title: Reduced port video-assisted thoracoscopic surgery using a needle scope for lung and mediastinal lesions.
abstract: OBJECTIVE
  There are many recent and minimally invasive surgical innovations, yet there has been little evaluation of the limitations of such techniques, particularly those related to video-assisted thoracoscopic surgery. The aims of this study were to determine the usefulness and limitations of video-assisted thoracoscopic surgery using one-port access and needle scope and to evaluate the feasibility of this procedure based on our institutional experience.
  
  
  METHODS
  This retrospective study involved 127 patients who underwent video-assisted thoracoscopic surgery using the one-window and puncture method at our institute from 1997 to 2011. One hundred patients underwent surgical treatment and 27 underwent diagnostic procedures. If there was one lesion present with only mild adhesion that did not require lymph node dissection, we decided to opt for the one-direction approach that provisionally indicates the one-window and puncture method. We compared the conversion and success groups for factors like age, sex, laterality of surgery, objective of surgery, target organ and surgery location.
  
  
  RESULTS
  Of 127 cases, 115 (91%) successfully underwent the one-window and puncture procedure. Twelve cases (9%) were converted to the two-window method or thoracotomy. Compared with those targeting the lung, patients with mediastinal lesions demonstrated a higher tendency for conversion (P<0.05). However, age (P=0.89), sex (P=0.46), laterality of surgery (P=0.34) and purpose of surgery (P=0.68) did not show any significant differences between the groups.
  
  
  CONCLUSIONS
  For lung and mediastinal diseases, video-assisted thoracoscopic surgery with the one-window and puncture method can be performed at any location (upper, middle and lower lobe of lung and anterior, middle and posterior of the mediastinum) under limited indications that include the possibility of one-way resection, mild adhesion and no requirement of lymph node dissection. Under provisional criteria, the procedure may be feasible.
authors: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan. kaga-cvs@umin.ac.jp
authors: Kichizo
authors: K
authors: Kaga
authors: Yasuhiro
authors: Y
authors: Hida
authors: Reiko
authors: R
authors: Nakada-Kubota
authors: Kazuto
authors: K
authors: Ohtaka
authors: Jun
authors: J
authors: Muto
authors: Keidai
authors: K
authors: Ishikawa
authors: Tatsuya
authors: T
authors: Kato
authors: Yoshiro
authors: Y
authors: Matsui
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008479:Mediastinal Neoplasms / Q000601:surgery*; D008875:Middle Aged; D018579:Patient Selection; D011677:Punctures; D012189:Retrospective Studies; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D020708:Thoracoscopes; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Lung disease; Mediastinal disease; Minimally invasive surgery; Needlescopic surgery; Single-port surgery; Video-assisted thoracoscopic surgery
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