Uniportal versus Multiportal Thoracoscopic Complex Segmentectomy: Propensity Matching Analysis

Abstract

Purpose: Uniportal video-assisted thoracoscopic surgery (VATS) complex segmentectomy has been challenging for thoracic surgeons. This study was designed to compare the perioperative outcomes between uniportal and multiportal VATS complex segmentectomy. Methods: Data on a total of 122 uniportal and 57 multiportal VATS complex segmentectomies were assessed. Propensity score (PS) matching yielded 56 patients in each group. A crude comparison and PS matching analyses, incorporating preoperative variables, were conducted to elucidate the short-term outcomes between uniportal and multiportal VATS complex segmentectomies. Results: The uniportal group had a significantly shorter operation time (173 min vs. 195 min, p = 0.004), pleural drainage duration (2.5 d vs. 3.5 d, p <0.001), and postoperative hospital stay (4.2 d vs. 5.3 d, p <0.001) before matching, and a significant difference was also observed after matching for pleural drainage duration (2.5 d vs. 3.6 d, p <0.001) and postoperative hospital stay (4.5 d vs. 5.2 d, p = 0.001). The numbers of dissected lymph nodes in N1 and N2 stations, the intraoperative and postoperative complication rates were not significantly different between these two groups. Conclusions: The uniportal VATS complex segmentectomy was not inferior to multiportal VATS in terms of perioperative outcomes and therefore should be considered as a viable surgical approach for treatment.

Technical aspects and early results of uniportal video-assisted thoracoscopic complex segmentectomy: a 30 case-series study

“…Segmentectomy can be subdivided into simple and complex segmentectomy according to the condition of the intersegmental boundaries [ 8 ]. The ability to obtain a ≥ 2-cm safe surgical margin is the key factor that makes complex segmentectomy superior to simple segmentectomy [ 7 , 11 , 13 ]. With the use of the reconstruction software “Mimics”, we designed a complex segmentectomy based on nodule-centered surgical planning with parenchymal resection margins ≥ 2 cm and a subsegment as a surgical unit.…”

Safety and feasibility of uniportal video-assisted thoracoscopic uncommon segmentectomy

“…We mainly use a stapler to create an intersegmental plane, and we previously reported no significant differences in perioperative results including blood loss, operation time, drainage, hospitalization and morbidity between common and uncommon segmentectomy group (16). Several papers comparing the results of segmentectomy by M-VATS and U-VATS have been reported, all of which were comparable (14,17,18). A technical difficulty with U-VATS is that the angle of the forceps and stapler insertion is limited.…”

Technical Aspects And Early Results of Uniportal Video-Assisted Thoracoscopic Complex Segmentectomy: A 30 Case-Series Study

“…Segmentectomy could be subdivided into simple and complex segmentectomy according to condition of the intersegmental boundaries [8]. The ability to obtain a ≥2 cm safe surgical margin is the key factor that makes complex segmentectomy superior to simple segmentectomy [7][13] [11]. With the use of reconstruction software "Mimics", we designed the complex segmentectomy based on a nodule centered surgical planning with parenchymal resection margins ≥2 cm and subsegment as a surgical unit.…”

“…It is generally considered that it can be more difficult to divide complex segments when instruments are operated in a single direction or are limited by angle changes in UP-VATS [14][15] [11]. However, with accumulated experience and familiarity with anatomy and operation techniques, the UP-VATS complex segmentectomy could be performed safely [15][16] [17].…”

“…Complex segmentectomy creates several, or intricate intersegmental planes, with more a complex procedure [7][8] [4] [9]. Currently, few articles have addressed complex segmentectomy, a procedure that may be particularly challenged in the setting of UP-VATS, as the dexterity and fineness of instrument operation under UP-VATS are limited [10] [11] [12].…”