recent advances in uniportal vats• teaching around the world • the concept of “advanced...
TRANSCRIPT
![Page 1: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/1.jpg)
RECENT ADVANCES IN UNIPORTAL VATS
Diego Gonzalez-Rivas, MD, FECTS Thoracic Surgery and Lung Transplantation DepartmentMinimally Invasive Thoracic Surgery Unit(UCTMI),Coruña, SpainShanghai Pulmonary Hospital, Tongi University, Shanghai, China Yunan cancer hospital, Kunming, China
www.diegogonzalezrivas.com
![Page 2: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/2.jpg)
![Page 3: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/3.jpg)
![Page 4: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/4.jpg)
![Page 5: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/5.jpg)
Learning VATS ?
![Page 6: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/6.jpg)
Begining (2007)
![Page 7: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/7.jpg)
![Page 8: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/8.jpg)
Double port technique
![Page 9: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/9.jpg)
First Uniportal lobectomyApril 2009
![Page 10: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/10.jpg)
First reported Uniportal VATS lobectomyJune 2010
![Page 11: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/11.jpg)
![Page 12: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/12.jpg)
“In our experience, this technique is possible for lowerlobes. For upper lobes, the hilar dissection is possible viaone incision but there are difficulties stapling the uppervein, mediastinal trunk and the bronchus. Probably, thedevelopment of new technologies (angled optics, angledand curved staplers) will lead to single-port upper lobectomiesbecoming possible in experienced VATS groups”
![Page 13: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/13.jpg)
Think Uniportal!
![Page 14: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/14.jpg)
Upper lobes
![Page 15: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/15.jpg)
Single-incision VATS lobectomy
![Page 16: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/16.jpg)
![Page 17: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/17.jpg)
Advanced cases
![Page 18: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/18.jpg)
18
Double sleeve 2014
Non intubated surgery
2014
No limitsCarinal resections 2015
Subxiphoid resections 2015
Unisurgeon surgery 2016
![Page 19: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/19.jpg)
![Page 21: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/21.jpg)
Why to change?
![Page 22: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/22.jpg)
Small vessels- Click aV-Grena-45 degree
![Page 23: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/23.jpg)
Published in journals, atlas, textbook, etcData and survival
![Page 24: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/24.jpg)
![Page 25: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/25.jpg)
Gonzalez-Rivas D et al. Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small celllung cancer? J Thorac Dis 2014 May 22. doi: 10.3978/j.issn.2072-1439.2014.05.17
Advanced cases
![Page 26: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/26.jpg)
Stage IA-Overall survival
![Page 27: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/27.jpg)
Study Uniportal patients
Multiportal patients
Study design Operation Pain & Morbidity Recovery
McElnay et al (2015) [50]
15 95 Retrospective Observational
- • Pain score – ND
• Analgesic use – ND
• Complications – ND
• Chest drain duration – ND
• Length of stay – ND
Chung et al (2015) [51]
90 60 Retrospective Observational
• Operative time – ND
• Nodes dissected – ND
• Complications – ND • Chest drain duration – ND
• Length of stay – ND
Liu et al (2015) [52]
46 46 Propensity matched
• Operative time – Uniportal faster
• Blood loss – Uniportal less
• Nodes dissected – Uniportal higher yield
• Complications – ND • Length of stay – ND
Zhu et al (2015) [53]
33 49 Retrospective Observational
• Operative time – Multiportal portal faster
• Blood loss – ND
• Nodes dissected – ND
• Pain score – Uniportal lower
• Complications – ND
• Chest drain duration – ND
• Length of stay – ND
Liu et al (2105) [54]
100 342 Retrospective Observational
• Operative time – Uniportal faster
• Blood loss – Uniportal less
• Nodes dissected – Uniportal higher yield
• Complications – ND • Length of stay – Uniportal shorter
Hirai et al (2015) [55]
60 20 Retrospective Observational
• Operative time – ND
• Blood loss – ND
• Pain score – Uniportal lower
• Analgesic use – Uniportal less
• Paresthesia – Uniportal less frequent
• Complications – ND
• Chest drain duration – ND
• Length of stay – ND
• CPKmax – ND
• CRPmax – ND
Shen et al (2015) [56]
100 100 Propensity matched
• Operative time – ND
• Blood loss – ND
• Nodes dissected – ND
• Complications – ND • Length of stay – ND
Mu et al (2015) [57]
47 47 Propensity matched
• Operative time – ND
• Blood loss – ND
• Nodes dissected – ND
• Complications – ND • Chest drain duration – ND
• Length of stay – Multiportal shorter
Abbreviations used: ND = no difference; CPKmax = maximum postop level of creatine phosphokinase; CRPmax = maximum postop level of C-reactive protein
![Page 28: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/28.jpg)
Uniportal VATS Conventional VATS
Operation times (mins) 170179
191208
Blood loss (ml) 5356
9578
Nodes dissected 2728
2225
Operation
![Page 29: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/29.jpg)
Operation
![Page 30: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/30.jpg)
Pain
![Page 31: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/31.jpg)
Pain
![Page 32: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/32.jpg)
Recovery
![Page 33: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/33.jpg)
Chin Med J 2015;128:2731-5
Recovery
![Page 34: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/34.jpg)
![Page 35: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/35.jpg)
![Page 36: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/36.jpg)
Wu C,Fernandez R, De la torre M, Delgado M, Fieira E, Wu C, Hsieh M, Paradela M, Liu Y, Gonzalez-Rivas D. Mid-Term Survival Outcome of Single Port Video Assisted Thoracoscopic Anatomic LungResection: Two Center Experience. EJCTS 2018. In Press. DOI 10.1093/ejcts/ezy067
![Page 37: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/37.jpg)
• Teaching around the world• The concept of “Advanced instrumentation” and “ultradvanced
instrumentation”• Complex hilum (lymph nodes or fibrosis)• Complex segmentectomies and lobectomies• Sleeve broncho-vascular procedures, carinal• Radical lymph node dissection• Bleeding control• Non intubated lobectomy• Subxiphoid and subcostal resections• Unisurgeon assisted with robotic arm• High volume Training courses
RECENT ADVANCES IN UNIPORTAL VATS
![Page 38: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/38.jpg)
![Page 39: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/39.jpg)
• Symposia
• Workshops
• Visiting (Observer)
• wetlabs
• Videos
• Training courses (2 weeks)
➢ Train the Team !!!
Correct Training!!
![Page 40: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/40.jpg)
Uniportal LUL and chest wall resection
Gonzalez-Rivas D, Xie B, Yang Y, Jiang G. Uniportal video-assisted thoracoscopiclobectomy with en bloc chest wall resection. J Vis Surg 2015;1:7.
![Page 41: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/41.jpg)
Vascular reconstruction
41
Direct suture Patch Sleeve anastomosis
Bronchial sleeve
![Page 42: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/42.jpg)
Uniportal bronchial sleeve
Gonzalez-Rivas D et al. Uniportal video-assisted thoracoscopic bronchovascular, trachealand carinal sleeve resections . Eur J Cardiothorac Surg 2015; doi:10.1093/ejcts/ezv410
![Page 43: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/43.jpg)
Right carinal sleeve pneumonectomy
![Page 44: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/44.jpg)
RUL and carinal resectionHigh frequency ventilation jet
Gonzalez-Rivas D et al. Advances in Uniportal video-assisted thoracoscopic surgery: pushing the envelope.Thoracic Surgery Clinics 2016. DOI: http://dx.doi.org/10.1016/j.thorsurg.2015.12.007
![Page 45: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/45.jpg)
Gonzalez-Rivas D. Double sleeve uniportal video-assisted thoracoscopic lobectomy for non-small cell lung cancer. Ann Cardiothorac Surg 2014 Apr 11. doi: 10.3978/j.issn.2225-319X.2014.03.13
![Page 46: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/46.jpg)
Gonzalez-Rivas D, Bonome C, Fieira E, Aymerich H, Fernandez R, Delgado M et al.Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg 2015; doi:10.1093/ejcts/ezv136.
Non intubated Uniportal VATS lobectomy
![Page 47: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/47.jpg)
Non intubated Uniportal carinal resection
Jiang L, Liu J, Gonzalez-Rivas D et al. Thoracoscopic Surgery for Tracheal and CarinalResection and Reconstruction under Spontaneous Ventilation. JTCVS 2018. In press. DOI: https://doi.org/10.1016/j.jtcvs.2017.12.153
![Page 48: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/48.jpg)
Subxiphoid single incision VATS
Hernandez L, Lin L, Yang Y, Liu M, Guido W, Gonzalez-Rivas D, Jiang G, Liang L.
Initial experience in subxiphoid uniportal video-assisted thoracoscopy major
pulmonary resections. Eur J Cardiothorac Surg. 2016 Jul 11. pii: ezw189. [Epub
ahead of print]
![Page 49: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/49.jpg)
Uniportal transcervical Right lower lobectomy
![Page 50: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/50.jpg)
What means advanced instrumentation?
![Page 51: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/51.jpg)
Ultra advanced instrumentation
![Page 52: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/52.jpg)
Advanced instrumentation: Lymph node dissection
![Page 53: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/53.jpg)
![Page 54: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/54.jpg)
Open gate to the futureUniportal Unisurgeon VATS lobectomy
![Page 55: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/55.jpg)
Uniportal UNISURGEON VATS lobectomy
Uniportal VATS left hand double finger technique
![Page 56: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/56.jpg)
Robotic arm voice control
![Page 57: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/57.jpg)
Wireless Steerable Endoscope
![Page 58: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/58.jpg)
Magnetic graspers
![Page 59: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/59.jpg)
Uniportal robotic platform
![Page 60: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/60.jpg)
![Page 61: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/61.jpg)
• Improved staplers (electric, more angulated, 5mm)
• Energy devices for vessels and fissure• Wireless cameras and graspers, remote control• Robotic instruments (paralel instrumentation)• Nano technology• 3D technology (naked eye)• Non intubated surgery• Portable drainage systems• Subxiphoid approach, NOTES?
Uniportal VATS in the future
![Page 62: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/62.jpg)
![Page 63: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/63.jpg)
Shanghai Pulmonary HospitalLung resections 2004-2017
11441440
16742164
24132651 2788
3350
4042
5321
6855
8320
10392
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
2017- 13.341 major resections
![Page 64: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/64.jpg)
![Page 65: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/65.jpg)
Continent Participants %
asia 115 25.50%
Europe 228 50.55%
America 83 18.40%
Africa 17 3.78%
Australia & New Zealand 8 1.77%
Asia, 115, 25%
Europe, 228, 51%
America, 83, 18%
Africa, 17, 4%Oceania, 8, 2%
21
10 11 10
1922 21
27 28
45
1815
19
10 10
0
5
10
15
20
25
30
35
40
45
50
Ind
ia
Isra
el
KSA
Ph
ilip
pin
e
Taiw
an
Ital
y
Ne
the
rlan
d
Po
lan
d
Ru
ssia
Spai
n
UK
USA
Bra
zil
Ch
ile
Egyp
t
Asia Europe North AmericaSouth AmericaAfrica
Top 15 Countries
0
5
10
15
20
25
Aze
rbai
jan
Ban
glad
esh
Mai
nla
nd
Ch
ina
HK
Ind
ia
Ind
on
esia
Isra
el
Jap
an
Jord
an
Ko
rea
Ku
wai
t
KSA
Mal
aysi
a
Pak
ista
n
Ph
ilip
pin
e
Sud
an
Taiw
an
Thai
lan
d
UA
E
Vit
nam
1
42 2
21
3
109
86
2
11
21
10
1
19
1 1 1
Surgeons from Asia
451 Surgeons from 68 countries & Taiwan/Hongkong
![Page 66: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/66.jpg)
![Page 67: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/67.jpg)
![Page 68: RECENT ADVANCES IN UNIPORTAL VATS• Teaching around the world • The concept of “Advanced instrumentation” and “ultradvanced instrumentation” • Complex hilum (lymph nodes](https://reader033.vdocuments.mx/reader033/viewer/2022042207/5ea9ca8262488a18c0053d9e/html5/thumbnails/68.jpg)
KEEP CALMAnd think Uniportal!!