Stepwise approaches to optimize strategy for holding thoracoscope during single port video-assisted thoracoscopic surgery

As an emerging technique, single port video-assisted thoracoscopic surgery (SP-VATS) was first reported by Rocco et al. in 2004 for dealing with simple thoracic procedures such as pneumothorax, pleural biopsy, and lung wedge resection, et al. (1). In 2011, Gonzalez et al. reported initial experience on SP-VATS lobectomy (2). Following that were numerous reports even on complicated cases of sleeve or even double-sleeve lobectomy within very short periods of time (3). Due to limited access it’s technically demanding for the surgeon during SP-VATS procedure, such as mutual interference among instruments, limited “work angle”, “arrow effect” among instruments, and lack of appropriate instruments. Coordination between the thoracoscope assistant and the surgeon was much more difficult. To provide good vision and enough operating room for the surgeon the thoracoscope assistant needed to hold the thoracoscope still in nearly distorted posture for hours, which was an exhausting work. In order to make the operation smoother and the assistant feel more comfortable during SP-VATS, we developed a strategy for holding the thoracoscope after stepwise approaches