Expert consensus on periareolar concealed uniportal video-assisted thoracoscopic lung resection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Junjie ² , CHEN Maohui ¹ , YU Xiaofeng ⁴ ,  MAO Zhangfan ³ ,  TIAN Dong ² ,  ZHENG Bin ¹ , Representatives of Professional Committee on Minimally Invasive Treatment of Thoracic Oncology, Fujian Anti-Cancer Association, Youth Committee of the Lung Cancer Committee , Fujian Anti-Cancer Association, Thoracic Surgery Branch, Sichuan International Medical Exchange and Promotion Association

1. Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, P. R. China;
4. Department of Thoracic Surgery, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, P. R. China;

Corresponding author：

MAO Zhangfan, Email: lacustrian@163.com; TIAN Dong, Email: 2tiandong@163.com; ZHENG Bin, Email: maozhangfan@whu.edu.cn

Keywords：

Lung resection; uniportal video-assisted thoracoscopic surgery; periareolar approach; expert consensus

DOI：

10.7507/1007-4848.202504069

Video：

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With the ongoing evolution of minimally invasive thoracic surgery techniques, innovative anatomical approaches facilitating rapid perioperative recovery while achieving optimal aesthetic results and pain-free outcomes have become a pivotal direction in pulmonary resection. While periareolar incisions have demonstrated well-established advantages in cosmetic preservation and pain management in breast and thyroid procedures, the standardization of this approach for video-assisted thoracoscopic pulmonary resection requires further refinement. This consensus synthesizes the collective expertise of China's leading thoracic surgery centers in periareolar approach pulmonary resections. It aims to establish comprehensive clinical consensus that encompasses prerequisite surgical criteria, standardized perioperative management protocols, technically optimized operative procedures, and evidence-based complication prevention and management strategies, ultimately providing guidance for the standardized application of this innovative surgical technique.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Lancaster HL, Heuvelmans MA, Oudkerk M. Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research. J Intern Med, 2022, 292(1): 68-80.
3.	Lee KH, Goo JM, Park SJ, et al. Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules. J Thorac Oncol, 2014, 9(1): 74-82.
4.	Yotsukura M, Asamura H, Motoi N, et al. Long-term prognosis of patients with resected adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung. J Thorac Oncol, 2021, 16(8): 1312-1320.
5.	Merlo A, Carlson R, Espey J 3rd, et al. Postoperative symptom burden in patients undergoing lung cancer surgery. J Pain Symptom Manage, 2022, 64(3): 254-267.
6.	Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 55(1): 91-115.
7.	Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
8.	Han D, Cao Y, Wu H, et al. Uniportal video-assisted thoracic surgery for the treatment of lung cancer: A consensus report from Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS) and Chinese Association of Thoracic Surgeons (CATS). Transl Lung Cancer Res, 2020, 9(4): 971-987.
9.	Kesler KA, Brooks-Brunn JA, Campbell RL, et al. Thoracoscopic sympathectomy for hyperhidrosis palmaris: A periareolar approach. Ann Thorac Surg, 2000, 70(1): 314-317.
10.	Austin RE, Saheb-Al-Zamani M, Lista F, et al. Periareolar augmentation-mastopexy. Aesthet Surg J, 2019, 39(9): 953-965.
11.	Oliveira KAS, Lousa A, Souza ML, et al. In-hospital outcomes of right minithoracotomy vs. periareolar access for minimally invasive video-assisted mitral valve repair. Braz J Cardiovasc Surg, 2022, 37(1): 7-12.
12.	Cerezo Madueño F, Arango Tomás E, Algar Algar FJ, et al. Periareolar approach for thoracoscopic lobectomy. Ann Thorac Surg, 2014, 97(4): 1427-1429.
13.	Pérez D, Cano JR, Quevedo S, et al. New minimally invasive technique for correction of pectus carinatum. Eur J Cardiothorac Surg, 2011, 39(2): 271-273.
14.	Fu H, Jin D, Wei Y. Thoracoscopic treatment of primary spontaneous pneumothorax without a drainage tube in male patients. J Int Med Res, 2023, 51(2): 3000605231154394.
15.	Liu Y, Dong P, Zhang S, et al. Transareolar video-assisted thoracoscopic surgery in females: A novel incision for pulmonary ground glass nodule resection. J Laparoendosc Adv Surg Tech A, 2024, 34(6): 490-496.
16.	Mao Z, Dong P, Zhou Q, et al. Periareolar approach in video-assisted thoracoscopic surgery for right middle lobectomy: A novel technique. Surg Endosc, 2024, 38(9): 5457-5463.
17.	Yang Z, Zheng B. Modified periareolar incision for uniportal segmentectomy. J Thorac Oncol, 2024, 19(10): S526.
18.	Tian D, Wang J, Jiang K, et al. The subcutaneous tunneled periareolar approach in lung resection performed through uniportal video-assisted thoracic surgery. J Thorac Dis, 2025, 17(2): 1073-1079.
19.	刘伦旭, 高树庚, 何建行, 等. 非小细胞肺癌术后随访中国胸外科专家共识(2025版). 中国胸心血管外科临床杂志, 2025, 32(3): 281-290.Liu LX, Gao SG, He JX, et al. Chinese expert consensus on postoperative follow-up for non-small cell lung cancer (version 2025). Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 281-290.
20.	Cheng MH, Huang JJ. Augmentation mammaplasty in Asian women. Semin Plast Surg, 2009, 23(1): 48-54.
21.	Sun J, Liu C, Mu D, et al. Chinese women's preferences and concerns regarding incision location for breast augmentation surgery: A survey of 216 patients. Aesthetic Plast Surg, 2015, 39(2): 214-226.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Lancaster HL, Heuvelmans MA, Oudkerk M. Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research. J Intern Med, 2022, 292(1): 68-80.
3. Lee KH, Goo JM, Park SJ, et al. Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules. J Thorac Oncol, 2014, 9(1): 74-82.
4. Yotsukura M, Asamura H, Motoi N, et al. Long-term prognosis of patients with resected adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung. J Thorac Oncol, 2021, 16(8): 1312-1320.
5. Merlo A, Carlson R, Espey J 3rd, et al. Postoperative symptom burden in patients undergoing lung cancer surgery. J Pain Symptom Manage, 2022, 64(3): 254-267.
6. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg, 2019, 55(1): 91-115.
7. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg, 2004, 77(2): 726-728.
8. Han D, Cao Y, Wu H, et al. Uniportal video-assisted thoracic surgery for the treatment of lung cancer: A consensus report from Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS) and Chinese Association of Thoracic Surgeons (CATS). Transl Lung Cancer Res, 2020, 9(4): 971-987.
9. Kesler KA, Brooks-Brunn JA, Campbell RL, et al. Thoracoscopic sympathectomy for hyperhidrosis palmaris: A periareolar approach. Ann Thorac Surg, 2000, 70(1): 314-317.
10. Austin RE, Saheb-Al-Zamani M, Lista F, et al. Periareolar augmentation-mastopexy. Aesthet Surg J, 2019, 39(9): 953-965.
11. Oliveira KAS, Lousa A, Souza ML, et al. In-hospital outcomes of right minithoracotomy vs. periareolar access for minimally invasive video-assisted mitral valve repair. Braz J Cardiovasc Surg, 2022, 37(1): 7-12.
12. Cerezo Madueño F, Arango Tomás E, Algar Algar FJ, et al. Periareolar approach for thoracoscopic lobectomy. Ann Thorac Surg, 2014, 97(4): 1427-1429.
13. Pérez D, Cano JR, Quevedo S, et al. New minimally invasive technique for correction of pectus carinatum. Eur J Cardiothorac Surg, 2011, 39(2): 271-273.
14. Fu H, Jin D, Wei Y. Thoracoscopic treatment of primary spontaneous pneumothorax without a drainage tube in male patients. J Int Med Res, 2023, 51(2): 3000605231154394.
15. Liu Y, Dong P, Zhang S, et al. Transareolar video-assisted thoracoscopic surgery in females: A novel incision for pulmonary ground glass nodule resection. J Laparoendosc Adv Surg Tech A, 2024, 34(6): 490-496.
16. Mao Z, Dong P, Zhou Q, et al. Periareolar approach in video-assisted thoracoscopic surgery for right middle lobectomy: A novel technique. Surg Endosc, 2024, 38(9): 5457-5463.
17. Yang Z, Zheng B. Modified periareolar incision for uniportal segmentectomy. J Thorac Oncol, 2024, 19(10): S526.
18. Tian D, Wang J, Jiang K, et al. The subcutaneous tunneled periareolar approach in lung resection performed through uniportal video-assisted thoracic surgery. J Thorac Dis, 2025, 17(2): 1073-1079.
19. 刘伦旭, 高树庚, 何建行, 等. 非小细胞肺癌术后随访中国胸外科专家共识(2025版). 中国胸心血管外科临床杂志, 2025, 32(3): 281-290.Liu LX, Gao SG, He JX, et al. Chinese expert consensus on postoperative follow-up for non-small cell lung cancer (version 2025). Chin J Clin Thorac Cardiovasc Surg, 2025, 32(3): 281-290.
20. Cheng MH, Huang JJ. Augmentation mammaplasty in Asian women. Semin Plast Surg, 2009, 23(1): 48-54.
21. Sun J, Liu C, Mu D, et al. Chinese women's preferences and concerns regarding incision location for breast augmentation surgery: A survey of 216 patients. Aesthetic Plast Surg, 2015, 39(2): 214-226.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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