Related Experiment Video
Updated: May 26, 2026
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Comparative outcomes of uniportal and multiportal video-assisted thoracoscopic surgery-a systematic review and
Ashley R Wilson-Smith1,2, Ayesh Ali3, Marina Bebawi4
1School of Medicine, Macquarie University, Sydney, Australia.
Background:
Uniportal video-assisted thoracoscopic surgery (uVATS) has emerged as a less invasive alternative to conventional multiportal video-assisted thoracoscopic surgery (mVATS) for lung cancer resections. While uVATS is associated with short-term perioperative advantages, uncertainty remains regarding its mid- to long-term oncologic outcomes. This systematic review and meta-analysis compares perioperative outcomes and mid-term survival following uVATS versus mVATS for non-small cell lung cancer (NSCLC).
Methods:
Four electronic databases were searched from inception to August 2025 in accordance with PRISMA guidelines. Comparative studies of uVATS and mVATS for NSCLC were included. Primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Secondary outcomes included perioperative outcomes, length of stay, postoperative complications, and early mortality. Data were pooled using random-effects models, and aggregated Kaplan-Meier survival curves were reconstructed. Risk of bias was assessed using the ROBINS-I tool.
Results:
Twenty-nine studies encompassing 6,708 patients (4,034 uVATS and 2,674 mVATS) were included. Perioperative outcomes favoured uVATS, including a shorter hospital stay (mean difference -0.87 days, P<0.001) and a lower conversion-to-thoracotomy rate [3.3% vs. 5.1%, odds ratio (OR) =0.63, P=0.03], with no significant differences in postoperative complications or early mortality. One- and 3-year OS were comparable between groups. At 5 years, reconstructed Kaplan-Meier analysis demonstrated higher OS in the uVATS cohort; however, this finding should be interpreted cautiously given baseline stage imbalance, selection bias, and shorter follow-up in uVATS cohorts. RFS was comparable between techniques across all reported time points.
Conclusions:
uVATS is a safe and effective minimally invasive approach for NSCLC when patients are appropriately selected, offering perioperative advantages without compromising RFS. While an association with improved mid-term OS was observed, this finding is hypothesis-generating and requires confirmation in randomized or well-matched long-term studies.
