Uniportal approach as an alternative to the three-portal approach to video-assisted thoracic surgery for primary spontaneous pneumothorax

BACKGROUND: In recent years, uniportal video-assisted thoracic surgery (U-VATS) has been used for primary spontaneous pneumothorax (PSP). This study compared the perioperative outcomes of U-VATS and three-port VATS (3P-VATS) and sought to determine the risk factors for postoperative recurrence. METHODS: From October 2010 to February 2017, 232 patients with PSP undergoing surgical treatment were enrolled in this study. The patients were divided into two groups: U-VATS (n=161) and 3P-VATS (n=71) depending on the period of surgery. Retrospective analysis of the perioperative results and the risk factors for recurrence was performed. RESULTS: Both the operation time and duration of postoperative drainage were initially longer in the U-VATS group, but the difference gradually decreased such that ultimately there was no significant difference compared to the 3P-VATS group (P=0.10 and P=0.12, respectively). The duration of postoperative hospital stay and postoperative recurrence rate were not different between the two groups (P=0.084 and P=0.44, respectively). By multivariate analysis, the age (HR, 0.42, 95% CI: 0.24−0.72, P<0.01) and number of bullae (single vs. multiple: HR, 0.03, 95% CI: 0.002−0.54, P=0.02) were risk factors for recurrence. CONCLUSIONS: The perioperative results and recurrence rate did not differ between the U-VATS and 3P-VATS groups, thereby demonstrating the non-inferiority of U-VATS. Postoperative risk factors for PSP recurrence were patient age and the number of bullae. Additional treatment may be needed to reduce recurrence in young patients with multiple bullae. Clinical registration number: The Institutional Review Board of Maebashi Red Cross Hospital (no. 2019-21).