Thoracoscopic lobectomy: comparison of intraoperative and postoperative outcomes between 3 and 4 incision accesses

Several techniques have been proposed to perform a video-assisted thoracic lobectomy. We compared the results of a 3 versus 4-port procedure, analyzing intraoperative data, morbidity, and mortality.

Prospective analysis of 30 consecutive patients who underwent a 4-port approach video-assisted thoracic lobectomy (group A) and comparison with a historical series with 30 patients who had a 3-port video-assisted thoracic lobectomy (group B).

The groups were comparable for clinical characteristics and pathological staging. There was no difference in operating time: median, 128 min for group A versus 129 min for group B (P = 0.9). There was a significant difference in rate of conversion to thoracotomy: 1 of 30 (3.3%) in group A and 7 of 30 (23.3%) in group B (3 ports) (P = 0.02). In group A, 11 patients (36.7%) experienced postoperative complications and in group B, 13 patients (43.3%; P = 0.6). The difference in median time to drain removal and median length of hospital stay between the two groups was not significant. There was a significant difference in persistent pain between group A and group B: 6 patients (20%) in group B presented with persistent neuropathic pain on regular medication (P = 0.02).

Our study showed that the 4-port approach was similar in operative time, length of drain and hospital stay but showed a statistically significant lower conversion rate and lower rate of persistent pain than the 3-port access.