Single-Port VATS vs Multiport VATS Multi-Institutional Single-Surgeon Training Experience Comparison

Abstract

The technique of single-port VATS surgery is widely practised. However, the safety and efficacy of this approach are not widely described. From 1 February 2015 to 15 July 2017 single-trainee multi-institutional supervised primary operator case series data were prospectively collected and retrospectively analysed comparing single-port video-assisted thoracoscopic surgery (VATS) versus standard multiport VATS. Multivariate analysis was performed on multiple clinical variables. A total of 243 patients underwent 316 procedures with 103 (32.6%) patients in the single-port VATS group. Mean age of the single-port VATS group was 52.2 years versus 58.1 years in the multiport VATS group. The proportion of patients over 80 years of age was 9.75% in the single-port group versus 5.6% in the multiport group. Two groups were almost equally gendered, with the male to female ratio being 62:38. The proportion of complex single-port surgery was lower, with only 21.4% versus 46.5% in the multiport cohort; however, complex sublobar and sleeve VATS resections were only performed multiport under supervision in the subspecialty thoracic unit. The total number of complications in the single-port cohort was 2.9% versus 5.6% in the multiport group. Conversion rate to open was 1.4% in the multiport group versus 0% in the single-port group. This was likely due to the less complex nosology dealt with, as well as the learning curve. Redo surgery either for bleeding or persistent infection or air leak was required in 1.9% of single-port cases versus 2.3% multiport cases. Comparable results in both groups likely represent learning curve experience and patient selection. The length of stay was 4.24 days for single-port patients and 4.89 days for multiport patients.