My name is Diego González Rivas, I am a thoracic surgeon, I work in La Coruña, in the Complejo Hospitalario Universitario de La Coruña and in the Minimally Invasive Thoracic Surgery Unit that belongs to three private hospitals in the city such as Hospital Modelo, Hospital San Rafael and Hospital Quirón.
I am dedicated to the treatment of pulmonary pathologies. Basically, what we usually treat the most is lung cancer. We are specialized in Minimally Invasive Surgery with a technique that we have developed here in La Coruña, which we are pioneers in the world and which is the video surgery through a single incision, called “Single Port”, for the treatment of Lung Cancer. “Major Lung Surgery through a single incision”.
In 2007 we went to the United States to learn video surgery to operate, above all, lung cancer. Video surgery through several incisions, which was the technique that since that time in the United States is beginning to have a lot of impact. We learned this technique in Los Angeles with Dr. MacKenna and we started to use it in our Hospital.
After an experience with approximately one hundred cases and seeing that there was a Hospital, a center in the United States, which was Duke, that performed only two incisions, we were concerned about going there to learn with Dr. Damiko that this could be done by reducing the number of incisions to one. That is to say, making only two incisions and we put it into practice again in our Hospital with very good results.
So in 2010, after this previous experience with two incisions and after seeing that in the last cases, with the two-way technique, practically the vision we had was more direct if we placed the camera through the main working incision, what we did was to develop the technique to perform video surgery through a single incision, which is called “Single Port”.
The main advantages that this technique, that is, the single incision technique, has for the patient are:
One, first of all, we make only a single incision, so the chances of pain are lower because we only open one intercostal space. It is less aggressive for the patient because there is less immunological aggression as there is less traumatic aggression on the thoracic wall.
Apart from this, there are a series of advantages for the surgeon: the vision is more anatomical and we reproduce the maneuvers that we do in open surgery inside the thorax, through a single incision. The camera goes in the same direction as our instruments go. It is as if we were performing open surgery but inside the thorax through a cut and looking at a monitor. Because the vision, the camera and the instruments go in the same direction, but not when we make several incisions, which is more anti-anatomical, because the camera enters through one hole and the instruments enter through another, which produces what is called a “Torsion Plane” at a geometric and physical level.
It allows us not to use a “Trocar”. A trocar is an instrument used to insert the camera when several incisions are used. Normally when a trocar is inserted, which is a kind of cylinder that protects the chamber, there is always more compression on the nerve. Since we do not use a trocar, the possibilities of nerve compression are probably lower.
For some months now we have been performing “Single Port” surgery in patients without the need to be intubated, which is called “Patients with spontaneous breathing”, which reduces even more the aggression produced during the surgical act. In other words, it is not a machine that breathes for the patient during surgery, but the patient himself, under a state of sedation. The patient is unaware of anything as if he were sleeping during the night and maintains his breathing, which is much more beneficial for the patient because the postoperative recovery is greater, since we do not apply the techniques of muscle relaxants, drugs and drugs that are used during a general anesthesia.
Therefore this combination is revolutionary, we have been pioneers in the world again, and we are now with this line of treatment of making a single tiny incision and not intubating the patient so that the postoperative period is more beneficial.