Luca Bertolaccini1, Hasan Batirel2, Alessandro Brunelli3, Diego Gonzalez-Rivas4, Mahmoud Ismail5, Antonio Martin Ucar6, Calvin S H Ng7, Marco Scarci8, Alan D L Sihoe9,10, Paula A Ugalde11, Firas Abu Akar12,13, Benedetta Bedetti14, Sergio Bolufer Nadal15, Jury Brandolini1, Pierfilippo Crucitti16, Attila Enyedi17, Hiran C Fernando18, Jozsef Furak19, Javier Gallego-Poveda20, Carlos Galvez-Munos15, Ivo Hanke21, Miroslav Janik22, Peter Juhos22, Lidia Libretti8, Paolo Lucciarini23, Paolo Macrì24, Stefano Margaritora25, Hamid Reza Mahoozi26, Dania Nachira25, Alessandro Pardolesi27, Vadim Pischik28, Dariusz Sagan29, Hermien Schreurs30, Dmitrii Sekhniaidze31, Davide Tosi32, Akif Turna33, Fernando Vannucci34, Marcin Zielinski35, Gaetano Rocco36. 1. Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy. 2. Department of Thoracic Surgery, Marmara University Hospital, Istanbul, Turkey. 3. Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK. 4. Minimally Invasive Thoracic Surgery Unit (UCTMI), Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain. 5. Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany. 6. Thoracic Surgery Units, Sheffield Teaching Hospital, Sheffield, UK. 7. Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China. 8. Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy. 9. Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. 10. Department of Thoracic Surgery, Tongji University Shanghai Pulmonary Hospital, Shanghai, China. 11. Department of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec (Hôpital Laval), Quebec, Canada. 12. Department of Cardiothoracic Surgery, Makassed Charitable Society Hospital, East Jerusalem, Israel. 13. Department of Cardiothoracic Surgery, Shaare Zedek Medical Center (SZMC), Jerusalem, Israel. 14. Department of Thoracic Surgery, Malteser Hospital, Bonn, Germany. 15. Department of Thoracic Surgery, General University Hospital, Alicante, Spain. 16. Division of Thoracic Surgery, Campus Bio-Medico University of Rome, Rome, Italy. 17. Division of Thoracic Surgery, University of Debrecen, Debrecen, Hungary. 18. Department of Surgery, Fairfax Medical Campus, Falls Church, VA, USA. 19. Department of Surgery, University of Szeged, Szeged, Hungary. 20. Department of Cardio-Thoracic, Santa Maria University Hospital, Lisbon, Portugal. 21. Department of Thoracic Surgery, University Hospital Hradec Kralove, Hradec, Kralov, Czech Republic. 22. Department of Thoracic Surgery, Slovak Medical University, University Hospital Bratislava, Bratislava, Slovakia. 23. Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Innsbruck, Austria. 24. Thoracic Surgery Unit, Istituto Clinico Humanitas CCO - Catania, Catania, Italy. 25. Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy. 26. Department of Thoracic Surgery, Evangelisches Krankenhaus Herne, Herne, Germany. 27. Department of Thoracic Surgery, National Cancer Institute, Milan, Italy. 28. Faculty of Medicine, St-Petersburg State University, Saint-Petersburg, Russia. 29. Department of Thoracic Surgery, Medical University of Lublin, Lublin, Poland. 30. Medish Centrum Alkmaar, Alkmaar, Netherlands. 31. Department of Thoracic Surgery, Regional Clinic Hospital, Tyumen, Russia. 32. Division of Thoracic and Transplant Surgery, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 33. Department of Thoracic Surgery, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey. 34. Department of Thoracic Surgery, Hospital Federal do Andaraí, Rio de Janeiro, Brazil. 35. Department of Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland. 36. Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Abstract
OBJECTIVES: Our goal was to report the results of the first consensus paper among international experts in uniportal video-assisted thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi process, the objective of which was to define and standardize the main procedural steps, optimize its indications and perioperative management and identify elements to assist in future training. METHODS: The 40 members of the working group were convened and organized on a voluntary basis by the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). An e-consensus finding exercise using the Delphi method was applied to require 75% agreement for reaching consensus on each question. Repeated iterations of anonymous voting continued for 3 rounds. RESULTS: Overall, 31 international experts from 18 countries completed all 3 rounds of questionnaires. Although a technical quorum was not achieved, most of the responders agreed that the maximum size of a UniVATS incision should be ≤4 cm. Agreement was reached on many points outlining the currently accepted definition of a UniVATS lobectomy, its indications and contraindications, perioperative clinical management and recommendations for training and future research directions. CONCLUSIONS: The UVIG Consensus Report stated that UniVATS offers a valid alternative to standard VATS techniques. Only longer follow-up and randomized controlled studies will predict whether UniVATS represents a valid alternative approach to multiport VATS for major lung resections or whether it should be performed only in selected cases and by selected centres. The next step for the ESTS UVIG is the establishment of a UniVATS section inside the ESTS databases.
OBJECTIVES: Our goal was to report the results of the first consensus paper among international experts in uniportal video-assisted thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi process, the objective of which was to define and standardize the main procedural steps, optimize its indications and perioperative management and identify elements to assist in future training. METHODS: The 40 members of the working group were convened and organized on a voluntary basis by the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). An e-consensus finding exercise using the Delphi method was applied to require 75% agreement for reaching consensus on each question. Repeated iterations of anonymous voting continued for 3 rounds. RESULTS: Overall, 31 international experts from 18 countries completed all 3 rounds of questionnaires. Although a technical quorum was not achieved, most of the responders agreed that the maximum size of a UniVATS incision should be ≤4 cm. Agreement was reached on many points outlining the currently accepted definition of a UniVATS lobectomy, its indications and contraindications, perioperative clinical management and recommendations for training and future research directions. CONCLUSIONS: The UVIG Consensus Report stated that UniVATS offers a valid alternative to standard VATS techniques. Only longer follow-up and randomized controlled studies will predict whether UniVATS represents a valid alternative approach to multiport VATS for major lung resections or whether it should be performed only in selected cases and by selected centres. The next step for the ESTS UVIG is the establishment of a UniVATS section inside the ESTS databases.
Authors: József Furák; Zsolt Szabó; Tamás Tánczos; Attila Paszt; Anna Rieth; Tibor Németh; Balázs Pécsy; Aurél Ottlakán; Ferenc Rárosi; György Lázár; Zsolt Molnár Journal: J Thorac Dis Date: 2020-05 Impact factor: 2.895