Preface

The first Asian Single Port Video-Assisted Thoracic Surgery (VATS) Symposium was held in 2013 in Hong Kong (1). At that time, single port approach was recognized as a modality to perform thoracic surgery that could further minimize access trauma to patients. Since that successful symposium, single port VATS has expanded rapidly. Last year, the 3^rd Single Port VATS Symposium was again held in Hong Kong, with enormous progress, including technical expertise, skills, as well as advances in instruments and equipment to facilitate ever more complex and challenging surgery (2). Now the spectrum of single port VATS indications is almost equal to that of conventional multi-port VATS or open thoracotomy surgery. The publication of single port thoracic surgery also greatly increases recently, with more than 50 publications annually in 2014 and 2015.

The 4^th Asian Single Port VATS Symposium will be held in Taipei, Taiwan from April 9 to 10, 2016. The faculty of the symposium includes the leading VATS experts from Taiwan, China, Hong Kong, Japan, Korea, Russia, as well as masters from Europe, such as Gaetano Rocco, Diego Gonzalez Rivas, and Eric Lim. Not only to review the progress of single port VATS in Asia and Europe, this symposium also aims to introduce the advanced techniques of single port VATS, including complicated thoracic surgeries and novel approaches, such as subxiphoid approaches. Moreover, the symposium encompasses the applications of high-resolution image and 3D reconstruction technology in preoperative diagnosis and staging workup, which facilitates the surgical planning in single port VATS. We anticipated interactive communication. In addition to live demonstration, we have also invited outstanding experts in the field of multiport VATS and robotic surgery to share their experiences. The in-depth discussion will highlight the advantages of each approach, and provide inspiration for all thoracic surgeons to become “You Zen You Yu”, which is a Chinese idiom meaning handling something skillfully and easily, during VATS procedures.

This special issue of the Journal of Thoracic Disease will extends the presentations and discussions of this exciting meeting to provide a comprehensive overview on current progress of single port VATS. Here we would like to highlight the articles by Yu et al. and Tu et al. (3,4). Yu reviewed the history of VATS and the development of single port VATS, especially in Asian region. With respect to technique feasibility, patient safety, oncological outcome, the single port approach is gaining popularity and being accepted by more and more thoracic surgeons. Most technical difficulties could be overcome with the advancement and refinement of surgical instruments. In Tu’s review, there was a rapid increase in the publication of transthoracic single port VATS, which means that transthoracic single port approach is now well adopted and supported by growing evidences to be a matured surgical approach.

In addition, we would like to highlight the articles by Song et al. (5). They reported 105 cases of lobectomy completed with only one port through subxiphoid approach. In their study, the technical difficulties and potential advantage of less chest pain caused by intercostal neuralgia were discussed. In another study, Zhao et al. completed 13 cases of thoracoscopic thymectomy for thymoma through subxiphoid and subcostal arch approaches (6). All were with clear resection margin. They pointed out the advantages including well exposed anterior mediastinum and reduced pain caused by intercostal nerve compression. Unlike transthoracic single port VATS, the efficacy and safety of subxiphoid approach have not been validated in a large cohort. However, these authors keep leading the evolution of such novel approaches and their results were very inspiring.

We are grateful to all the speakers and authors who have shared their expertise, experience and knowledge for this excellent issue. We believed that all these outstanding achievements will contribute to future improvements of single port VATS.

References

1. 1st Asian Single Port VATS Symposium & Live Surgery. Available online: http://www.surgery.cuhk.edu.hk/vats2013/
2. 3rd Asian Single Port VATS Symposium & Live Surgery. Available online: http://www.surgery.cuhk.edu.hk/VATS2015/
3. Yu PS, Capili F, Ng CS. Single port VATS: recent developments in Asia. J Thorac Dis 2016;8:S302-7.
4. Tu CC, Hsu PK. Global development and current evidence of uniportal thoracoscopic surgery. J Thorac Dis 2016;8:S308-18.
5. Song N, Zhao DP, Jiang L, et al. Subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) for lobectomy: a report of 105 cases. J Thorac Dis 2016;8:S251-7.
6. Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: a safe and feasible minimally invasive procedure for selective stage III thymomas. J Thorac Dis 2016;8:S258-64.

Chia-Chuan Liu, MD

Po-Kuei Hsu, MD, PhD