Uniport vs. multiport video-assisted thoracoscopic surgery for anatomical lung resection—which is less invasive?

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has been recognized as a standard procedure, but whether uniport VATS (U-VATS) is a more effective and minimally invasive approach compared with multiport VATS (M-VATS) is controversial. METHODS: The medical records of 184 patients in the M-VATS group and 69 patients in the U-VATS group who underwent anatomical lung resection from April 2017 to July 2020 at our institution were retrospectively reviewed. Postoperative outcomes were compared among U-VATS and M-VATS. Multivariate analysis was performed to identify factors that reduce postoperative pain. RESULTS: The mean operation time was significantly shorter in U-VATS than in M-VATS (172±43 min in M-VATS vs. 143±43 min in U-VATS, P<0.0001). Duration of postoperative drainage (2.2±1.2 days in M-VATS vs. 1.6±1.0 days in U-VATS, P=0.0002) and hospitalization (4.0±1.6 days in M-VATS vs. 3.1±1.6 days in U-VATS, P=0.0003) were significantly shorter in U-VATS than in M-VATS. The rate of postoperative complications was not significantly different between the groups (P=0.732). The number of analgesic prescriptions over 10 days postoperatively was significantly less in U-VATS than in M-VATS [68 (37.0%) in M-VATS vs. 8 (11.6%) in U-VATS, P<0.0001]. A multivariate logistic regression model showed that U-VATS was the only significant predictor for reduction of postoperative pain (odds ratio =0.204, P=0.0001). CONCLUSIONS: U-VATS shortened the operation time, postoperative drainage duration, and hospitalization compared with conventional M-VATS, and it significantly reduced the use of analgesics. There were no differences in perioperative results such as blood loss and the postoperative complication rate. U-VATS can be said to be a safe and minimally invasive surgical procedure.