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            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A guide for assisting the smoker&#46; The first step in treating tobacco use and dependence is to identify tobacco users&#46; Asking systematically whether your patients smoke at every visit is imperative &#40;ASK&#41;&#46; All smokers should be advised to quit&#46; This advice should be clearly stated and specifically adapted in relation to the patient&#39;s problems &#40;ADVISE&#41;&#46; The willingness of smokers to make a quit attempt at this time should be assessed &#40;ASSESS&#41;&#46; If the patient is ready to quit&#44; health care providers should be prepared to offer assistance&#46; This entails working together with the patient to set a sensible plan with a commitment to a quit date and to frequent follow-up visits&#46; Alternatively&#44; referring the patient to a tobacco intervention resource &#40;eg&#44; a smoking cessation quit line or health educator&#41; that would deliver additional treatment to the patient might be contemplated &#40;ASSIST&#41;&#46; All patients who receive a tobacco dependence intervention should be regularly assessed for abstinence&#44; beginning within the first week after the quit date&#46; Abstinent patients should have their quitting success acknowledged&#46;</p>"
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        "titulo" => "Cirurgia toracosc&#243;pica de porta &#250;nica &#40;single-port&#41; pode ser uma abordagem de primeira linha para a cirurgia toracosc&#243;pica eletiva"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Thoracoscopic surgery has been developing over several years&#46; At present&#44; it is very popular in many institutions&#46; In order to handle the endoscopic instruments with ease&#44; thoracic surgeons usually need three or more small port wounds&#46; One of the port wounds is usually intended for the rigid endoscope&#46; A second port wound is utilized for manipulation of grasping instruments to search for lesions and hold the suspicius lesion to be resected&#46; A third wound is usually for a stapler or other instruments to assist dissection&#46; An obvious benefit of multi-port wounds is that the function of port wounds is inter-changeable&#46; When the thoracic surgeon initially creates a wound but then finds the field-of-view is very limited due to adhesion or fibrosis&#44; a second wound might help to change the viewing field&#46; If the second wound fails&#44; the third wound would usually be successful&#46; Owing to the limitations of the semi-rigid nature of the thoracic cage&#44; an inappropriate port wound is essentially redundant&#46; The preoperative planning of the port wound is crucial for successful single-port thoracoscopic surgery&#46; We want to find out if routine thoracoscopic operations can be safely accomplished with single-port thoracoscopic techniques&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">From July 1st&#44; 2010 to March 31st&#44; 2011&#44; 90 consecutive patients underwent general thoracoscopic surgery by the same thoracic surgeon&#46; Two patients with severe trauma and massive bleeding were excluded from the study&#46; All patients who had been initially indicated for thoracoscopic surgery in our team were included except any patient for whom open surgery had initially been planned&#46; All procedures were performed by the same thoracic surgeon in order to avoid the effect of the varied experience of different thoracic surgeons&#46; Patient data were prospectively recorded and patients were followed in the outpatient department for at least six months after operation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The preoperative evaluation and techniques of anesthesia were routine&#44; like any normal anesthesia&#46; Patients are intubated with a double-lumen endotracheal tube after sufficient induction of anesthesia to allow single-lung ventilation&#46; Not all patients received intravenous or epidural patient-controlled anesthesia&#46; The endoscope we used in the procedure was 5<span class="elsevierStyleHsp" style=""></span>mm in diameter with 30&#176; viewing angle&#46; Whenever possible&#44; we removed the endotracheal tube immediately after the procedure&#46; Most patients were transferred to intensive care units &#40;ICU&#41; for observation for one night&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our surgical strategy was very straightforward&#46; With patients for thoracoscopic surgery&#44; we always tried a single-port approach to complete the procedure&#46; If technically unavoidable&#44; we made a second port wound and then completed the procedure&#46; In case of difficulty&#44; a mini-thoracotomy or thoracotomy would be made to continue the procedure&#46; A port wound is defined as any wound less than 3&#46;5<span class="elsevierStyleHsp" style=""></span>cm at the longest point&#46; A port wound is usually 1&#46;5<span class="elsevierStyleHsp" style=""></span>cm for uncomplicated procedure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Mini-thoracotomy is defined as a wound greater than 3&#46;5 and less than 7<span class="elsevierStyleHsp" style=""></span>cm&#46; Any wound greater than 7<span class="elsevierStyleHsp" style=""></span>cm is defined as thoracotomy&#46; An important difference in our methodology was that we never used a rib retractor in thoracoscopic operation even when there was a larger port wound&#46; With single-port thoracoscopic surgery&#44; a chest tube &#40;24 French to 28 French&#41; was placed in the same port wound &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">This study aims to evaluate the efficacy of the single-port approach for routine thoracoscopic surgery&#46; It was important to find out if the initial single-port approach in routine thoracoscopic surgery is worthwhile because there are still a lot of thoracic surgeons who habitually create three or more port wounds initially and then carry out the procedure&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">SPSS &#40;version 13&#46;0&#41; was used to help compare the perioperative results of both single and two port thoracoscopic approaches&#46; Chi square test and Student&#39;s <span class="elsevierStyleItalic">t</span>-test were used to compare the hospital stay&#44; operative time and visual analog pain scores&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The number of patients included in this study was eighty-eight&#46; The mean age was 49&#46;97 years &#40;range 16&#8211;93&#41;&#46; The indications for elective thoracoscopic surgery were empyema thoracis in 34 patients&#44; primary spontaneous pneumothorax in 25 patients&#44; lung tumor in 19 patients&#44; interstitial lung disease in 4 patients&#44; mediastinal tumor in 2 patients&#44; traumatic lung laceration in 2 patients&#44; diaphragm eventration in 1 patient and diaphragm herniation in 1 patient&#46; A total of 68 patients underwent the single-port thoracoscopic approach&#44; 19 patients converted to two-port approach and one patient was operated on by a mini-thoracotomy&#46; The mean hospital stay was 8&#46;72 days &#40;range&#58; 3&#8211;45 days&#41;&#46; The average operative time &#40;skin incision to skin closure&#41; was 84&#46;78<span class="elsevierStyleHsp" style=""></span>min &#40;range&#58; 25&#8211;240<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; The time required before chest tubes could be removed was 2&#46;3 days in the single-port group and 2&#46;5 days in the two-port group&#46; There was no statistical difference&#46; The perioperative mortality rate was 2&#46;27&#37; and the complication rate was 7&#46;95&#37;&#46; Two patients died because of widespread metastasis of lung cancer and acute heart failure due to severe mitral regurgitation respectively&#46; There was no procedure-related mortality&#46; Complications were respiratory failure in 3 patients&#44; pneumonia in 1 patient&#44; congestive heart failure in 1 patient and wound infection in 1 patient&#46; The indications for thoracoscopic procedure are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The overall conversion rate from single-port to two-port approach was 21&#46;6&#37;&#46; In the empyema group&#44; the conversion rate was much higher than in other groups &#40;41&#46;2&#37;&#41;&#46; The conversion rates were 4&#46;0&#37;&#44; 15&#46;8&#37;&#44; and 25&#37; in the group of primary spontaneous pneumothorax&#44; lung tumor and interstitial lung disease&#46; The conversion rate was zero in the remaining group&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">When we compared the features of patients undergoing the different approaches of thoracoscopic surgery &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; there was no statistical difference in average age&#46; However&#44; patients of male gender and with a right side approach were more likely to be converted to two-port approach &#40;22&#46;8&#37; and 33&#46;0&#37; respectively&#41;&#46; The operating time was much shorter in the single-port approach group than in the two-port approach group &#40;77&#46;1<span class="elsevierStyleHsp" style=""></span>min <span class="elsevierStyleItalic">vs</span> 109&#46;5<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; The ICU stay&#44; the hospital stay&#44; perioperative mortality rate and complication rate did not differ&#46; The subjective pain score&#44; however&#44; was better in the single-port approach than in the two-port approach at 24 and 48<span class="elsevierStyleHsp" style=""></span>h after operation &#40;4&#46;12 <span class="elsevierStyleItalic">vs</span> 4&#46;72 and 3&#46;21 <span class="elsevierStyleItalic">vs</span> 3&#46;72&#41;&#46; After 72<span class="elsevierStyleHsp" style=""></span>h&#44; the difference was only minimal&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Single-incisional thoracoscopic surgery is an increasingly popular surgical technique&#46; Even in some complicated cancer resections&#44; a single-port approach is still feasible in some situations&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A lot of experience of single-incision in laparoscopic surgery has been gained in recent years&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;5</span></a> However&#44; the conversion rate and surgical outcome are still limited in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> For this study&#44; we designed a simple strategy to evaluate the feasibility of the procedure&#46; The simple strategy was always to try single-incision to complete the operation&#46; If technically unavoidable&#44; a second port wound would be created&#46; Then if needed&#44; a third port wound would be made&#46; If necessary&#44; we would perform mini-thoracotomy or thoracotomy to continue with the operation&#46; In the study of consecutive 88 patients&#44; no patient required conventional 3-port thoracoscopic surgery&#46; Only one patient was operated on by a mini-thoracotomy&#59; this was because of the lack of tactile sensation&#44; which prevented us from identifying her lung neoplasm&#46; Finger palpation is sometimes important when we cannot be sure of the location of tumor&#46; Needle localization by radiologists may be helpful in such situations&#46; If we had had needle localization in this case&#44; a mini-thoracotomy might not have been required and the procedure could have been accomplished by single-port approach&#46; Not performing needle localization in the patient was probably not the best decision because we assume that we would have been able to find the lesion easily through video-assisted thoracoscopic surgery &#40;VATS&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Using multiple trocars in one port wound as described by Chen et al&#46;&#44; was not favored<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> because multiple trocars take up a lot of space in the wound and placing multiple instruments is more difficult especially when the instruments are not curved&#46; There are two ways of solving the problem of the small space of the single port wound&#59; one is to use multi-access trocar&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> as this trocar is relatively soft and allows more than 1 instrument to be placed and worked in the body cavity&#46; Another and simpler solution is just not to use a trocar at all&#46; In mundane diseases of a benign nature there is no danger of tumor seeding&#44; such as primary spontaneous pneumothorax&#46; Direct placement of multiple instruments &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and B&#41; allows maximum working space within a very small incision&#46; With rigid trocar&#44; the long and cylindrical rigid lumen limits the working space&#44; especially when we use regular straight endoscopic instruments rather than reticulating &#40;curved&#41; instruments&#46; When malignant disease is concerned&#44; we use a plastic wound protector to prevent possible contamination or cancer seeding in the wound&#46; A plastic wound protector is even better than multiple trocars or a multi-access trocar if our main concern is to maximize working flexibility&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">A major problem we encountered is that the final size of wound may vary&#46; In the setting of primary spontaneous pneumothorax&#44; the specimen is usually soft&#44; collapsed and benign&#46; It is easy to pull out such a specimen in a plastic protective bag &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Even in the case of a very large specimen but one which has only a small nodule inside&#44; it is definitely possible to pull it out from a small wound&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> But care should be taken not to break the plastic bag &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41;&#46; With the use of jelly and other lubricants it is feasible to slowly and gently retract the lung &#40;whole lobe&#41; without the danger of lacerating the lung &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>B&#41;&#46; However&#44; when a huge&#44; solid tumor is to be resected&#44; a very small wound is not suitable because a such a large tumor may be squeezed and ruptured when pulled out by force&#46; Squeezing and rupture of the mass may cause the pathologist problems&#46; Therefore&#44; we did not include such patients in the study because we realized there would have to be a larger wound when we finished the procedure&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In this study&#44; we found 59&#46;8&#37; patients of empyema could be successfully treated by single-port approach but a good proportion of patients needed another port wound&#46; The reasons why all the 14 patients concerned had to be operated by the two-port approach came in the organizing stage&#46; Single-incisional thoracoscopic decortication in patients with very dense peels in the lung is technically more difficult and is usually very time-consuming and so in order to shorten the operative time we performed two-port approach&#46; In the group of primary spontaneous pneumothorax&#44; single-port approach was relatively easier and safely performed in 96&#37; patients&#46; The mean operative time was 60<span class="elsevierStyleHsp" style=""></span>min&#46; At the beginning of the study&#44; performing a wedge resection of apical lung and mechanical pleurodesis was a lengthy process&#46; After repeated operations and more practice with single-port thoracoscopic procedures&#44; the time required for the same procedures of wedge resection and abrasion pleurodesis was significantly shorter &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; For one patient&#44; the procedure took only 25<span class="elsevierStyleHsp" style=""></span>min from skin incision to complete tube fixation&#46; After overcoming the learning curve&#44; the procedure was not so time-consuming&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In the lung tumor group&#44; single-incisional thoracoscopic lobectomy was successful in three patients &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A and B&#41;&#46; The mean operative time of the three patients undergoing lobectomy was 204<span class="elsevierStyleHsp" style=""></span>min and the mean time for patients undergoing wedge resection was 78&#46;3<span class="elsevierStyleHsp" style=""></span>min&#46; The major difficulties in lobectomy and radical lymph node dissection are dividing the pulmonary arterial branches and lymph node dissection&#46; Our methods were basically identical to that of multi-port VATS&#46; The fissure was first divided by a linear stapler and when the interlobar structures could be seen&#44; we used peanut sponge on the tip of an instrument to dissect bluntly and at times with an electrical cautery as far as the arterial branches and pulmonary vein were exposed&#46; Then the vessels are looped with a clamp attached to a silk &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>A&#41;&#46; The branches were ligated with silk directly and divided by scissors or we used a rotating stapler to divide the arterial branches &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>B&#41;&#46; Lymph node dissection was another difficulty&#46; The one-port must be correctly positioned for dissection of the subcarina lymph node&#46; With a combination of conventional and endoscopic instruments&#44; lymph nodes of each station can be sampled or radically dissected&#46; In the case we described of lung cancer in the upper right lobe&#44; the tumor was about 2&#46;5<span class="elsevierStyleHsp" style=""></span>cm at maximum length and the lymph nodes we dissected were station 3&#44; 4&#44; 7&#44; 10 and 11&#46; The pathology report showed that there was no nodal metastasis of lung cancer&#46; Therefore&#44; the pathological staging was IA&#44; lung adenocarcinoma&#44; T1bN0M0&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Single-port wedge resection was successful in 12 patients&#46; Three patients required another port wound for successful wedge resection because of the problem of location of the first port wound&#46; From our limited experience&#44; it seems that poor port location may cause technical difficulties in the major resection of the lung&#46; We usually marked the tumor location on the CT scan and tried to make an antero-lateral wound corresponding to the intercostal space between anterior and mid-axillary line&#44; usually in the 4th&#44; 5th and 6th intercostal space&#44; thus avoiding wounds that are too lateral or too far back&#46; If the intercostal space was too narrow it would hinder the manipulation of endoscopic instruments&#46; One patient required mini-thoracotomy because the tumor could not be found through gross endoscopic view&#46; We had to try finger palpation to search for the lesion&#46; In the case of soft lesions with air-bronchogram features&#44; preoperative needle localization may be helpful for biopsy without needing to extend for a larger incision&#46; In other groups&#44; techniques such as suture for eventration&#44; herniation&#44; repairing lung laceration and for benign mediastinal tumor resection are feasible&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In brief&#44; nearly 80&#37; of all patients requiring elective thoracoscopic surgery were safely operated by single-port approach&#46; There was less acute pain in the initial 48<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; so this type of procedure is worth trying&#46; Conversion from single-port approach to two-port approach should not be considered a failure but a necessary modification according to circumstances&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This study is important because it showed the feasibility and usefulness of single-incisional VATS as an appropriate first-line strategy for elective thoracoscopic surgery&#46; Conversion should not be considered as a failure but as a modification because the procedure can be safely accomplished with a second small port wound&#46; The results should encourage thoracic surgeons to try single wound VATS because it was not as time-consuming as we had expected after the initial learning curve&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">With improvements in the design of endoscopic instruments and endoscope&#44; the actual wound size may be further decreased&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The limitation of this study is the fact that this was an initial experiment by a single surgeon for a short period&#46; For more solid evidence&#44; we need to compare the surgical outcomes of different procedures within the same time period&#46; However&#44; to design such a study is not easy because different surgeons prefer different surgical procedures&#44; which is why we presented the results by a single surgeon&#46; The long-term surgical outcomes&#44; long-term safety&#44; and acceptability among thoracic surgeons should be evaluated in the future&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Single-incisional thoracoscopic surgery is technically feasible in most conditions&#46; With similar perioperative outcomes&#44; single-incisional thoracoscopic approach can be a viable alternative to conventional thoracoscopic surgery with multi-port wounds&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Thoracoscopy"
            1 => "Video-assisted thoracic surgery"
            2 => "Single-incisional endoscopic Surgery"
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            0 => "Torascopia"
            1 => "Cirurgia toracosc&#243;pica video-assistida"
            2 => "Cirurgia Endosc&#243;pica de incis&#227;o &#250;nica"
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        "titulo" => "Abstract"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Thoracoscopic surgery has become very popular in recent years&#46; Conventional thoracoscopic surgery requires three or more port wounds for manipulations of endoscopic instruments&#46; For complicated cancer surgery&#44; more port wounds and a larger thoracotomy wound may be required due to technical reasons&#46; We want to investigate the effectiveness of single-port thoracoscopic approach in elective thoracoscopic surgery for thoracic disease&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">From July 1st&#44; 2010 to March 31&#44; 2011&#44; 90 consecutive patients underwent general thoracoscopic surgery performed by the same thoracic surgeon&#46; Two patients with severe trauma and massive bleeding were excluded from the study&#46; All patients included had thoracoscopic surgery with a single-port approach&#46; The surgical outcomes&#44; complications&#44; mortality and conversion rates were recorded and analyzed&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 88 patients were included in this study&#46; All these patients were operated on by the same surgeon&#46; For sixty-eight patients&#44; the single-port thoracoscopic approach was used&#46; Nineteen patients were changed to a two-port thoracoscopic approach and one patient&#39;s was changed to mini-thoracotomy&#46; Two patients died from terminal lung cancer and severe mitral regurgitation&#46; Complications occurred in six cases&#46; Eighty-seven patients &#40;98&#46;8&#37;&#41; were effectively managed with either single-port or a two-port approach&#46; Only one patient was managed by mini-thoracotomy&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Elective thoracoscopic surgery performed through a single-port wound is feasible&#46; Single-incisional thoracoscopic surgery can be safely applied as a first-line approach in most cases of elective thoracoscopic procedures&#46;</p></span>"
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        "resumen" => "<span><span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A cirurgia toracosc&#243;pica tornou-se muito popular nos &#250;ltimos anos&#46; A cirurgia toracosc&#243;pica convencional requer tr&#234;s ou mais incis&#245;es para manipula&#231;&#227;o dos instrumentos endosc&#243;picos&#46; Para cirurgias de cancro complicadas&#44; podem ser requeridas mais incis&#245;es e uma incis&#227;o toracotomia maior&#44; por raz&#245;es t&#233;cnicas&#46; Pretendemos investigar a efic&#225;cia da abordagem toracosc&#243;pica de incis&#227;o &#250;nica em cirurgias toracosc&#243;pica eletivas&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Materiais e m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Desde 1 de julho de 2010 at&#233; 31 de mar&#231;o de 2011&#44; 90 pacientes consecutivos foram submetidos a cirurgia toracosc&#243;pica geral realizada pelo mesmo cirurgi&#227;o tor&#225;cico&#46; Dois pacientes com trauma grave e hemorragia massiva foram exclu&#237;dos do estudo&#46; Todos os pacientes inclu&#237;dos foram submetidos a cirurgia toracosc&#243;pica com uma abordagem de incis&#227;o &#250;nica&#46; Os resultados cir&#250;rgicos&#44; complica&#231;&#245;es&#44; mortalidade e taxas de convers&#227;o foram registados e analisados&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Um total de 88 pacientes foram inclu&#237;dos neste estudo&#46; Todos estes pacientes foram operados pelo mesmo cirurgi&#227;o&#46; Para sessenta e oito pacientes&#44; foi usada a abordagem de incis&#227;o &#250;nica tor&#225;cica&#46; Dezanove pacientes foram convertidos para uma abordagem dupla porta e um paciente convertido em mini-toracotomia&#46; Dois pacientes morreram de cancro do pulm&#227;o terminal e regurgita&#231;&#227;o mitral grave&#46; Ocorreram complica&#231;&#245;es em seis casos&#46; Oitenta e sete pacientes &#40;98&#44;8&#37;&#41; foram tratados eficazmente com uma abordagem de incis&#227;o &#250;nica ou de incis&#227;o dupla&#46; Apenas um paciente foi tratado por mini-toracotomia&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A cirurgia toracosc&#243;pica eletiva realizada atrav&#233;s de incis&#227;o &#250;nica &#233; vi&#225;vel&#46; A cirurgia toracosc&#243;pica de incis&#227;o &#250;nica pode ser aplicada em seguran&#231;a como uma abordagem de primeira linha na maioria dos casos de procedimentos toracosc&#243;picos eletivos&#46;</p></span>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The picture shows when a lesion was localized&#44; an instrument can be placed to hold lesion and a linear stapler can be used to resect the lesion &#40;A&#41;&#46; The scope can change viewing angle when needed&#46; Without any trocar&#44; such procedure is very easy to perform because the working space will not be limited by the lumen of rigid trocar &#40;B&#41;&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An example of single incisional thoracoscopic surgery for lobectomy of right upper lobe performed in our team&#46; The lobe was dissected and then was placed inside a protecting bag &#40;A&#41;&#46; With gentle force for pulling out&#44; the lobe can be completely removed through the small wound &#40;B&#41;&#46; We applied some jelly as lubricant between the lung&#44; the bag and the wound&#46; The pull-out procedure may take 20<span class="elsevierStyleHsp" style=""></span>min&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">From the first case of primary spontaneous pneumothorax to the most recent case&#44; the operative time decreased significantly when we gained more and more experiences to perform the procedures&#46; The initial attempt took longer time than conventional methods&#46; For uncomplicated cases&#44; the operative time can be less than 30<span class="elsevierStyleHsp" style=""></span>min&#46;</p>"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">An example of hilar dissection of lobectomy of left lower lobe&#46; In the condition of lobectomy through a single port-wound&#46; The arterial branches can be exposed and then looped &#40;A&#41;&#46; After looping with a silk&#44; a rotating linear stappler can be placed for division of the vessels &#40;B&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">VATS&#58; video-assisted thoracoscopic surgery&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Indications for VATS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">One port&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Two port&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mini-thoracotomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Empyema thoracis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Primary spontaneous pneumothorax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lung tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Interstitial lung disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">mediastinal tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lung laceration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diaphragm herniation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diaphragm eventration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The indications for thoracoscopic surgery&#46;</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">OP&#58; operation&#59; ICU&#58; intensive care units&#59; VAS&#58; visual analog score&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Approach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Single-port&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Two-port&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Number</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;mean&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;057&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Location</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Right side&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Left side&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">OP time</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">ICU stay</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hospital stay</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Chest tube placement</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Outcome</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Complication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">VAS for pain</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>48<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>72<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The characteristics of patients in the group of single and two-port approach&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:11 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Single-incision video-assisted thoracoscopic lobectomy&#58; initial results"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46; Gonzalez-Rivas"
                            1 => "M&#46; Paradela"
                            2 => "E&#46; Fieira"
                            3 => "C&#46; Velasco"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtcvs.2011.07.049"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg"
                        "fecha" => "2012"
                        "volumen" => "143"
                        "paginaInicial" => "745"
                        "paginaFinal" => "747"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21868042"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
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Original article
Single-port thoracoscopic surgery can be a first-line approach for elective thoracoscopic surgery
Cirurgia toracoscópica de porta única (single-port) pode ser uma abordagem de primeira linha para a cirurgia toracoscópica eletiva
C.-H. Chena,b,d,
Corresponding author
musclenet2003@yahoo.com.tw

Corresponding author.
, H. Changa, S.-Y. Leec,d, H.-C. Liua,b,d, T.-T. Hunga,b,d, W.-C. Huangb,d
a Graduate Institute of Mechanical and Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan
b Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
c Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, Taipei, Taiwan
d Mackay Medicine, Nursing and Management College, Taipei, Taiwan
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        "titulo" => "Cirurgia toracosc&#243;pica de porta &#250;nica &#40;single-port&#41; pode ser uma abordagem de primeira linha para a cirurgia toracosc&#243;pica eletiva"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A case of primary spontaneous pneumothorax&#44; a single incision is just 1&#46;5<span class="elsevierStyleHsp" style=""></span>cm in length &#40;A&#41;&#46; Resection of pulmonary tissue is feasible through a small wound&#46; The chest tube is placed in the same operating port wound &#40;B&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Thoracoscopic surgery has been developing over several years&#46; At present&#44; it is very popular in many institutions&#46; In order to handle the endoscopic instruments with ease&#44; thoracic surgeons usually need three or more small port wounds&#46; One of the port wounds is usually intended for the rigid endoscope&#46; A second port wound is utilized for manipulation of grasping instruments to search for lesions and hold the suspicius lesion to be resected&#46; A third wound is usually for a stapler or other instruments to assist dissection&#46; An obvious benefit of multi-port wounds is that the function of port wounds is inter-changeable&#46; When the thoracic surgeon initially creates a wound but then finds the field-of-view is very limited due to adhesion or fibrosis&#44; a second wound might help to change the viewing field&#46; If the second wound fails&#44; the third wound would usually be successful&#46; Owing to the limitations of the semi-rigid nature of the thoracic cage&#44; an inappropriate port wound is essentially redundant&#46; The preoperative planning of the port wound is crucial for successful single-port thoracoscopic surgery&#46; We want to find out if routine thoracoscopic operations can be safely accomplished with single-port thoracoscopic techniques&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">From July 1st&#44; 2010 to March 31st&#44; 2011&#44; 90 consecutive patients underwent general thoracoscopic surgery by the same thoracic surgeon&#46; Two patients with severe trauma and massive bleeding were excluded from the study&#46; All patients who had been initially indicated for thoracoscopic surgery in our team were included except any patient for whom open surgery had initially been planned&#46; All procedures were performed by the same thoracic surgeon in order to avoid the effect of the varied experience of different thoracic surgeons&#46; Patient data were prospectively recorded and patients were followed in the outpatient department for at least six months after operation&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The preoperative evaluation and techniques of anesthesia were routine&#44; like any normal anesthesia&#46; Patients are intubated with a double-lumen endotracheal tube after sufficient induction of anesthesia to allow single-lung ventilation&#46; Not all patients received intravenous or epidural patient-controlled anesthesia&#46; The endoscope we used in the procedure was 5<span class="elsevierStyleHsp" style=""></span>mm in diameter with 30&#176; viewing angle&#46; Whenever possible&#44; we removed the endotracheal tube immediately after the procedure&#46; Most patients were transferred to intensive care units &#40;ICU&#41; for observation for one night&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our surgical strategy was very straightforward&#46; With patients for thoracoscopic surgery&#44; we always tried a single-port approach to complete the procedure&#46; If technically unavoidable&#44; we made a second port wound and then completed the procedure&#46; In case of difficulty&#44; a mini-thoracotomy or thoracotomy would be made to continue the procedure&#46; A port wound is defined as any wound less than 3&#46;5<span class="elsevierStyleHsp" style=""></span>cm at the longest point&#46; A port wound is usually 1&#46;5<span class="elsevierStyleHsp" style=""></span>cm for uncomplicated procedure &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Mini-thoracotomy is defined as a wound greater than 3&#46;5 and less than 7<span class="elsevierStyleHsp" style=""></span>cm&#46; Any wound greater than 7<span class="elsevierStyleHsp" style=""></span>cm is defined as thoracotomy&#46; An important difference in our methodology was that we never used a rib retractor in thoracoscopic operation even when there was a larger port wound&#46; With single-port thoracoscopic surgery&#44; a chest tube &#40;24 French to 28 French&#41; was placed in the same port wound &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">This study aims to evaluate the efficacy of the single-port approach for routine thoracoscopic surgery&#46; It was important to find out if the initial single-port approach in routine thoracoscopic surgery is worthwhile because there are still a lot of thoracic surgeons who habitually create three or more port wounds initially and then carry out the procedure&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">SPSS &#40;version 13&#46;0&#41; was used to help compare the perioperative results of both single and two port thoracoscopic approaches&#46; Chi square test and Student&#39;s <span class="elsevierStyleItalic">t</span>-test were used to compare the hospital stay&#44; operative time and visual analog pain scores&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall">The number of patients included in this study was eighty-eight&#46; The mean age was 49&#46;97 years &#40;range 16&#8211;93&#41;&#46; The indications for elective thoracoscopic surgery were empyema thoracis in 34 patients&#44; primary spontaneous pneumothorax in 25 patients&#44; lung tumor in 19 patients&#44; interstitial lung disease in 4 patients&#44; mediastinal tumor in 2 patients&#44; traumatic lung laceration in 2 patients&#44; diaphragm eventration in 1 patient and diaphragm herniation in 1 patient&#46; A total of 68 patients underwent the single-port thoracoscopic approach&#44; 19 patients converted to two-port approach and one patient was operated on by a mini-thoracotomy&#46; The mean hospital stay was 8&#46;72 days &#40;range&#58; 3&#8211;45 days&#41;&#46; The average operative time &#40;skin incision to skin closure&#41; was 84&#46;78<span class="elsevierStyleHsp" style=""></span>min &#40;range&#58; 25&#8211;240<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; The time required before chest tubes could be removed was 2&#46;3 days in the single-port group and 2&#46;5 days in the two-port group&#46; There was no statistical difference&#46; The perioperative mortality rate was 2&#46;27&#37; and the complication rate was 7&#46;95&#37;&#46; Two patients died because of widespread metastasis of lung cancer and acute heart failure due to severe mitral regurgitation respectively&#46; There was no procedure-related mortality&#46; Complications were respiratory failure in 3 patients&#44; pneumonia in 1 patient&#44; congestive heart failure in 1 patient and wound infection in 1 patient&#46; The indications for thoracoscopic procedure are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The overall conversion rate from single-port to two-port approach was 21&#46;6&#37;&#46; In the empyema group&#44; the conversion rate was much higher than in other groups &#40;41&#46;2&#37;&#41;&#46; The conversion rates were 4&#46;0&#37;&#44; 15&#46;8&#37;&#44; and 25&#37; in the group of primary spontaneous pneumothorax&#44; lung tumor and interstitial lung disease&#46; The conversion rate was zero in the remaining group&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">When we compared the features of patients undergoing the different approaches of thoracoscopic surgery &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; there was no statistical difference in average age&#46; However&#44; patients of male gender and with a right side approach were more likely to be converted to two-port approach &#40;22&#46;8&#37; and 33&#46;0&#37; respectively&#41;&#46; The operating time was much shorter in the single-port approach group than in the two-port approach group &#40;77&#46;1<span class="elsevierStyleHsp" style=""></span>min <span class="elsevierStyleItalic">vs</span> 109&#46;5<span class="elsevierStyleHsp" style=""></span>min&#41;&#46; The ICU stay&#44; the hospital stay&#44; perioperative mortality rate and complication rate did not differ&#46; The subjective pain score&#44; however&#44; was better in the single-port approach than in the two-port approach at 24 and 48<span class="elsevierStyleHsp" style=""></span>h after operation &#40;4&#46;12 <span class="elsevierStyleItalic">vs</span> 4&#46;72 and 3&#46;21 <span class="elsevierStyleItalic">vs</span> 3&#46;72&#41;&#46; After 72<span class="elsevierStyleHsp" style=""></span>h&#44; the difference was only minimal&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Single-incisional thoracoscopic surgery is an increasingly popular surgical technique&#46; Even in some complicated cancer resections&#44; a single-port approach is still feasible in some situations&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A lot of experience of single-incision in laparoscopic surgery has been gained in recent years&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;5</span></a> However&#44; the conversion rate and surgical outcome are still limited in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> For this study&#44; we designed a simple strategy to evaluate the feasibility of the procedure&#46; The simple strategy was always to try single-incision to complete the operation&#46; If technically unavoidable&#44; a second port wound would be created&#46; Then if needed&#44; a third port wound would be made&#46; If necessary&#44; we would perform mini-thoracotomy or thoracotomy to continue with the operation&#46; In the study of consecutive 88 patients&#44; no patient required conventional 3-port thoracoscopic surgery&#46; Only one patient was operated on by a mini-thoracotomy&#59; this was because of the lack of tactile sensation&#44; which prevented us from identifying her lung neoplasm&#46; Finger palpation is sometimes important when we cannot be sure of the location of tumor&#46; Needle localization by radiologists may be helpful in such situations&#46; If we had had needle localization in this case&#44; a mini-thoracotomy might not have been required and the procedure could have been accomplished by single-port approach&#46; Not performing needle localization in the patient was probably not the best decision because we assume that we would have been able to find the lesion easily through video-assisted thoracoscopic surgery &#40;VATS&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Using multiple trocars in one port wound as described by Chen et al&#46;&#44; was not favored<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> because multiple trocars take up a lot of space in the wound and placing multiple instruments is more difficult especially when the instruments are not curved&#46; There are two ways of solving the problem of the small space of the single port wound&#59; one is to use multi-access trocar&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> as this trocar is relatively soft and allows more than 1 instrument to be placed and worked in the body cavity&#46; Another and simpler solution is just not to use a trocar at all&#46; In mundane diseases of a benign nature there is no danger of tumor seeding&#44; such as primary spontaneous pneumothorax&#46; Direct placement of multiple instruments &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A and B&#41; allows maximum working space within a very small incision&#46; With rigid trocar&#44; the long and cylindrical rigid lumen limits the working space&#44; especially when we use regular straight endoscopic instruments rather than reticulating &#40;curved&#41; instruments&#46; When malignant disease is concerned&#44; we use a plastic wound protector to prevent possible contamination or cancer seeding in the wound&#46; A plastic wound protector is even better than multiple trocars or a multi-access trocar if our main concern is to maximize working flexibility&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">A major problem we encountered is that the final size of wound may vary&#46; In the setting of primary spontaneous pneumothorax&#44; the specimen is usually soft&#44; collapsed and benign&#46; It is easy to pull out such a specimen in a plastic protective bag &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Even in the case of a very large specimen but one which has only a small nodule inside&#44; it is definitely possible to pull it out from a small wound&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> But care should be taken not to break the plastic bag &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41;&#46; With the use of jelly and other lubricants it is feasible to slowly and gently retract the lung &#40;whole lobe&#41; without the danger of lacerating the lung &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>B&#41;&#46; However&#44; when a huge&#44; solid tumor is to be resected&#44; a very small wound is not suitable because a such a large tumor may be squeezed and ruptured when pulled out by force&#46; Squeezing and rupture of the mass may cause the pathologist problems&#46; Therefore&#44; we did not include such patients in the study because we realized there would have to be a larger wound when we finished the procedure&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In this study&#44; we found 59&#46;8&#37; patients of empyema could be successfully treated by single-port approach but a good proportion of patients needed another port wound&#46; The reasons why all the 14 patients concerned had to be operated by the two-port approach came in the organizing stage&#46; Single-incisional thoracoscopic decortication in patients with very dense peels in the lung is technically more difficult and is usually very time-consuming and so in order to shorten the operative time we performed two-port approach&#46; In the group of primary spontaneous pneumothorax&#44; single-port approach was relatively easier and safely performed in 96&#37; patients&#46; The mean operative time was 60<span class="elsevierStyleHsp" style=""></span>min&#46; At the beginning of the study&#44; performing a wedge resection of apical lung and mechanical pleurodesis was a lengthy process&#46; After repeated operations and more practice with single-port thoracoscopic procedures&#44; the time required for the same procedures of wedge resection and abrasion pleurodesis was significantly shorter &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; For one patient&#44; the procedure took only 25<span class="elsevierStyleHsp" style=""></span>min from skin incision to complete tube fixation&#46; After overcoming the learning curve&#44; the procedure was not so time-consuming&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In the lung tumor group&#44; single-incisional thoracoscopic lobectomy was successful in three patients &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A and B&#41;&#46; The mean operative time of the three patients undergoing lobectomy was 204<span class="elsevierStyleHsp" style=""></span>min and the mean time for patients undergoing wedge resection was 78&#46;3<span class="elsevierStyleHsp" style=""></span>min&#46; The major difficulties in lobectomy and radical lymph node dissection are dividing the pulmonary arterial branches and lymph node dissection&#46; Our methods were basically identical to that of multi-port VATS&#46; The fissure was first divided by a linear stapler and when the interlobar structures could be seen&#44; we used peanut sponge on the tip of an instrument to dissect bluntly and at times with an electrical cautery as far as the arterial branches and pulmonary vein were exposed&#46; Then the vessels are looped with a clamp attached to a silk &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>A&#41;&#46; The branches were ligated with silk directly and divided by scissors or we used a rotating stapler to divide the arterial branches &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>B&#41;&#46; Lymph node dissection was another difficulty&#46; The one-port must be correctly positioned for dissection of the subcarina lymph node&#46; With a combination of conventional and endoscopic instruments&#44; lymph nodes of each station can be sampled or radically dissected&#46; In the case we described of lung cancer in the upper right lobe&#44; the tumor was about 2&#46;5<span class="elsevierStyleHsp" style=""></span>cm at maximum length and the lymph nodes we dissected were station 3&#44; 4&#44; 7&#44; 10 and 11&#46; The pathology report showed that there was no nodal metastasis of lung cancer&#46; Therefore&#44; the pathological staging was IA&#44; lung adenocarcinoma&#44; T1bN0M0&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Single-port wedge resection was successful in 12 patients&#46; Three patients required another port wound for successful wedge resection because of the problem of location of the first port wound&#46; From our limited experience&#44; it seems that poor port location may cause technical difficulties in the major resection of the lung&#46; We usually marked the tumor location on the CT scan and tried to make an antero-lateral wound corresponding to the intercostal space between anterior and mid-axillary line&#44; usually in the 4th&#44; 5th and 6th intercostal space&#44; thus avoiding wounds that are too lateral or too far back&#46; If the intercostal space was too narrow it would hinder the manipulation of endoscopic instruments&#46; One patient required mini-thoracotomy because the tumor could not be found through gross endoscopic view&#46; We had to try finger palpation to search for the lesion&#46; In the case of soft lesions with air-bronchogram features&#44; preoperative needle localization may be helpful for biopsy without needing to extend for a larger incision&#46; In other groups&#44; techniques such as suture for eventration&#44; herniation&#44; repairing lung laceration and for benign mediastinal tumor resection are feasible&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In brief&#44; nearly 80&#37; of all patients requiring elective thoracoscopic surgery were safely operated by single-port approach&#46; There was less acute pain in the initial 48<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; so this type of procedure is worth trying&#46; Conversion from single-port approach to two-port approach should not be considered a failure but a necessary modification according to circumstances&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">This study is important because it showed the feasibility and usefulness of single-incisional VATS as an appropriate first-line strategy for elective thoracoscopic surgery&#46; Conversion should not be considered as a failure but as a modification because the procedure can be safely accomplished with a second small port wound&#46; The results should encourage thoracic surgeons to try single wound VATS because it was not as time-consuming as we had expected after the initial learning curve&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">With improvements in the design of endoscopic instruments and endoscope&#44; the actual wound size may be further decreased&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The limitation of this study is the fact that this was an initial experiment by a single surgeon for a short period&#46; For more solid evidence&#44; we need to compare the surgical outcomes of different procedures within the same time period&#46; However&#44; to design such a study is not easy because different surgeons prefer different surgical procedures&#44; which is why we presented the results by a single surgeon&#46; The long-term surgical outcomes&#44; long-term safety&#44; and acceptability among thoracic surgeons should be evaluated in the future&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Single-incisional thoracoscopic surgery is technically feasible in most conditions&#46; With similar perioperative outcomes&#44; single-incisional thoracoscopic approach can be a viable alternative to conventional thoracoscopic surgery with multi-port wounds&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "xres547637"
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            0 => "Resumo"
            1 => "Introdu&#231;&#227;o"
            2 => "Materiais e m&#233;todos"
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          "titulo" => "References"
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    "fechaRecibido" => "2012-01-16"
    "fechaAceptado" => "2012-05-02"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec565517"
          "palabras" => array:3 [
            0 => "Thoracoscopy"
            1 => "Video-assisted thoracic surgery"
            2 => "Single-incisional endoscopic Surgery"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:3 [
            0 => "Torascopia"
            1 => "Cirurgia toracosc&#243;pica video-assistida"
            2 => "Cirurgia Endosc&#243;pica de incis&#227;o &#250;nica"
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        "titulo" => "Abstract"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Thoracoscopic surgery has become very popular in recent years&#46; Conventional thoracoscopic surgery requires three or more port wounds for manipulations of endoscopic instruments&#46; For complicated cancer surgery&#44; more port wounds and a larger thoracotomy wound may be required due to technical reasons&#46; We want to investigate the effectiveness of single-port thoracoscopic approach in elective thoracoscopic surgery for thoracic disease&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">From July 1st&#44; 2010 to March 31&#44; 2011&#44; 90 consecutive patients underwent general thoracoscopic surgery performed by the same thoracic surgeon&#46; Two patients with severe trauma and massive bleeding were excluded from the study&#46; All patients included had thoracoscopic surgery with a single-port approach&#46; The surgical outcomes&#44; complications&#44; mortality and conversion rates were recorded and analyzed&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 88 patients were included in this study&#46; All these patients were operated on by the same surgeon&#46; For sixty-eight patients&#44; the single-port thoracoscopic approach was used&#46; Nineteen patients were changed to a two-port thoracoscopic approach and one patient&#39;s was changed to mini-thoracotomy&#46; Two patients died from terminal lung cancer and severe mitral regurgitation&#46; Complications occurred in six cases&#46; Eighty-seven patients &#40;98&#46;8&#37;&#41; were effectively managed with either single-port or a two-port approach&#46; Only one patient was managed by mini-thoracotomy&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Elective thoracoscopic surgery performed through a single-port wound is feasible&#46; Single-incisional thoracoscopic surgery can be safely applied as a first-line approach in most cases of elective thoracoscopic procedures&#46;</p></span>"
      ]
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        "resumen" => "<span><span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A cirurgia toracosc&#243;pica tornou-se muito popular nos &#250;ltimos anos&#46; A cirurgia toracosc&#243;pica convencional requer tr&#234;s ou mais incis&#245;es para manipula&#231;&#227;o dos instrumentos endosc&#243;picos&#46; Para cirurgias de cancro complicadas&#44; podem ser requeridas mais incis&#245;es e uma incis&#227;o toracotomia maior&#44; por raz&#245;es t&#233;cnicas&#46; Pretendemos investigar a efic&#225;cia da abordagem toracosc&#243;pica de incis&#227;o &#250;nica em cirurgias toracosc&#243;pica eletivas&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Materiais e m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Desde 1 de julho de 2010 at&#233; 31 de mar&#231;o de 2011&#44; 90 pacientes consecutivos foram submetidos a cirurgia toracosc&#243;pica geral realizada pelo mesmo cirurgi&#227;o tor&#225;cico&#46; Dois pacientes com trauma grave e hemorragia massiva foram exclu&#237;dos do estudo&#46; Todos os pacientes inclu&#237;dos foram submetidos a cirurgia toracosc&#243;pica com uma abordagem de incis&#227;o &#250;nica&#46; Os resultados cir&#250;rgicos&#44; complica&#231;&#245;es&#44; mortalidade e taxas de convers&#227;o foram registados e analisados&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Um total de 88 pacientes foram inclu&#237;dos neste estudo&#46; Todos estes pacientes foram operados pelo mesmo cirurgi&#227;o&#46; Para sessenta e oito pacientes&#44; foi usada a abordagem de incis&#227;o &#250;nica tor&#225;cica&#46; Dezanove pacientes foram convertidos para uma abordagem dupla porta e um paciente convertido em mini-toracotomia&#46; Dois pacientes morreram de cancro do pulm&#227;o terminal e regurgita&#231;&#227;o mitral grave&#46; Ocorreram complica&#231;&#245;es em seis casos&#46; Oitenta e sete pacientes &#40;98&#44;8&#37;&#41; foram tratados eficazmente com uma abordagem de incis&#227;o &#250;nica ou de incis&#227;o dupla&#46; Apenas um paciente foi tratado por mini-toracotomia&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A cirurgia toracosc&#243;pica eletiva realizada atrav&#233;s de incis&#227;o &#250;nica &#233; vi&#225;vel&#46; A cirurgia toracosc&#243;pica de incis&#227;o &#250;nica pode ser aplicada em seguran&#231;a como uma abordagem de primeira linha na maioria dos casos de procedimentos toracosc&#243;picos eletivos&#46;</p></span>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A case of primary spontaneous pneumothorax&#44; a single incision is just 1&#46;5<span class="elsevierStyleHsp" style=""></span>cm in length &#40;A&#41;&#46; Resection of pulmonary tissue is feasible through a small wound&#46; The chest tube is placed in the same operating port wound &#40;B&#41;&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The picture shows when a lesion was localized&#44; an instrument can be placed to hold lesion and a linear stapler can be used to resect the lesion &#40;A&#41;&#46; The scope can change viewing angle when needed&#46; Without any trocar&#44; such procedure is very easy to perform because the working space will not be limited by the lumen of rigid trocar &#40;B&#41;&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An example of single incisional thoracoscopic surgery for lobectomy of right upper lobe performed in our team&#46; The lobe was dissected and then was placed inside a protecting bag &#40;A&#41;&#46; With gentle force for pulling out&#44; the lobe can be completely removed through the small wound &#40;B&#41;&#46; We applied some jelly as lubricant between the lung&#44; the bag and the wound&#46; The pull-out procedure may take 20<span class="elsevierStyleHsp" style=""></span>min&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">From the first case of primary spontaneous pneumothorax to the most recent case&#44; the operative time decreased significantly when we gained more and more experiences to perform the procedures&#46; The initial attempt took longer time than conventional methods&#46; For uncomplicated cases&#44; the operative time can be less than 30<span class="elsevierStyleHsp" style=""></span>min&#46;</p>"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">An example of hilar dissection of lobectomy of left lower lobe&#46; In the condition of lobectomy through a single port-wound&#46; The arterial branches can be exposed and then looped &#40;A&#41;&#46; After looping with a silk&#44; a rotating linear stappler can be placed for division of the vessels &#40;B&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">VATS&#58; video-assisted thoracoscopic surgery&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Indications for VATS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">One port&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Two port&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mini-thoracotomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Empyema thoracis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Primary spontaneous pneumothorax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lung tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Interstitial lung disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">mediastinal tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Lung laceration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diaphragm herniation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diaphragm eventration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">OP&#58; operation&#59; ICU&#58; intensive care units&#59; VAS&#58; visual analog score&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Approach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Single-port&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Two-port&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Number</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;mean&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;057&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Location</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Right side&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Left side&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">ICU stay</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Hospital stay</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Chest tube placement</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Outcome</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Complication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">VAS for pain</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>48<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>72<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">The characteristics of patients in the group of single and two-port approach&#46;</p>"
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          "bibliografiaReferencia" => array:11 [
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                          ]
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                      "autores" => array:1 [
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                          "etal" => true
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                            2 => "M&#46; Whiteford"
                            3 => "S&#46; Lee"
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                            5 => "M&#46; Mutch"
                          ]
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                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Rehman"
                            1 => "A&#46;M&#46; Rao"
                            2 => "I&#46; Ahmed"
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                        ]
                      ]
                    ]
                  ]
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46;H&#46; Chen"
                            1 => "W&#46;C&#46; Huang"
                            2 => "H&#46;C&#46; Liu"
                            3 => "T&#46;Y&#46; Chen"
                          ]
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                      "Revista" => array:6 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;A&#46; Berlanga"
                            1 => "O&#46; Gigirey"
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                      ]
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                    0 => array:2 [
                      "doi" => "10.1007/s00464-010-1470-7"
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                        "fecha" => "2011"
                        "volumen" => "25"
                        "paginaInicial" => "2044"
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                          "etal" => true
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                            3 => "H&#46;C&#46; Huang"
                            4 => "J&#46;S&#46; Tsai"
                            5 => "C&#46;Y&#46; Chen"
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                    0 => array:2 [
                      "doi" => "10.1186/1749-8090-6-58"
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                        "volumen" => "6"
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                      "titulo" => "Comparison of clinical outcome of single-incision laparoscopic surgery using a simplified access system with conventional laparoscopic surgery for malignant colorectal disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            2 => "K&#46;C&#46; Chung"
                            3 => "K&#46;M&#46; Rau"
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Article information
ISSN: 08732159
Original language: English
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