number of surgeons.