Video-assisted uniportal pulmonary segmentectomy: description of Safe Accurate Feasible and Easy technique and analysis of short-term outcome

Background: Parenchymal preserving lung surgeries for lung cancer have been largely restricted to select patients with pulmonary compromise. Recent evidence has largely questioned the need for lobectomy in early stage lung cancer especially with the increased detection rates of early lesion by advanced imaging techniques. Conservative surgeries in the form segmental resections have been increasing used for management of early stage lesions. Minimal invasive technique like uniportal video-assisted thoracoscopic surgery (U-VATS) segmentectomy, further reduces the morbidity. Methods: Retrospective analysis of prospectively maintained data base of patients undergoing uniportal Segmental resection was done. Data from July 2014 to March 2018 was analysed. Patient's preoperative demographic data, intra operative and post-operative outcomes along with surgical pathology details were collected and analysed. Statistical analysis was done using SPSS 17.0. Results: A total of 371 patients underwent uniportal segmentectomy. Median age was 58 years. Majority were asymptomatic (73.74%). Smoking was less prevalent (12.4%). Most of these patients were thin built with a mean BMI of 23.76 (+/- 3.05) with a mean FEV1/FVC (%) of 79.45 (+/- 8.51). On preoperative CT imaging, the median lesion diameter was 10.00 mm. 65.5% underwent single Segmental resection, 19.4% had bi-segmentectomy while multiple segmentectomy in 14.02%. The mean operating time was 1.75 (+/- 0.65) hours with median intra operative blood loss of 50 mL. Conversion to thoracotomy was done in 2 patients (0.54%) for intraoperative bleeding and conversion to lobectomy was done on 1 patient (0.27%) due to nonidentification of lesion. The median duration of intercostal drainage was 2.5 days and mean postoperative stay in hospital was 3.7 +/- 1.8 days. Postoperative complications observed were seen in 6% with prolonged intercostal drainage being the most prevalent. The 30-day mortality was zero. Conclusions: U-VATS segmentectomy for early stage lung cancer was found to be feasible and safe with respect to short term outcomes. Long-term follow-up including survival analysis is required to confirm its ontological efficacy.