This video shows how a left upper lobe tumor completely attached to the chest wall was detached by using the excellent uniportal VATS view (sagital plane). This is the real speed and real time of whole procedure to show all the steps. An extrapleural detachment was performed through a 4 cm incision. No signs of chest wall involvement. A left upper lobectomy and radical lymph node dissection was performed as the next step
Even though the field of vision is only obtained through the anterior access site, the movement of the camera alongside the incision as well as its rotation will create different angles of vision (30 degree camera recommended to achieve a panoramic view). The advantage of using the camera in coordination with the instruments is that the vision is directed to the target tissue, bringing the instruments to address the target lesion from a straight perspective, thus we can obtain similar angle of view as for open surgery. Conventional three-port triangulation makes a forward motion of VATS camera to the vanishing point. This triangulation creates a new optical plane with genesis of dihedral or torsional angle that is not favorable with standard two-dimension monitors. Instruments inserted parallel to the videothoracoscope also mimic inside the chest maneuvers performed during open surgery. There is a physical and mathematical demonstration about better geometry obtained for instrumentation and view in the uniportal VATS over conventional approach. Video by Diego Gonzalez Rivas, MD.
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