Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax—a propensity matched bicentric study

Abstract

Background: The role of triportal video-assisted thoracoscopic surgery (VATS) is widely recognized for the treatment of primary spontaneous pneumothorax (PSP). The aim of this study was to assess the effectiveness and the potential advantages of uniportal VATS (U-VATS) for the treatment of PSP compared with triportal VATS. Methods: A total of 104 triportal (n=39) and uniportal (n=65) VATS procedures where performed for the treatment of PSP in two University hospitals. The prospectively collected data of postoperative outcomes were retrospectively reviewed and a 1:1 propensity score matching analysis was performed to compare the two VATS approaches. Results: No major adverse events occurred after operation. Compared with triportal-VATS, Uniportal-VATS showed the same effectiveness in terms of risk of recurrence (null in both groups), post-operative complications (P=1.000) and operating time (66.04±16.92 vs. 74.57±21.38 min, P=0.141). However, there was a statistically significant difference in favor of uniportal-VATS in terms of necessity of further access [0 vs. 7 (30.4%), P=0.004], chest tube duration (4.39±1.41 vs. 6.32±0.94 days, P<<0.001), postoperative hospital stay (4.78±1.31 vs. 6.61±1.67 days, P<<0.001), visual analogue pain score (VAS) at 24 hours (3.45±1.41 vs. 6.44±2.45, P<<0.001), number of patients who had pain after chest drain removal [1 (4.3%) vs. 16 (69.6%), P<<0.001], VAS after drainage removal (0.11±0.47 vs. 2.74±2.25, P<<0.001), postoperative pain duration (2.50±1.20 vs. 14.82±37.41 days, P<<0.001), pain killers intake (0.75±1.06 vs. 7.53±3.96 days, P=0.001), chronic paresthesia (level scale: 0 to 2; 0 vs. 0.52±0.66, P<<0.001), chronic neuralgia (0 vs. 0.43±0.59, P<<0.001) and cosmetic results (level scale: 0 to 3; 2.91±0.28 vs. 2.00±0.77, P<<0.001). Conclusions: U-VATS is feasible and safe and may be a less invasive alternative to triportal VATS for the treatment of PSP because of its effectiveness in reducing postoperative pain, paresthesia, hospital stay and in improving cosmetic results.

Minimally invasive approach to pneumothorax: Single port or two ports?

“…They also showed that the SP group had significantly less pain on the same day, the first day, and the second day of the operation. Nachira et al [7] showed no significant difference between the SP and three-port VATS groups in terms of mortality, recurrence, and complications and reported that SP-VATS technique was clinically as safe as three-port VATS technique. The results of a recent meta-analysis also support these findings.…”

“…[6] Compared to open surgery, it has been clearly shown that traditional VATS has a greater advantage in terms of shorter postoperative stay, operative time, and duration of chest tube drainage and less postoperative pain, and more rapid recovery due to its less invasive nature. [7][8][9] Video-assisted thoracoscopic surgery using a SP is a safe and effective approach for the surgical treatment of pneumothorax. [5] An acceptable rate of recurrence, better patient satisfaction, and improved tolerability are shown in the VATS technique.…”

“…The SP approach has emerged as an alternative to the traditional method. [6,7] The SP-VATS technique was first described by Migliore and popularized by Rocco et al [10][11][12][13] In 2013, they published their 10-year experience. [14] The singleincision technique has gained popularity over the past few years, compared to multiple incisions.…”

“…[5] In pneumothorax surgery, bullectomy and pleurodesis are the most effective treatments which reduce the recurrence rate. [7] According to the British Thoracic Society report, bullectomy and pleurodesis are recommended for the surgical treatment of recurrence. [20] Although many thoracic surgeons prefer mechanical pleural abrasion or pleurectomy for benign diseases, there is no study comparing the significant long-term complications of talc pleurodesis in young patients.…”

Next-day discharge following small uniportal thoracoscopic bullectomy assisted with an anchoring suture

“…7 However, surgery should also be selected strictly based on the risk factors and the patients' wishes to avoid overtreatment. 8 U-VATS may have advantages over a multiport procedure in terms of postoperative pain, 9,10 but high-quality evidence is still lacking. The major concern of U-VATS is the collision of the instruments through a single port, necessitating a relatively long skin incision (at least >20 mm).…”