Totally thoracoscopic versus standard VATS lobectomies: perioperative differences.

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Procedures

Background:

• Minimally invasive surgery is the standard for early-stage lung cancer.
• Current techniques include three-port and uniportal approaches, with no clear superiority.
• This study compares pain outcomes between a standard utility incision and a totally thoracoscopic technique.

Purpose of the Study:

• To compare postoperative pain outcomes between totally thoracoscopic and standard utility incision approaches for VATS lobectomy.
• To evaluate the impact of surgical technique on perioperative pain, chronic pain, and analgesic requirements.

Main Methods:

• Retrospective analysis of 168 patients undergoing VATS lobectomy (January 2015 - December 2019).
• Group A: Totally thoracoscopic approach (82 patients).
• Group B: Standard approach with utility incision (86 patients).
• Comparison of operative time, complications, length of stay, Visual Analog Scale (VAS) pain scores, and painkiller use.
• Analysis of covariance (ANCOVA) assessed the effect of surgical time and drainage duration on VAS scores.

Main Results:

• Group A showed significantly less pain on postoperative days 1 and 2 (p=0.025, p=0.020).
• No significant differences were observed in baseline characteristics, perioperative factors, mean VAS scores at 1 month and 1 year, NSAID doses, or chronic pain incidence.
• ANCOVA indicated no significant impact of surgical time or drainage duration on VAS scores (p>0.05).

Conclusions:

• A totally thoracoscopic approach may alleviate acute postoperative pain following VATS lobectomy.
• This technique does not appear to compromise oncological outcomes or patient safety.
• Further research may explore long-term pain trajectories and patient-reported outcomes.