Single-port Video-assisted Thoracic Surgery Research Articles

Subxiphoid Single-Port Robotic Thymectomy Using the Single-Port Robotic System versus VATS: A Multi-Institutional, Retrospective, and Propensity Score-Matched Study.

Subxiphoid thymectomy is a novel alternative to the transthoracic approach and sternotomy, with potential benefits, such as reduced postoperative pain and faster recovery. We previously reported the initial experience with subxiphoid single-port robotic-assisted thoracic surgery (SRATS) thymectomy using the single-port robotic system (SPS). However, the efficacy of this technique remains unknown. Thus, this study examined the multi-institutional experience with SRATS thymectomy and compared the perioperative outcomes of this technique to those of subxiphoid single-port video-assisted thoracic surgery (SVATS) thymectomy. The data of patients who underwent subxiphoid SRATS and SVATS thymectomy, performed by three thoracic surgeons at three institutions between September 2018 and May 2024, were retrospectively collected. In total, 110 patients were included, with 85 and 25 undergoing SRATS and SVATS thymectomy, respectively. After propensity score matching, 25 patients were included in each group. The SRATS group was associated with a lower conversion rate to multi-port surgery (0% vs. 20%, p = 0.05), shorter chest tube drainage duration (1.32 ± 0.75 vs. 2.00 ± 1.29 days, p = 0.003), and a shorter postoperative hospital stay (2.52 ± 1.00 vs. 5.08 ± 5.20 days, p = 0.003). Subxiphoid SRATS thymectomy using the SPS is feasible and is a good alternative to conventional thymectomy. Further studies are necessary to confirm its benefits.

Electronic symptom monitoring after lung cancer surgery: establishing a core set of patient-reported outcomes for surgical oncology care in a longitudinal cohort study.

Electronic symptom monitoring via patient-reported outcome in surgical oncology is limited owing to lengthy instruments and non-specific items in common patient-reported outcome instruments. To establish electronic symptom monitoring through a clinically relevant and fit-for-purpose core set of patient-reported outcome in patients undergoing lung cancer surgery. One qualitative (Cohort 1) and two prospective studies (Cohorts 2 and 3) were conducted between 2018 and 2023. Patients undergoing lung cancer surgery were recruited. Items of symptoms and daily functioning were generated through extensive interviews in Cohort 1 and incorporated into a smartphone-based platform to establish the electronic Perioperative Symptom Assessment for Lung surgery (ePSA-Lung). This tool was finalized and validated in Cohort 2. Patients in Cohort 3 were longitudinally monitored for the first year post-surgery using the validated ePSA-Lung. In total, 1,037 patients scheduled for lung cancer surgery were recruited. The 11-item draft PSA-Lung was generated based on qualitative interview with 39 patients and input from a Delphi study involving 42 experts. A 9-item ePSA-Lung was finalized by assessing 223 patients in the validation cohort; the results supported the instrument's understandability, reliability, sensitivity, and surgical specificity. In Cohort 3 (n=775), compliance ranged from 63.21% to 84.76% during the one-year follow-up after discharge. Coughing, shortness of breath, and disturbed sleep were the most severe symptoms after discharge. Longitudinally, patients who underwent single-port video-assisted thoracic surgery had a lower symptom burden than those who underwent multi-port video-assisted thoracic surgery or thoracotomy (all symptoms, P<0.001). The ePSA-Lung is valid, concise, and clinically applicable as it supports electronic symptom monitoring in surgical oncology care. The need for long-term extensive care was identified for patients after discharge, even in early-stage cancer with potential curative treatment.

Single- versus multi-port video-assisted thoracic surgery for pulmonary aspergilloma: a propensity-matched study.

The utilization of single-port video-assisted thoracic surgery for pulmonary aspergilloma (PA) has not been well studied. The study was performed to evaluate the safety and feasibility of it for PA compared with multi-port video thoracic-assisted surgery. From August 2007 to December 2019, consecutive PA patients receiving surgeries at Shanghai Pulmonary Hospital were enrolled retrospectively. Propensity score matching based on preoperative clinical variables was utilized to compare perioperative and long-term outcomes. In all 358 patients, a total of 63 patients underwent single-port video-assisted thoracic surgery, and 63 out of 145 patients for multi-port surgeries were paired with the single-port video-assisted thoracic surgery recipients. The median follow-up period was 40 months (range, 2-140 months). Patients receiving single-port video-assisted thoracic surgery showed a similar operation time, intraoperative blood loss, drainage duration and drainage volume to those of multi-port video-assisted thoracic surgery recipients (P > 0.05). Patients undergoing lobectomy by single-port approach experienced a shorter postoperative hospital stay {4.9 [standard deviation (SD): 2.0] vs 5.9 (SD: 2.3), P = 0.014}. The average postoperative pain scores [day 0: 2.6 (SD: 0.7) vs 3.1 (SD: 0.8), day 3: 4.0 (SD: 0.9) vs 4.8 (SD: 3.9), day 7: 2.2 (SD: 0.5) vs 3.1 (SD: 0.8), P < 0.001] and the number of days that patients required analgesic agents [3.0 (SD: 2.2) vs 4.8 (SD: 2.1), P < 0.001] were also decreased in the single-port video-assisted thoracic surgery group. Single-port video-assisted thoracic surgery is a safe and feasible alternative to multi-port video-assisted thoracic surgery for simple PA and selected complex ones, with a potential advantage of reduced postoperative pain.

Uniportal video-assisted thoracic S9+10 segmentectomy using a single-direction approach is good for pulmonary function

BackgroundUniportal video-assisted thoracic surgery is still a technical challenge, especially anatomical segmentectomy for the lateral basal segment (S9), posterior basal segment (S10), or both (S9+10). Different surgical procedures determine a variable pulmonary functional reduction depending on the extent of the resection. This study aimed to compare the efficiency of uniportal video-assisted thoracic surgery S9+10 segmentectomy with video-assisted thoracic surgery basal segmentectomy in preserving pulmonary function. MethodsThe patients who had undergone single-port video-assisted thoracic surgery S9+10 segmentectomy using a single-direction approach were age, sex, and pulmonary function matched with those undergoing video-assisted thoracic surgery basal segmentectomy. The pulmonary function tests were performed preoperatively, and at 3 and 6 months postoperatively. The operative details, postoperative complications, and pulmonary function were statistically analyzed. ResultsAfter matching, a total of 46 patients undergoing video-assisted thoracic surgery S9+10 segmentectomy and 58 patients undergoing video-assisted thoracic surgery basal segmentectomy were eligible for analysis. There was no significant difference in the average blood loss, the duration of chest tube, intensive care unit stay, or hospital stay between these 2 groups. There were no major postoperative complications and surgical mortality was found in the 2 groups. The uniportal video-assisted thoracic surgery S9+10 segmentectomy group had a greater preserved pulmonary function (concerning the values of the forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second %, and diffusion capacity of carbon monoxide %) than video-assisted thoracic surgery basal segmentectomy group at 1 and 3 months postoperatively. ConclusionUniportal video-assisted thoracic surgery anatomic S9+10 segmentectomy using a single-direction approach was safe and feasible for early stages of nonsmall cell lung cancer, and it offered significantly better functional preservation compared with basal segmentectomy.

Comparison of Chronic Postsurgical Pain Between Single-Port and Multi-Port Video-Assisted Thoracoscopic Pulmonary Resection: A Prospective Study.

Background Little is known about the prevalence of chronic postsurgical pain (CPSP) among patients receiving single-port video-assisted thoracic surgery (SP-VATS) compared with those undergoing multi-port VATS (MP-VATS). This study aimed to compare the incidence of CPSP between SP-VATS and MP-VATS lung resection and assess how the pain affected the daily living activities of this patient population. Methods We prospectively collected data regarding the demographic features, clinical factors during surgery, the intensity of acute postoperative pain, and complications after surgery among patients receiving elective SP-VATS or MP-VATS lung resection at our institution between June 2015 and August 2018. At 3-, 6-, and 12-months following surgery, the patients were followed up through a telephonic interview. The Brief Pain Inventory-Short Form was adopted to assess the incidence, severity and location of the CPSP, analgesic consumption, as well as the interference of pain with daily activities. Results In total, 476 patients were screened for eligibility, 411 patients were followed up for 12 months and included in final analysis. Among these, 190 patients had undergone an SP-VATS pulmonary resection and 221 had an MP-VATS pulmonary resection. At both 3 and 6 months, the incidence of CPSP in the SP-VATS group was lower than that in the MP-VATS group (25.3 vs. 38.0%, p = 0.006; 11.1 vs. 19.0%, p = 0.026, respectively). At 12 months after surgery, the prevalence of CPSP was comparable between groups (4.7 vs, 9.0%, p = 0.089). In addition, the SP-VATS technique alleviated pain interference with the daily living activities of patients with CPSP in several domains, including sleep, mood, and enjoyment of life compared with the MP-VATS technique. The two predictive factors for CPSP at postoperative 3 months were the MP-VATS technique (odds ratio [OR] = 1.792, p = 0.019) and postoperative chemotherapy (OR = 1.718, p = 0.033). Conclusions This study indicated that the SP-VATS technique reduced the prevalence of CPSP at 3- and 6-months post-pulmonary resection compared with the MP-VATS technique. The SP-VATS technique also significantly alleviated pain interference with the daily living activities of the patients.

Comparison of single-port, multi-port video-assisted thoracoscopic and open lobectomy for children: a single-center experience.

The feasibility of single-port video-assisted thoracic surgery (SPVATS) for pediatric lobectomy has not been clearly established. We compared the feasibilities of single-port (SP), multi-port (MP) VATS and open lobectomy (OL) for surgical treatment of children with lung disease. In this study, we retrospectively analyzed and compared data for 22,19 and 30 pediatric lung disease patients who had been subjected to SP, MP and OL, respectively. These procedures were performed between March, 2012 and August, 2020 at the Second Affiliated Hospital of Wenzhou Medical University. Perioperative clinical indicators were analyzed. Compared to OL, SP was associated with lower intraoperative blood loss (p = 0.008), lower postoperative thoracic drainage volume (p = 0.041),shorter chest drainage duration (p = 0.002) and hospital stay (p = 0.001). Operation time (p = 0.437), volume of estimated blood loss (p = 0.979), conversion rate to thoracotomy (p = 0.861), total thoracic drainage volume (p = 0.824), duration of chest tube drainage (p = 0.543), length of hospital stay (p = 0.812) and incidences of postoperative complications were comparable in MP and SP groups. SPVATS is a safe and feasible approach for lobectomy in pediatrics, with comparable postoperative clinical outcomes to MPVATS and better outcomes relative to OL. However, studies with large sample sizes in multicenter should be performed to verify our findings.

Prognostic significance of postoperative longitudinal change of serum carcinoembryonic antigen level in patients with stage I lung adenocarcinoma completely resected by single-port video-assisted thoracic surgery: a retrospective study.

BackgroundPatients with stage I lung adenocarcinoma (LUAD) have varying postoperative prognosis. This study aimed to investigate the prognostic significance of postoperative longitudinal change of serum carcinoembryonic antigen (CEA) level in patients with stage I LUAD.MethodsThe study cohort comprised 241 patients with stage I LUAD completely resected with single-port video-assisted thoracic surgery (VATS). The patients were categorized into 4 groups according to the postoperative longitudinal change of serum CEA levels measured in the third and sixth months after surgery: the NN group (continuously normal), HN group (increase first and then decrease), NH group (decrease first and then increase), and HH group (continuously high). Recurrence-free survival (RFS) was analyzed by the Kaplan-Meier method and compared by log-rank test. A nomogram was developed to predict recurrence in the stage I LUAD patients.ResultsIn univariate analysis, differentiation (P<0.001), visceral pleural invasion (VPI) (P=0.025), tumor diameter (P<0.001), tumor-node-metastasis (TNM) stage (P=0.008), preoperative CEA levels (≥10.0 vs. <10.0 ng/mL, P<0.001), and postoperative CEA grouping (NH/HH vs. NN/HN, P<0.001) were significant prognostic factors for stage I LUAD patients. Multivariate analysis showed that tumor diameter (P=0.009) and postoperative CEA grouping (P<0.001) were considered to be independent prognostic factors of postoperative recurrence of stage I LUAD. Tumor diameter (≥20 mm) and postoperative CEA (NH/HH vs. NN/HN) were associated with worse RFS. Receiver operating characteristic (ROC) curve analysis showed that postoperative CEA (NH/HH vs. NN/HN) have high sensitivity (64.7%) and specificity (83.2%) for early prediction of postoperative recurrence of stage I LUAD. The area under curve (AUC) value was 0.745. The nomogram based on multivariate Cox regression had a concordance index (value of 0.789). The calibration plot showed that the predicted probabilities closely matched the observed probabilities.ConclusionsLongitudinal change in serum CEA level after surgery was found to be an independent unfavorable prognostic factor in completely resected stage I LUAD patients. The NH group and HH group were significantly associated with worse RFS. A nomogram was established to predict the postoperative recurrence of patients with stage I LUAD.

Video-Assisted Thoracic Surgery Thymectomy: Subxiphoid Approach.

In this paper, I present the technique of subxiphoid single-port video-assisted thoracic surgery (VATS) thymectomy for thoracic surgeons to perform this procedure safely. This procedure is indicated for all anterior mediastinal masses and may be extended to lung cancer. The patient is placed in the lithotomy position, and the operator should be on the midline. Below the xiphoid process, a skin incision is made 4–5 cm horizontally at a single thumb’s width down. Under two-lung ventilation, CO2 is insufflated, maintaining 10 mm Hg. The fat tissue and thymic tissue are all resected from the sternum and pericardium between both phrenic nerves using an articulated grasper and an energy device. After retrieval of the mass with a wrap bag, a Jackson-Pratt drain is inserted instead of a chest tube. One of the advantages of this procedure is less postoperative pain than intercostal VATS. The subxiphoid approach can be used for bilateral pneumothorax, bilateral pulmonary metastasectomy, and simple lobectomy for both upper lobes and the right middle lobe.

Are postoperative pain and patient satisfaction influenced by the number of ports in VATS for malignant pleural effusion treatment?

ABSTRACTObjectives: The aim of this research is by using sociological methods of scientific research for tracking the pain and satisfaction indicators to prove that decreasing the number of ports in the VATS (Video-assisted thoracic surgery) for Malignant Pleural Effusion reduces postoperative pain and improves patient’s satisfaction.Methods: Our study included 117 VATS procedures performed in the period from 01 January 2013 to 31 September 2016. The sociological method used to measure the pain indicator was an interview. The severity of postoperative pain was determined and reported according to a ten-point pain visual analogue scale (VAS). The degree of satisfaction was determined and reported according to a six-point and ten-point grading systems on the basis of a research interview procedure.Results: In the single-port method, the verbal pain scale for all the days covered by the research study statistically showed significantly lower values (P ˂ 0.0001) in comparison with the conventional method (P ˂ 0.0001). With regard to the patient’s satisfaction, determined on the basis of the six-point system, the results were as follows: conventional VATS approach – average 3.1 with a standard deviation of 1.1 and ranging from 0 to 5; single-port VATS approach – average 4.3 with a standard deviation of 1.0 and within the range from 0 to 6. Conventional VATS approach – 6.8 – neutral. Single-port VATS approach – 8.1 – prevailing satisfaction.Conclusions: Based on our study and the studies of other authors, it can be concluded that postoperative pain and satisfaction after VATS in patients with MPE (Malignant pleural effusion) are influenced by the number of ports and the one-port technique shows better results than the conventional three-port method.The research study was registered and approved by the Clinical Research and Ethics Committee at the ‘Prof. Dr. Stoyan Kirkovich’ AD University Multi-Profile Hospital for Active Treatment Hospital, Stara Zagora. According to Protocol No. 11, Ref. No. 12471/30.10.2015 approved are the methods used by the sociological research study which uses predefined indicators to track patients who have undergone conventional VATS and single-port VATS. Indicators: postoperative pain and satisfaction.

Unilateral single-port thoracoscopic surgery for bilateral pneumothorax\xa0or\xa0pulmonary bullae

BackgroundRapid rehabilitation surgery has become a widely accepted approach. Thoracic surgeons have attempted in many ways to make surgery less invasive. We combined tubeless technology, single-port technology and mediastinum approach for the treatment of simultaneous bilateral primary spontaneous pneumothorax(PSP)or pulmonary bullae. And we evaluated its therapeutic effect. This study aimed to investigate if tubeless single-port video-assisted thoracic surgery (Tubeless-SPVATS) via anterior mediastinum can be used as an alternative surgical treatment for bilateral lung diseases, especially for concurrent or contralateral recurrence PSP.MethodsFrom November 2014 to December 2016, 18 patients with simultaneous bilateral PSP or pulmonary bullae were treated with tubeless -SPVATS via anterior mediastinum. They were 13 males and 5 females with an average age of 20.2 ± 2.3 years (17 to 24 years). They all had preoperative chest CT and were diagnosed with simultaneous bilateral PSP or pulmonary bullae.ResultsFifteen patients underwent bilateral bullae resection with Tubeless-SPVATS via anterior mediastinum. Three patients underwent bilateral single-port video-assisted thoracic surgery. No thoracotomy was performed. No death and grade 3-4 mobidity were found. All the patients started eating 6 hours after surgery. The average operation time was 44.56±17.8min. The patients were discharged 3. 5±1.0 days postoperatively.ConclusionsTubeless-SPVATS via anterior mediastinum is a safe and feasible treatment for patients with simultaneous bilateral PSP or pulmonary bullae. However,contralateral thoracic is not explored fully enough. And when contralateral lung bullae are located near the hilum, endoscopic linear stapler cannot be easily used to conduct suture. Thus, the recurrence rate after performing Tubeless-SPVATS may be increased compared to performing thoracotomy. However, compared to bilateral thoracic surgery, this method reduced postoperative pain. And it took significantly less time than bilateral thoracic surgery. Thus, this method has some clinic value.

Posterior fissure first approach in single port video-assisted thoracoscopic surgery

More than 20 years have passed since thoracoscopic surgery became common as a low-invasive surgery. Thoracic surgeons have since aimed for further low-invasive surgical treatments and progress in this concept has resulted in an increase in reduced port surgery and new procedures such as robot-assisted surgery. Single-port video-assisted thoracic surgery (SPVATS) has already become common in some countries. It is an ultimate form of reduced port surgery and can be applied for the surgical treatment of most surgically-treated diseases including lung cancer. Regarding the approach to the interlobular regions in surgical procedures, it has been discussed which of the anterior fissure first and posterior fissure first is appropriate for multi-port VATS (M-VATS). In this report, the propriety of the posterior fissure first approach to the interlobular region in SPVATS lobectomy for early lung cancer is reviewed.

Is single-port video-assisted thoracic surgery for mediastinal cystectomy feasible?

BackgroundVideo-assisted thoracic surgery (VATS) for mediastinal cysts has been used with increasing frequency. Both single-port VATS and three-port VATS procedures are used for mediastinal cystectomy. Few studies have been published to compare three-port VATS and single-port VATS procedures in mediastinal cystectomy.MethodsForty-five patients with mediastinal cysts who underwent single-port procedures (n = 23) or three-port procedures (n = 22) in our department from January 2016 to July 2018 were retrospectively analysed. The perioperative conditions and pathological findings were analysed.ResultsThe single-port group showed shorter operation times [45 (35–60) vs 55 (45–80) min, p = 0.013], less retention time of the thoracic drainage tube [27(24–48) vs 48(48–70) p < 0.001)], shorter postoperative hospital stays [5(4–6) vs 7(5–7), p = 0.011] and less costs [2.0)1.2–2.5) vs 2.5(1.9–3.5), p = 0.032] than those of the three-port group. No difference was found in case conversions to open procedures (p > 0.99) or second operations (p > 0.99). Logistic regression analysis showed that the surgical method (p = 0.426) and surgeon experience (p = 0.719) were not independent prognostic factors for the success of surgery.ConclusionsThe single-port VATS procedure was not inferior to the three-port VATS procedure for mediastinal cystectomy. The single-port VATS procedure is a feasible choice for mediastinal cystectomy.

Transitioning from multiple ports to a single port in video-assisted thoracic surgery: early results

Single-port video-assisted thoracic surgery (SPVATS) is a relatively new minimally invasive thoracic approach and is rapidly being adopted around the world. SPVATS is not merely a variation of the established multi-portal VATS, because it requires specific skills. We here describe our transition from 2-port VATS to SPVATS. From January 2017 to May 2018, we performed SPVATS in 54 patients. The procedures performed included 21 anatomic lung resections and 23 decortications for empyema. Perioperative outcomes were good with few complications and low postoperative pain scores. Despite some challenges due to our location and public health system, we successfully integrated SPVATS into our operative repertoire in a relatively short time.

Novel perspectives in the surgical treatment of posterior mediastinal masses

Posterior mediastinal lesions represent a relatively small proportion of the case loads in thoracic surgery. As the minimally-invasive approaches to the lung and anterior mediastinum continued to advance and improve, many of those techniques can also be employed for posterior mediastinal lesions. Single-port video-assisted thoracic surgery and robot-assisted thoracic surgery are the two leading techniques in this field. Due to the lower incidence of posterior mediastinal lesions and the heterogeneity of the pathologies, evidence for their application is limited. Nevertheless, the available literature demonstrated high safety and effectiveness of these new approaches for surgical management of posterior mediastinal lesions with satisfactory short-term outcomes comparable to their conventional counterparts. Based on the promising early results, more evidence is expected to consolidate the role of these new techniques for posterior mediastinal lesions.

Intraoperative analgesic regimens may affect postoperative pain: single-port versus multi-port video-assisted thoracic surgery

Intraoperative analgesic regimens may affect postoperative pain: single-port versus multi-port video-assisted thoracic surgery

A glance at the history of uniportal video-assisted thoracic surgery.

In the history of thoracic surgery, the advent of video-assisted thoracic surgery (VATS) had on effect equivalent to that provoked by a true revolution. VATS successfully allowed minor, major and complex procedures for various lung and mediastinal pathologies with small incision instead of the traditional accesses. These small incisions abolished ugly scars, generated less acute and chronic pain, reduced hospital stay and costs, allowed faster return to normal day life activities. Conventional VATS was initially performed through 3-4 ports and rapidly evolved to uniportal or single portal access [uniportal video-assisted thoracic surgery (uniVATS)]. First uniportal procedures were published in 2000. In 2010, uniportal technique for lobectomy was described. Focused experimental courses, live surgery events, the internet media favored the rapid diffusion of this technique over the world. Major and complex uniVATS lung resections involving segmentectomy, pneumonectomy, bronchoplasty and vascular reconstruction, redo VATS, en bloc chest wall resections have been accomplished with satisfactory outcomes. Interestingly, different uniportal approaches and techniques are emerging from a number of VATS centers particularly experienced in the mini-invasive thoracic surgery. As confidence grew, in 2014, the first uniVATS left upper lobectomy via the subxiphoid approach was reported. This novel technique is quite challenging but appropriate patient selection as well as availability of dedicated instruments allowed to perform procedures safely. The diffusion of uniVATS paralleled with the development of nonintubated awake anesthesia technique. In 2007 the first nonintubated lobectomy was described. In 2014 the first single port VATS lobectomy in a nonintubated patient with lung cancer of the right middle lobe was accomplished. The nonintubated uniVATS represents an intriguing technique, so that very experienced thoracoscopic surgeons may enroll to surgery elderly and high risk patients. Decreased postoperative pain and hospitalization, faster access to the radio-chemotherapy and diminished inflammatory response are important benefits of the modern approach to the thoracic pathologies. The history of uniVATS documented a constant and irresistible progress. This technique may further provide unthinkable surprises in next future.

Minimally invasive surgical procedures for thymic disease in Asia.

Video-assisted thoracic surgery (VATS) procedures for thymic tumors and myasthenia gravis were introduced in Asia in the middle 1990s in at least two regions, Hong Kong and Japan. To overcome difficulties in obtaining a wide view of the anterior mediastinum, several methods for lifting the sternum or anterior chest wall have been presented, mainly by Japanese surgeons. More recently, single port VATS through a subxiphoid incision was also introduced in Japan. The long-term outcome of a VATS extended thymectomy for myasthenia gravis has been shown to be comparable to that of a trans-sternal extended thymectomy, while the long-term outcome of a VATS thymectomy for thymic epithelial tumors remains to be elucidated. Nevertheless, its indication for tumors in an early stage is now widely accepted, and the number of VATS procedures is steadily increasing in Japan and China. Single-port VATS through a subxiphoid incision was developed in Japan and might become accepted as a useful approach in the near future when combined with robot-assisted thoracoscopic surgery. In addition, robot-assisted thoracoscopic surgery for the thymus has also been introduced in some areas in Asia. Although few of those surgical procedures for the thymus have been performed, results obtained thus far indicate that it might be preferable to lung resection. Several novel minimally invasive thymectomy techniques have been invented and developed in Asia, and further advancements in this field by Asian surgeons are anticipated.

Single-port video-assisted thoracic surgery versus three-port video-assisted thoracic surgery for primary spontaneous pneumothorax

Objective To explore the effects of single-port video-assisted thoracic surgery versus three-port videoassisted thoracic surgery for primary spontaneous pneumothorax. Methods Video-assisted thoracic surgery was performed for primary spontaneous pneumothorax in 58 patients from April 2012 to April 2013. We reviewed the medical records of these 58 patients, retrospectively. Thirty patients underwent the three-port video-assisted thoracic surgery (three-port group) and 28 patients underwent the single-port video-assisted thoracic surgery (single-port group). Following the operation, clinical outcomes, complications and overall survival were evaluated. Results There was no difference in patient characteristics between two groups. Compared with three-port video-assisted thoracic surgery, single-port video-assisted thoracic surgery had shorter hospital stay, shorter chest tube drainage, lower visual analog scale score score of 6 h postoperative pain and visual analog scale score score of 24 h postoperative pain. Meanwhile, there were no statistical differences between both groups in intraoperative bleeding, overall survival and progression-free survival. Conclusions Single-port video-assisted thoracic surgery can reduce the postoperative pain and get better clinical outcomes in treatment of primary spontaneous pneumothorax. Key words: Thoracoscopes; Monotremata; Pneumothorax; Case-control studies

Does single-port video-assisted thoracic lobectomy have favorable perioperative results for non-small cell lung cancer compared with multi-port approach? A systematic review and meta-analysis

Background: The preliminary clinical outcomes and short-term results of single-port video-assisted thoracic surgery (VATS) are encouraging. This study was aimed to assess whether single-port VATS lobectomy have favorable perioperative results for non-small cell lung cancer (NSCLC) compared with multi-port approach. Methods: An electronic search of five databases was performed to find out relevant comparative studies. Outcome measures included operative time, perioperative blood loss, conversion rate, the number of lymph nodes dissection, postoperative pain, chest drainage duration, length of hospital stay, overall postoperative morbidity and mortality. Relative risk (RR) and standard mean difference (SMD) with their 95% confidence intervals (CI) were calculated by means of Stata version 12.0. Results: Eight retrospective observational studies met the inclusion criteria, with a total of 1,257 patients (482 in single-port group and 775 in multi-port group). Meta-analysis showed that single-port VATS lobectomy was associated with less blood loss (SMD =−0.24, 95% CI: −0.48 to 0, P=0.047) and lower overall postoperative morbidity (RR=0.64, 95% CI: 0.45 to 0.92, P=0.015), but higher conversion rate (RR =2.02, 95% CI: 1.10 to 3.73, P=0.024) when compared to multi-port approach. However, when propensity-matched data were analyzed, single-port approach was only associated with less blood loss (SMD =−0.48, 95% CI: −0.69 to −0.25, P Conclusions: Single-port VATS lobectomy is a safe and feasible procedure for patients with NSCLC in selected cases. But based on the present findings, there is still insufficient evidence to prove its superior short-term effects than multi-port approach.

Feasibility and Safety of Single-Port Video-Assisted Thoracic Surgery for Primary Lung Cancer.

BackgroundThe feasibility of single-port video-assisted thoracic surgery (SPVATS) for primary lung cancer is not well understood. In this study, we compared SP and multi-port (MP) VATS for the surgical treatment of patients with primary lung cancer.MethodsSurgical treatment was performed in 181 patients with primary lung cancer at Inje University Haeundae Paik Hospital between June 2012 and December 2015. A propensity-matched analysis was used to compare the postoperative outcomes and to evaluate the comparative feasibility and safety of SPVATS and MPVATS.ResultsThere were 37 patients in the SPVATS group and 67 patients in the MPVATS group. Propensity matching produced 32 pairs. The operation time (210 minutes versus 200 minutes, p=0.11), volume of the estimated blood loss (170 mL versus 160 mL, p=0.19), duration of chest tube drainage (5 days versus 6 days, p=0.66), and length of hospital stay (9 days versus 10 days, p=0.89) were similar between the 2 groups.ConclusionIn our study, SPVATS for primary lung cancer was safe and feasible in well selected patients. A prospective, randomized study with a large group and long-term follow-up is necessary to evaluate the clinical feasibility and the advantages of SPVATS for primary lung cancer.