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Updated: Jul 31, 2025
Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Single- versus multi-port video-assisted thoracic surgery for pulmonary aspergilloma: a propensity-matched study
Cong Jiang1, Tao Ge1, Gening Jiang1
1Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China.
Objectives:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
Insights
Single-port video-assisted thoracic surgery is a safe and feasible option for pulmonary aspergilloma (PA), offering reduced postoperative pain compared to multi-port approaches. This minimally invasive technique demonstrates comparable outcomes for both simple and complex PA cases.
Area of Science:
- Thoracic Surgery
- Minimally Invasive Procedures
- Pulmonary Medicine
Background:
- Pulmonary aspergilloma (PA) management often involves surgical resection.
- Single-port video-assisted thoracic surgery (SP-VATS) is a less invasive approach, but its efficacy for PA is not well-established.
- Comparison with traditional multi-port VATS is necessary to understand its potential benefits.
Purpose of the Study:
- To evaluate the safety and feasibility of SP-VATS for PA.
- To compare perioperative and long-term outcomes of SP-VATS versus multi-port VATS for PA.
- To assess the impact of SP-VATS on postoperative pain and recovery.
Main Methods:
- Retrospective study of 358 PA patients from August 2007 to December 2019.
- Propensity score matching used to compare SP-VATS (63 patients) and multi-port VATS (63 patients).
- Analysis of perioperative data, long-term outcomes, postoperative pain, and analgesic requirements.
Main Results:
- SP-VATS showed similar operation time, blood loss, and drainage duration/volume compared to multi-port VATS.
- Patients undergoing lobectomy via SP-VATS had a shorter postoperative hospital stay (4.9 vs 5.9 days).
- SP-VATS group reported significantly lower postoperative pain scores and required fewer analgesic days.
Conclusions:
- SP-VATS is a safe and feasible alternative for treating PA, including selected complex cases.
- SP-VATS offers potential advantages over multi-port VATS, notably reduced postoperative pain.
- This minimally invasive approach may improve patient recovery after PA surgery.
