European Journal of Cardio-Thoracic Surgery Advance Access published September 16, 2014
Uniportal versus standard video-assisted thoracoscopic surgery for lung lobectomy: changing the standards requires scientific evidence Marcelo F. Jimenez* Thoracic Surgery Service, Salamanca University Hospital, Salamanca, Spain * Corresponding author. Thoracic Surgery Service, Salamanca University Hospital, Paseo de San Vicente 58, 37007 Salamanca, Spain. Tel: +34-923-291100-55383; fax: +34-923-291383; e-mail: [email protected] (M.F. Jimenez).
Keywords: Lobectomy • Video-assisted thoracoscopic surgery • Lung cancer
To my knowledge, the manuscript by McElnay et al. [1] is the first comparing uniportal versus standard video-assisted thoracoscopic surgery (VATS) approach for lung lobectomy. The authors conclude that both techniques are comparable in terms of reported pain and morphine use in the first 24 h and that uniportal VATS has no negative impact on hospital length of stay or postoperative morbidity. To date, the feasibility of uniportal VATS has been demonstrated for early [2] and, in very selected cases, advanced tumours [3], but never the advantages over the conventional VATS technique. The study presented by McElnay et al. goes in the right direction to achieve some evidence. Uniportal VATS lobectomy has been proposed based on hypothetical, non-demonstrated advantages. In some papers, the authors have compared the outcomes after uniportal VATS lobectomy to those achieved in non-comparable historical controls [2]. In fact, the paper by McElnay et al. confirms once again the feasibility of the procedure, finding no differences between uni- and multiportal VATS. Currently, VATS lobectomy is performed in a low percentage of cases in Europe [4] and, from my point of view, raising the standards of clinical care is paramount to promoting
the use of standard multiportal VATS surgery rather than trying to modify this recently achieved technique. Of course, innovation through changing the standards of surgical practice, is not only acceptable but also should be the aim of professional associations and individuals, but doing so requires scientific evidence, gained through well-designed studies.
REFERENCES [1] McElnay PJ, Molyneux M, Krishnadas R, Batchelor TJP, West D, Casali G. Pain and recovery are comparable after either uniportal and multiport video assisted thoracoscopic lobectomy: an observation study. Eur J Cardiothorac Surg 2014; doi:10.1093/ejcts/ezu324. [2] Gonzalez-Rivas D, Paradela M, Fernandez R, Delgado M, Fieira E, Mendez L et al. Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Ann Thorac Surg 2013;95:426–32. [3] Gonzalez-Rivas D, Fieira E, Delgado M, Mendez L, Fernandez R, de la Torre M. Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small cell lung cancer? J Thorac Dis 2014;6:641–8. [4] The ESTS Database Report Silver Book 2014. http://www.ests.org/ collaboration/database_reports.aspx (29 July 2014, date last accessed).
© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
THORACIC
EDITORIAL COMMENT
European Journal of Cardio-Thoracic Surgery (2014) 1–1 doi:10.1093/ejcts/ezu355
Uniportal versus standard video-assisted thoracoscopic surgery for lung lobectomy: changing the standards requires scientific evidence Marcelo F. Jimenez* Thoracic Surgery Service, Salamanca University Hospital, Salamanca, Spain * Corresponding author. Thoracic Surgery Service, Salamanca University Hospital, Paseo de San Vicente 58, 37007 Salamanca, Spain. Tel: +34-923-291100-55383; fax: +34-923-291383; e-mail: [email protected] (M.F. Jimenez).
Keywords: Lobectomy • Video-assisted thoracoscopic surgery • Lung cancer
To my knowledge, the manuscript by McElnay et al. [1] is the first comparing uniportal versus standard video-assisted thoracoscopic surgery (VATS) approach for lung lobectomy. The authors conclude that both techniques are comparable in terms of reported pain and morphine use in the first 24 h and that uniportal VATS has no negative impact on hospital length of stay or postoperative morbidity. To date, the feasibility of uniportal VATS has been demonstrated for early [2] and, in very selected cases, advanced tumours [3], but never the advantages over the conventional VATS technique. The study presented by McElnay et al. goes in the right direction to achieve some evidence. Uniportal VATS lobectomy has been proposed based on hypothetical, non-demonstrated advantages. In some papers, the authors have compared the outcomes after uniportal VATS lobectomy to those achieved in non-comparable historical controls [2]. In fact, the paper by McElnay et al. confirms once again the feasibility of the procedure, finding no differences between uni- and multiportal VATS. Currently, VATS lobectomy is performed in a low percentage of cases in Europe [4] and, from my point of view, raising the standards of clinical care is paramount to promoting
the use of standard multiportal VATS surgery rather than trying to modify this recently achieved technique. Of course, innovation through changing the standards of surgical practice, is not only acceptable but also should be the aim of professional associations and individuals, but doing so requires scientific evidence, gained through well-designed studies.
REFERENCES [1] McElnay PJ, Molyneux M, Krishnadas R, Batchelor TJP, West D, Casali G. Pain and recovery are comparable after either uniportal and multiport video assisted thoracoscopic lobectomy: an observation study. Eur J Cardiothorac Surg 2014; doi:10.1093/ejcts/ezu324. [2] Gonzalez-Rivas D, Paradela M, Fernandez R, Delgado M, Fieira E, Mendez L et al. Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Ann Thorac Surg 2013;95:426–32. [3] Gonzalez-Rivas D, Fieira E, Delgado M, Mendez L, Fernandez R, de la Torre M. Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small cell lung cancer? J Thorac Dis 2014;6:641–8. [4] The ESTS Database Report Silver Book 2014. http://www.ests.org/ collaboration/database_reports.aspx (29 July 2014, date last accessed).
© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
THORACIC
EDITORIAL COMMENT
European Journal of Cardio-Thoracic Surgery (2014) 1–1 doi:10.1093/ejcts/ezu355
