Dorsal incision shows more efficacy and safety to traditional incision in single-portal video-assisted thoracoscopic surgery segmentectomy of LS9+10: a non-randomized prospective clinical trial

BACKGROUND: Segmentectomy is increasingly performed as a surgical technique. Traditional anterior axillary line and mid-axillary line video-assisted thoracoscopic surgery (VATS) incision meets difficulties when dealing with left segment 9+10 (LS9+10), as the distance and angle of view make it uneasy to expose the trachea, blood vessels and intersegment plane. As an alternative, dorsal incision may be advantageous as which faces the key structures of LS9+10, may facilitate the management of trachea and blood vessels of LS9+10, but there was no clinical proof reported ever. This study is targeted to compare the efficacy and safety of these two incisions in segmentectomy of LS9+10. METHODS: The dorsal incision is made behind the posterior axillary line, 8th intercostal space. Patients with ground glass opacity (GGO) which solid ingredients is less than 25%, locates at LS9+10, and segmentectomy of LS9+10 could ensure the cut edge were enrolled in the study and were allocated to the traditional incision group or dorsal incision group based on the parity of hospital number. Efficacy outcomes such as the duration of surgery and safety outcomes including postoperative air-leakage duration, length of hospital stay, amount of bleeding and pain score were recorded. The Independent-samples t-test and Mann-Whitey U test were applied in data analysis. RESULTS: A total of 68 patients were enrolled and allocated into the traditional incision group and dorsal incision group. In the traditional incision group, the average surgery time was 71.03±6.87 min (median 71.5 min), while that in the dorsal incision group was an average of 62.72±6.24 min (median 61.0 min, P=0.001). The postoperative duration of air-leakage was 2.16±1.63 and 1.36±1.33 days for traditional incision group and dorsal incision group (P=0.030), respectively. The traditional incision group had a greater length of postoperative hospital stay (3.69±1.36 days) than the dorsal incision group (3.08±1.03 days, P=0.041), when amount of bleeding and pain score showed no differences between these two groups. Data suggested a statistically significant advantage for the dorsal incision procedure. CONCLUSIONS: Dorsal incision can facilitate the segmentectomy of LS9+10, and significantly reduce the surgery time, postoperative duration of air-leakage and length of hospital stay.