“Ipsilateral, high, single-hand, sideways”—Ruijin rule for camera assistant in uniportal video-assisted thoracoscopic surgery

Video-assisted thoracoscopic surgery (VATS), also known as minimally invasive thoracic surgery, has experienced great development since it was introduced to China in the 1990s (1). As VATS indications have been extended to various kinds of general thoracic surgeries, numerous patients benefit from it. Nowadays VATS lobectomy has become the standard operation for peripheral lung cancer (2-4), however, it is still developing all the time. So many thoracic surgeons are enthusiastic about the advances of minimally invasive surgery, and the number of ports have been progressively reduced, developing from 3- to 2-port, and now the latest uniportal VATS (3,5,6). Camera assistants who don’t operate on the patients directly, as the eye of the VATS team, should provide the surgeons with a stable image and enable them to control their own view direction. All the manipulation activities should be performed together by surgeons and camera assistants to ensure eye-hand coordination, which is an intricate surgical procedure and requires more skills for camera assistants. Camera assistants should be well acquainted with not only the working principles and the adjustment of endoscopic instruments, but also the surgical procedures and the intention of surgeons. Uniportal VATS requires more for camera assistant compared with the 3- or 2-port VATS. Camera assistant should expertly adjust the camera lens, focal length, angle and clarity, simultaneously avoid the collision of instruments and limbs to provide enough room for operating (7). So far, more than 100 uniportal VATS have been performed in the Department Of Thoracic Surgery in Ruijin Hospital, we summarized the method of holding camera, known as “ipsilateral, high, single-hand, sideways”, which largely improves the comfort and fluency of surgery. Here we will introduce our experience in the following content for your reference