Outcomes of single- versus multi-port video-assisted thoracoscopic surgery: Data from a multicenter randomized controlled trial of video-assisted thoracoscopic surgery versus thoracotomy for lung cancer

Initial outcomes with uniportal video-assisted lung resection

OBJECTIVES

Uniportal video-assisted lung resection is increasingly reported, but adoption in North America has been low. This study examines the early experience with the uniportal technique by a surgeon experienced in multiportal thoracoscopic surgery.

METHODS

Operation was performed using a 4-cm incision crossing the anterior axillary line. Primary objectives were to evaluate short-term outcomes, and secondary objectives included evaluation for learning curve and oncological outcomes for patients with non-small cell lung cancer.

RESULTS

Over a 45-month period, 212 patients underwent uniportal lung resection. Procedures included 128 lobectomies (60.4%), 41 segmentectomies (19.3%), 40 wedge resections (18.9%) and 3 extended resections (1.4%). Conversion was required in 24 patients (12.8%); 17 to multiportal surgery and 7 to thoracotomy. Major adverse events occurred in 13 patients (6.1%) and included 3 deaths (1.4%). Median hospital stay was 3 days, and median chest tube duration was 2 days. When comparing the early and late experience, there was no difference in hospital stay, adverse events, conversion and readmissions. The mean number of lymph nodes and nodal stations dissected were 10.08 and 4.79, respectively. The number of nodal stations dissected improved with experience (P < 0.001).

CONCLUSIONS

Uniportal video-assisted lung resection is safe with good perioperative outcomes. Lymph node dissection improved with experience; otherwise, no significant learning curve was demonstrated when transitioning from a multiport approach.