Abstract
Background There is no criterion on the length of the uniportal video-assisted thoracoscopic
surgery (UVATS) incision when performing lobectomy. We aimed to develop a nomogram
to assist surgeons in designing incision length for different individuals.
Methods A cohort consisting of 290 patients were enrolled for nomogram development. Univariate
and multivariate logistic regression analyses were performed to identify candidate
variables among perioperative characteristics. C-index and calibration curves were utilized for evaluating the performance of the
nomogram. Short-term outcomes of nomogram-predicted high-risk patients were compared
between long incision group and conventional incision group.
Results Of 290 patients, 150 cases (51.7%) were performed incision extension during the surgery.
Age, tumor size, and tumor location were identified as candidate variables related
with intraoperative incision extension and were incorporated into the nomogram. C-index of the nomogram was 0.75 (95% confidence interval: 0.6961–0.8064), indicating
the good predictive performance. Calibration curves presented good consistency between
the nomogram prediction and actual observation. Of high-risk patients identified by
the nomogram, the long incision group (n = 47) presented shorter duration of operation (p = 0.03), lower incidence of total complications (p = 0.01), and lower incidence of prolonged air leak (p = 0.03) compared with the conventional incision group (n = 55).
Conclusion We developed a novel nomogram for predicting the risk of intraoperative incision
extension when performing uniportal video-assisted thoracoscopic lobectomy. This model
has the potential to assist clinicians in designing the incision length preoperatively
to ensure both safety and minimal invasiveness.
Keywords
lobectomy - minimally invasive surgery - uniportal video-assisted thoracoscopic surgery
