J.Jpn. Surg. Soc.. 125(4): 310-316, 2024

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Feature topic

REDUCED-PORT VIDEO-ASSISTED THORACIC SURGERY FOR LUNG CANCER

Video-assisted thoracic surgery (VATS) is used worldwide for treating primary lung cancer. The advantage of VATS is its less invasiveness, as respiratory function is preserved and pain is reduced due to less thoracic damage. This review describes reduced-port VATS for primary lung cancer, which could be less invasive than conventional VATS. VATS lobectomy for lung cancer was first performed in 1991, initially with a mini-thoracotomy and multiple ports. Later, procedures such as two-window VATS and needlescopic VATS were developed. Today, uniportal VATS is being employed and applied not only in lung lobectomy but also in complex surgeries such as segmentectomy, bronchoplasty, and angioplasty. This trend of reduced-port procedures is spreading even to robot-assisted VATS. The results of many clinical trials comparing uniportal VATS and multiportal VATS have shown that uniportal VATS is equivalent to multiportal VATS in terms of less invasiveness and safety and that it may reduce pain and maintain quality of life after surgery. However, uniportal VATS requires a high level of skill； therefore, surgeons should receive practical training under a well-trained surgeon coach. As new types of reduced-port VATS are developed, we must continue in improving surgical techniques for the purpose of serving our patients.

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