P-217 * PERIAREOLAR VIDEO-ASSISTED THORACOSCOPIC APPROACH

Abstract

Objectives: Describe a new minimally invasive and aesthetic approach for thoracoscopic lung resections, bullectomies, and mediastinal tumour resections. Method(s): From January to November 2013, we performed 20 surgeries using the periareolar approach. The patient is positioned in semilateral decubitus (almost supine) to enable a video-assisted thoracoscopic (VATS) approach using an external periareolar incision (inferolateral and inferomedial quadrants) encompassing 50% of the circumference of the areola. Operating table mobilization modifies and improves field exposure. It is possible to move the areola with tapes. A camera-port is placed at the seventh intercostal space in the anterior axillary line. Thoracoscope: 10-mm, 120-degree angle. Result(s): There were 8 major resections, 10 sublobar resections, and 2 mediastinal tumour resections. We used the main periareolar wound to remove the resected specimen in 16 cases. In our experience for lobes, this is possible only when we perform an intraoperative biopsy of the nodule, when it is an upper lobe, when we cut the specimen in two parts, or when we do a prior decompression of the specimen retrieval bag with an Abocath. Expanding the camera-port was necessary in 4 cases. The postoperative period was uneventful and the patients were discharged on the 2.5 postoperative day. In the follow-up, there were a case of periareolar pain, a subcutaneous emphysema, and a pneumothorax. Significant associations were observed between complications and age (P < 0.000), type of lesion (P < 0.024), and lobectomy (P < 0.002). Conclusion(s): A periareolar incision offers not only easy access and satisfactory aesthetic results with respect to classical incisions, it is also a technique without difficulty for the surgeon and comfortable for the assistant who is separated from him. The wider breadth and greater elasticity of the costal arches in the anterior thoracic region allows insertion of several instruments into the chest, without interfering with the optical's direction, also the use of traditional long instruments.