Uniportal vs. multiportal thoracoscopic segmentectomy: a north American study

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Uniportal video-assisted thoracoscopic surgery (VATS) segmentectomy is increasingly adopted globally.
• North American experience with uniportal VATS segmentectomy remains limited.
• This study compares uniportal versus multiportal VATS segmentectomy in a North American multicenter setting.

Purpose of the Study:

• To compare the outcomes of uniportal VATS segmentectomy with multiportal VATS segmentectomy.
• To evaluate the feasibility and safety of uniportal VATS segmentectomy in North America.
• To assess perioperative data and postoperative complications between the two VATS approaches.

Main Methods:

• Retrospective chart review of prospectively collected data from two North American centers (2012-2020).
• Inclusion of all VATS segmentectomy patients, excluding emergent cases and combined resections.
• Propensity score matching (1:1) to compare outcomes between uniportal and multiportal VATS cohorts.

Main Results:

• A total of 423 VATS segmentectomies were performed (181 uniportal, 242 multiportal).
• Operating time was significantly lower for uniportal VATS (130 min) compared to multiportal VATS (161 min) (P<0.001).
• No significant differences were observed in estimated blood loss, severe complications, conversion rates, resection margins, nodal upstaging, hospital stay, or 30-day mortality.

Conclusions:

• Uniportal VATS segmentectomy demonstrates comparable postoperative outcomes to multiportal VATS segmentectomy.
• In experienced hands, uniportal VATS is a safe and effective alternative for lung segmentectomy in North America.
• The findings support the wider adoption of uniportal VATS segmentectomy in the region.