Uniportal Videothoracoscopic Surgery: Our Indications and Limits

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Techniques

Background:

• Video-assisted thoracic surgery (VATS) has evolved, with uniportal VATS (VATS-U) emerging as a less invasive option.
• Assessing the indications, limitations, and outcomes of VATS-U is crucial for its wider adoption.

Purpose of the Study:

• To evaluate the experience with uniportal VATS (VATS-U) in a cohort of 66 patients.
• To determine the indications, limits, and clinical results of VATS-U.
• To compare VATS-U outcomes with conventional multiportal VATS.

Main Methods:

• Retrospective analysis of 66 patients undergoing VATS-U for pneumothorax, lung nodules, wedge biopsy, hyperhidrosis, and chest wall tumors.
• Evaluation of conversion rates, postoperative pain, complications, paraesthesia, and hospitalization.
• Comparison with 172 cases of conventional multiportal VATS regarding operative time, pain, and paraesthesia.

Main Results:

• VATS-U was successfully performed in most cases, with a low conversion rate (2/66).
• Mean operative time was significantly lower in the VATS-U group (42 minutes) compared to multiportal VATS.
• Patients reported minimal postoperative pain (mean score 0.8) and short hospital stays (mean 3 days), with transient paraesthesia in some cases.

Conclusions:

• Uniportal VATS-U demonstrates a broad range of indications, including pneumothorax, lung nodules, interstitial lung diseases, hyperhidrosis, and chest wall tumors.
• The technique is limited by pleural adhesions or difficult nodule locations.
• VATS-U offers a valid alternative to multiportal VATS, providing benefits such as reduced pain and shorter recovery, though further randomized trials are needed.