title: Uniportal and single-incision video-assisted thoracic surgery: the state of the art.
abstract: Over the past decade, uniportal video-assisted thoracic surgery (VATS) has evolved dramatically into a sophisticated technique capable of performing some of the most complex thoracic procedures. The idea of operating through fewer surgical incisions and, therefore, with potentially better cosmesis, less postoperative pain and paraesthesia, has led to uniportal VATS increasing in popularity worldwide. The uniportal approach demands instrument design to be better suited for operating with multiple instruments through a single small incision. Furthermore, the drive by surgeons and industry to develop novel, smaller, more specialized procedure-specific instruments for uniportal VATS to further allow reduction in incision size is relentless. Refinement of uniportal VATS instruments, angulated and narrower endostaplers, and improvements in video-camera systems, including 3D systems, and 120° articulating lens will make uniportal VATS major lung resection easier to perform and learn. In the future, we could see the development of subcostal or e-NOTES access, endorobotic arms that open and operate within the chest cavity, and cross-discipline imaging assistance for uniportal VATS procedures.
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China calvinng@surgery.cuhk.edu.hk.
authors.forename: Calvin S H
authors.initials: CS
authors.lastname: Ng
authors.affiliation: National Cancer Institute, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Rocco
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Randolph H L
authors.initials: RH
authors.lastname: Wong
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Rainbow W H
authors.initials: RW
authors.lastname: Lau
authors.affiliation: Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Simon C H
authors.initials: SC
authors.lastname: Yu
authors.affiliation: Minimally Invasive Thoracic Surgery Centre, Central, Hong Kong, China.
authors.forename: Anthony P C
authors.initials: AP
authors.lastname: Yim
mesh_terms: D004059:Diffusion of Innovation; D004867:Equipment Design; D005544:Forecasting; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery; D065287:Robotic Surgical Procedures; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D020708:Thoracoscopes; D016896:Treatment Outcome
keywords: DynaCT; Hookwire; Hybrid; Magnetic anchoring and guidance systems; NOTES; Robotic