Safe introduction of uniportal video-assisted thoracoscopic surgery in an academic center: the learning process and...

We evaluated the perioperative outcomes and learning process during the introduction of uniportal video-assisted thoracoscopic surgery (uVATS) at a university hospital.

uVATS was initiated by two experienced thoracic surgeons using a safety-oriented, stepwise approach with a flexible team rotation. We retrospectively reviewed 83 consecutive patients (84 lesions) who underwent uVATS between October 2020 and December 2024 for clinically node-negative primary lung cancer or metastatic lung tumors. Learning patterns were analyzed using the cumulative sum (CUSUM) of the operative time.

The procedures included 46 lobectomies and 38 segmentectomies (23 complex). No conversion to thoracotomy occurred; four cases (4.8%) required conversion to multiportal VATS (mVATS) owing to lymph node dissection difficulty. The median operative time was 174 min, and reoperation was performed in two patients (2.4%). Among the 84 lesions, 76 were primary lung cancers, and eight were non-primary lesions. Among the primary lung cancer cases, the median tumor size was 19.0 mm. Most patients had early stage disease, including stage 0 (n = 5), stage IA1 (n = 17), stage IA2 (n = 19), stage IA3 (n = 14), and stage IB (n = 12), whereas a smaller proportion had more advanced disease (stage IIA, n = 2; stage IIB, n = 4; stage IIIA, n = 3). During a median follow-up period of 2.6 years, tumor recurrence was observed in five patients, including two cases of local recurrence. A CUSUM analysis did not demonstrate a distinct early learning phase, and operative performance remained relatively stable from the initial cases.

uVATS was safely introduced without any early performance deterioration, likely reflecting the transfer of skills from prior open and mVATS experience.