Multiport Versus Single-Port Video-Assisted Thoracic Surgery for Pulmonary Resection

There have been many attempts to compare Uniportal Video-Assisted Thoracic Surgery (UVATS) with Multiportal VATS (MVATS) for anatomic lung resection. A review is warranted to appreciate: what has been learnt about the relative benefits of the 2 approaches; what lessons have been learned by the process of comparing approaches; and whether such comparisons should influence surgical practice.

A narrative review and qualitative analysis of the literature pertaining to UVATS and especially to comparisons between UVATS and MVATS was conducted.

The balance of currently published evidence suggests that UVATS offers the following when compared to MVATS: equivalent safety; similar or slightly better post-operative outcomes (especially in reducing pain); equivalent treatment outcomes for lung cancer (measured by lymph node yields and medium-term survival); and broadly similar learning curves. There has been a general trend for studies comparing UVATS with MVATS in recent years to exhibit greater scientific rigor and to investigate a broader range of clinically relevant outcome measures.

Over a decade's worth of comparisons between UVATS and MVATS have validated UVATS as a mainstream approach for minimally invasive pulmonary resections. The direct comparisons have generally suggested non-inferiority vis-à-vis MVATS. However, the true value of the ongoing process of comparison lies in its elevation of good clinical research practices and increasing awareness of those outcome measures most pertinent to patients.