The Feasibility And Advantage Of Uniportal Video-assisted Thoracoscopic Surgery(VATS)in Achalasia

Objective: Achalasia is an dyskinesia of esophageal characterized by aperi-stalsis of the esophageal body and loss of relaxation of the lower esophageal sphincter,leading to difficulty in swallowing and food regurgitation.With the development of technique and instruments for video-assisted thoracoscopic surgery(VATS)have made minimally-invasive uniportal VATS in achalasia a reality.However,the outcomes of the procedure are still under investigation,and at present,uniportal VATS Heller myotomy,fundoplication is performed infrequently at most hospitals.We have therefore reviewed our outcomes with this procedure in an attempt to confirm its safety,efficacy,and feasibility.Methods:Fourty-four patients who were diagnosed with Achalasia have been treated with operation since February 2015 to December 2019 at The fourth affiliated hospital of China medical university and shengjing hospital affiliated to China medical university.Among the patients twenty-one underwent uniportal VATS,twenty-three underwent traditional thoracotomy.The functional status of esophagus before and after treatment was compared between the two groups.CT was used to measure the diameter of the widest part of the esophagus,the esophageal dynamic monitor was used to measure the pressure at the end of the esophagus,and the PH at the end of the esophagus was monitored.Operation time,intraoperative blood loss and hospital stay in the thoracotomy group and uniportal VATS group.The VAS pain scores of the thoracotomy group were compared with those of the uniportal VATS group 6 hours,1 day,2 days,3 days and 1week after surgery.The scores of dysphagia were used to observe the improvement of symptoms in 2 groups 6 months after operation.Results: Among Fourty-four patients who had successful Heller myotomy and Dor fundoplication during the study period,twenty-one underwent uniportal VATS,twenty-three underwent traditional thoracotomy.There was no postoperative esophageal leakage or hospital death.All included patients were followed up for 6 months.Both groups of patients could improve the esophageal functional state through surgicaltreatment,Symptoms such as dysphagia were significantly improved in both groups 6months after surgery.However,the intraoperative blood loss in the uniportal VATS group was significantly lower than that in the thoracotomy group,and the hospital stay was significantly shorter than that in the thoracotomy group.VAS pain scores at 6 hours,1 day,2 days and 3 days after surgery were significantly lower in the single-orifice thoracoscopy group than in the thoracotomy group(P < 0.05).Conclusions: Our study demonstrates that uniportal VATS is a feasible surgical procedure to treat achalasia.It has the advantages of less postoperative pain,faster recover to traditional thoracotomy.