title: Clinical application of single incision thoracoscopic surgery: early experience of 264 cases.
abstract: BACKGROUND
  Single incision thoracoscopic surgery (SITS) is recognized as a difficult procedure and surgeons hesitate to perform this technique. We describe our experience of SITS and determine whether SITS can be a routine approach in minimally invasive surgery.
  
  
  METHODS
  From May 2011 to April 2013, a single operator attempted SITS for 264 cases. Their medical records were retrospectively reviewed with regard to age, sex, diagnosis, operation time, hospital stay, need of additional incision, morbidity, and early outcome.
  
  
  RESULTS
  A number of thoracic diseases and procedures were attempted with SITS including primary (n = 172) or secondary (n = 22) spontaneous pneumothorax, biopsy for lung (n = 29), pleura (n = 3), and mediastinal lymph node (n = 3), mediastinal mass excision (n = 11), empyema decortication (n = 11), lobectomy (n = 6), pulmonary metastasectomy (n = 3), pericardial window formation (n = 3), and hematoma evacuation (n = 1). Of these, 237 cases underwent SITS successfully. However, additional incision was needed in 10.2% (n = 27). Reasons for conversions were as follows: extensive pleural adhesion (n = 14), difficulty in endoscopic stapling (n = 11), bleeding (n = 1), and intolerance of one lung ventilation (n = 1). Conversion rate of empyema was 54.5%, which was the most difficult for SITS. In contrast, the conversion rate of PSP was 4.7%, which means PSP was the most applicable for SITS. Postoperative complications included air leak (≥ 3 days) (n = 1), wound problem (n = 4), delayed pleural effusion (n = 1), and postoperative bleeding (n = 1).
  
  
  CONCLUSIONS
  SITS can be a routine approach from simple to more complicated diseases. However, we still have difficulties in cases with extensive pleural adhesion or location of lesion with difficult accessibility for endoscopic stapling.
authors.forename: In-Hag
authors.initials: IH
authors.lastname: Song
authors.forename: Sungwon
authors.initials: S
authors.lastname: Yum
authors.forename: Wonsuk
authors.initials: W
authors.lastname: Choi
authors.forename: Sukki
authors.initials: S
authors.lastname: Cho
authors.forename: Kwhanmien
authors.initials: K
authors.lastname: Kim
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Jheon
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Seoul, Korea. pda1052@gmail.com.
authors.forename: Hee Chul
authors.initials: HC
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000601:surgery; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult