Uniportal thoracoscopic pulmonary segmentectomy provides good perioperative results and early postoperative recovery

Abstract

Background: Although video-assisted thoracoscopic surgery (VATS) segmentectomy has become widespread, the advantage of uniportal VATS (U-VATS) segmentectomy over multiportal VATS (M-VATS) remains controversial. The purpose of this study was to verify the safety and usefulness of U-VATS segmentectomy compared with conventional hybrid/multiportal segmentectomy.Methods: Here, we retrospectively reviewed the data from anatomical pulmonary segmentectomy cases in a single institution from March 2010 to March 2021. Patients were divided into the U-VATS and hybrid/ multiportal VATS (H/M-VATS) groups. Perioperative results were compared between the groups after matching for patient background characteristics. In addition, cases of complex segmentectomy were selected from each group and compared in terms of perioperative results.Results: A total of 180 patients underwent pulmonary segmentectomy during the study period at this institution, comprising 57 cases in the U-VATS group and 123 cases in the H/M-VATS group. After matching for age, sex, disease, tumor location, and type of segmentectomy, no significant differences between the groups were seen in blood loss, major intraoperative bleeding, rate of conversion to thoracotomy, postoperative complications, or re-hospitalization within 30 days after discharge. Operation time (141±46 vs.174±45 min, P<0.001), postoperative drainage duration (1.5±1.2 vs. 2.3±1.8 days, P=0.007), and postoperative hospital stay (3.4±2.0 vs. 4.6±2.5 days, P=0.006) were significantly lower in the U-VATS group. Subgroup analysis of the complex segmentectomy cases also revealed that operation time (146±34 vs. 185±47 min, P<0.001), postoperative drainage duration (1.5±1.3 vs. 2.2±1.2 days, P=0.021), and postoperative hospital stay (3.0±1.4 vs. 4.9±2.1 days, P<0.001) were significantly reduced in the U-VATS group.Conclusions: U-VATS segmentectomy appears as safe and feasible as H/M-VATS segmentectomy. An experienced surgeon can make a smooth transition to U-VATS.

Combined basilar subsegmentectomy for intralobar sequestration via uniportal VATS: a case report

“…However, a previous study has reported U-VATS for treating ILPS and that uniportal VATS is comparable to multiportal VATS in terms of blood loss, surgical time, and postoperative outcomes [ 2 ]. Interestingly, a recent report revealed that U-VATS segmentectomies are better than multiportal VATS segmentectomies in postoperative outcomes [ 4 , 5 ]. Factors including postoperative symptom relief and recovery time for U-VATS are encouraging.…”

The pros and cons of uniportal VATS segmentectomy in the treatment of early-stage lung cancer: should the procedure be prioritized?

“…Can we demonstrate a similar difference between multi-portal VATS and uniportal VATS? Although there are some data suggesting the benefit of uniportal VATS over multi-portal VATS (16,17), contradictory data also exist (18). Specifically, one or two additional small ports (5 mm or less) would not compromise the benefit of the uniportal VATS regarding post-operative pain (19).…”

Is it true that less is more in thoracic surgery?

“…As reported in the study titled “ Uniportal thoracoscopic pulmonary segmentectomy provides good perioperative results and early postoperative recovery ” by Numajiri et al ( 1 ), uniportal video-assisted thoracoscopic surgery (U-VATS) segmentectomy appears as safe and feasible as hybrid/multiportal video-assisted thoracoscopic surgery (H/M VATS) segmentectomy. They also stated that an experienced surgeon can make a smooth transition from H/M VATS to U-VATS.…”

“…However, most of procedures are performed using M-VATS in Japan because of the lack of sufficient evidence to prove the superiority of U-VATS to M-VATS. Numajiri and colleagues reported their experiences of U-VATS segmentectomy and compared it with their early experiences of H/M VATS in this issue of the journal ( 1 ).…”