Related Experiment Video
Updated: Jun 5, 2025
Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
[Evaluation of Reduced Port Surgery for Primary Spontaneous Pneumothorax:Marionette Surgery]
Shoji Nakata1, Yoshitomo Okumura
1Department of Thoracic Surgery, Itami City Hospital, Itami, Japan.
Background:
We aimed to assess the outcomes of reduced port surgery using "marionette technique" in patients with primary spontaneous pneumothorax (PSP) compared to conventional three-port video-assisted thoracoscopic surgery( VATS).
Methods:
Ninety patients were enrolled in this study from August 2015 to July 2021. The marionette technique was performed as follow. A small single incision less than 2 cm was made at the 5th or 6th intercostal space( ICS) and silicone port was placed. The lesion near the bulla was sutured for traction and the needle was pulled out anchoring suture through the third ICS. The lesion was lifted by traction suture and resected using a mechanical stapler (one-port marionette technique). If a case of incompletely confirm the surgical margin, additional port was added (two-port marionette technique). All clinical data were analyzed retrospectively.
Results:
Compared with conventional VATS, equivalent results were obtained with marionette technique:operation time (57.0±17.9 vs. 74.9±21.9 minutes), duration of drainage after operation [2.4±1.4 vs. 2.9±0.3 days, not siguificant (NS)], postoperative hospital stay (3.8±2.5 vs. 3.9±2.0 days, NS), recurrence rate after 2 years( 5.3% vs. 9.4%, NS), respectively. Post-operative frequency of pneumothorax (FOP) with marionette technique was significantly less than conventional three port VATS (0.032 vs 0.119 time/year).
Conclusion:
Marionette technique for PSP proved to be feasible as a surgical treatment and acceptable outcomes.
Insights
The marionette technique offers a feasible surgical option for primary spontaneous pneumothorax (PSP) with outcomes comparable to conventional VATS, notably reducing postoperative pneumothorax frequency.
Area of Science:
- Thoracic Surgery
- Minimally Invasive Procedures
- Pulmonary Medicine
Context:
- Primary spontaneous pneumothorax (PSP) management often involves surgical intervention.
- Conventional three-port video-assisted thoracoscopic surgery (VATS) is a standard approach.
- Exploring reduced-port techniques is crucial for optimizing patient outcomes.
Purpose:
- To evaluate the efficacy and safety of the "marionette technique" for PSP.
- To compare the outcomes of the marionette technique with conventional three-port VATS.
- To assess key surgical and postoperative parameters.
Summary:
- Ninety patients underwent either marionette technique or conventional VATS for PSP.
- The marionette technique, a reduced-port approach, demonstrated equivalent operation time, drainage duration, and hospital stay.
- Recurrence rates were similar, but the marionette technique showed a significantly lower postoperative frequency of pneumothorax.
Impact:
- The marionette technique is a feasible and effective surgical treatment for PSP.
- This reduced-port approach may offer advantages in reducing postoperative air leaks.
- Findings support the consideration of the marionette technique in PSP surgical protocols.
Related Concept Videos
01:27Pneumothorax-II
Clinical Manifestations:
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History: