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Eur J Cardiothorac Surg 2005;28:358-359
© 2005 Elsevier Science NL

Letter to the Editor

Reply to Rocco et al.

Masato Sasaki * , Seiya Hirai, Masakazu Kawabe, Kuniyoshi Tanaka

Department of Surgery (II), Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka Fukui 910-1193, Japan

Received 18 April 2005; accepted 20 April 2005.

* Corresponding author. Tel.: +81 776 61 3111x2350; fax: 81 776 61 8114. (Email: masato{at}fmsrsa.fukui-med.ac.jp).

Key Words: Video-assisted thoracoscopic surgery (VATS) • Postoperative pain • Intraoperative palpation via trocar • Lung tumors

We appreciate the comments of Dr Gaetano Rocco about our paper concerning the Triangle Target Principle (TTP) [1]. With uniportal VATS [2] which he has described as superior to conventional methods, wound pain is considered to be reduced, and only a single small scar remains. In terms of disruption of deeper structures, he emphasized that port creation via only one intercostal space instead of two or three can reduce postoperative pain, speeding functional recovery and return to work. However, whether three-port VATS is actually inferior to uniportal VATS with respect to pain may depend on factors apart from number of ports. For example, when VATS is performed to treat pneumothorax by three-port method at our institution, we use one trocar of with 11.5-mm outer diameter and two trocars of with 5-mm outer diameter. Most patients asking for relief of postoperative wound pain localize it only where the larger trocar had been inserted.

VATS according to the TTP is better than uniportal VATS for resecting mediastinal, diaphragmatic and lower lobe basal segment lesions. Effectiveness in palpating tumors under VATS is a particularly important advantage of the TTP. Experienced operators using standard thoracoscopic methods occasionally fail to detect small, deeply located nodules by palpation. We consider one of the indications for the TTP procedure to be a lung tumor whose center is less than 2cm from the visceral pleura [1]. If such a tumor is more than 1cm in diameter, the tumor can be palpated through the wound of the target trocar. For smaller tumors, even when located less than 2cm from the pleura, we performed CT-guided marking preoperatively.

Uniportal VATS is superior in some respects, but has limited versatility, especially considering that special equipment is necessary. Our TTP is intended to assist thoracic surgeons who are beginning their thoracoscopic experience with a basic operative set-up for VATS. With the TTP, the operator is guided by easily obtained images during the course of surgery. We believe that positional fixation of the trocar in relation to the lesion is not important, because of individual differences in habitus and in shape of the chest. Therefore, the TTP method provides images to adjust trocar positioning and to carry out the operation smoothly.

References

  1. Sasaki M, Hirai S, Kawabe M, Uesaka T, Morioka K, Ihaya A, Tanaka K. Triangle target principle for the placement of trocars during video-assisted thoracic surgery. Eur J Cardiothorac Surg 2005;27:307-312.[Abstract/Free Full Text]
  2. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg 2004;77:726-728.[Abstract/Free Full Text]




This Article
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Kuniyoshi Tanaka
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Right arrow Lung - cancer
Right arrow Lung - other
Right arrow Mediastinum

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