Outcomes of Uniportal vs Multiportal Video-Assisted Thoracoscopic Lobectomy

Bourdages-Pageau, Etienne; Vieira, Arthur; Lacasse, Yves; Figueroa, Paula Ugalde

doi:10.1053/j.semtcvs.2019.05.021

Cited by 34 publications

(27 citation statements)

References 15 publications

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“…The learning curve of thoracoscopic surgery in a single surgeon and successful implementation of uniportal approach of a uniportal thoracoscopic approach for major pulmonary resection has been demonstrated in several reports (3)(4)(5). Al-Ameri et al found that uniportal and multiportal approaches for thoracoscopic lobectomy were equivalent in terms of feasibility and safety, but the former has an additional advantage of faster postoperative recovery (3).…”

Section: Original Articlementioning

confidence: 99%

“…Bourdages et al reported a significantly shorter operative time, shorter-duration postoperative chest tube drainage and hospitalization periods, and decreased intraoperative bleeding using a uniportal rather than multiportal approach. However, they noted that the former was performed likely to be performed by a highly experienced surgeon (4).…”

Section: Original Articlementioning

confidence: 99%

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The learning curve of thoracoscopic surgery in a single surgeon and successful implementation of uniportal approach

Igai¹,

Kamiyoshihara²,

Furusawa³

et al. 2021

J Thorac Dis

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Background: In some institutions, a recently introduced uniportal approach has replaced the multiportal approach for thoracoscopic major pulmonary resection. This study investigated the effect of this change on the surgical learning curve by examining the perioperative results of a single surgeon. Methods: Between April 2012 and August 2020, 376 patients with primary lung cancer underwent thoracoscopic lobectomy with ND2a-1/2 lymphadenectomy in the authors' hospital. Surgery was performed by one of the authors in 189 of these patients, who were thus enrolled in this retrospective study. The surgeries were classified chronologically into five phases and the operative time, rate of intraoperative massive bleeding, and rate of postoperative prolonged air leak (PAL) were then compared. The learning curve (i.e., operative time) was assessed by Spearman's rank correlation test. The perioperative results achieved with the uniportal and multiportal approaches were also compared before and after the patients were matched for their characteristics based on the propensity score. Results: The five phases differed significantly with respect to the operative time and rate of postoperative PAL (P<0.0001, P=0.0061). The correlation between operative time and number of consecutive cases was also significant (r=−0.579, P<0.0001). Superior results in terms of operative time (P<0.0001), duration of postoperative drainage (P<0.0001), and rate of postoperative PAL (P=0.0034) were obtained using a uniportal rather than multiportal approach. Conclusions: The transition from a multiportal to a uniportal approach did not cause a decline in the learning curve of thoracoscopic lobectomy with ND2a-1/2 lymphadenectomy.

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Section: Original Articlementioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

The learning curve of thoracoscopic surgery in a single surgeon and successful implementation of uniportal approach

Igai¹,

Kamiyoshihara²,

Furusawa³

et al. 2021

J Thorac Dis

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“…Although some of them have demonstrated several potential advantages of the uniportal VATS technique, such as less intraoperative blood loss, shorter hospital stay, and reduced postoperative pain [11][12][13], the results of these studies were highly heterogeneous. For instance, Lin et al indicated that U-VATS significantly increased operation time compared to M-VATS approach [14], while Bourdages-Pageau et al held the idea that operation time was significantly decreased in U-VATS group [15]. One study reported shorter average hospital stay with uniportal VATS [16], while another showed it was longer [17].…”

Section: Introductionmentioning

confidence: 99%

Uniportal versus multiportal video-assisted thoracoscopic anatomical resection for NSCLC: a meta-analysis

Yan

Han

Zhang

et al. 2020

J Cardiothorac Surg

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Background Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); however, whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown. Methods We performed a systematic review of two databases (Pubmed and Web of Science) to search comparative studies of U-VATS and M-VATS anatomical pulmonary resection for NSCLC. Operative time, blood loss, number of resected lymph nodes, drainage duration, length of postoperative stay, pain in postoperative day 1(POD1) and conversion rates were retrieved to estimate the comparison of outcomes. A subgroup analysis stratified by study type (propensity-matched analysis and randomized-controlled trial versus non-propensity matched analysis) was performed. Result A total of 20 studies with 4142 patients were included in this meta-analysis. U-VATS was performed on 1869 patients, whereas the other 2173 patients underwent M-VATS. This meta-analysis showed that there was no significant difference in operative time (U-VATS: 146.48 ± 55.07 min versus M-VATS: 171.70 ± 79.40 min, P = 0.81), blood loss (74.49 ± 109.03 mL versus 95.48 ± 133.67 mL, P = 0.18), resected lymph nodes (17.28 ± 9.46 versus 18.31 ± 10.17, P = 0.62), conversion rate (6.18% versus 4.34%, P = 0.14), drainage duration (3.90 ± 2.94 days versus 4.44 ± 3.12 days, p = 0.09), length of postoperative stay (6.16 ± 4.40 days versus 6.45 ± 4.80 days, P = 0.22), and pain in POD1 (3.94 ± 1.68 versus 3.59 ± 2.76, p = 0.07). Subgroup analysis showed the value of PSM and RCT group consistency with overall value. Conclusion This up-to-date meta-analysis shows that the perioperative outcomes of U-VATS and M-VATS anatomical pulmonary resection are equivalent. In addition, the differences in long-term outcomes of these two approaches are still unclear. Thoracic surgeons should pay more emphasize on providing high-quality and personalized surgical care for patients, to improve the survival ultimately.

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“…For instance, Lin et al indicated that U-VATS signi cantly increased operation time compared to M-VATS approach, [14] while Bourdages-Pageau et al held the idea that operation time was signi cantly decreased in U-VATS group. [15] One study reported shorter average hospital stay with uniportal VATS, [16] while another showed it was longer. [17] Comparative clinical outcomes of U-VATS versus M-VATS still remain uncertain.…”

Section: Introductionmentioning

confidence: 99%

Uniportal versus multiportal video-assisted thoracoscopic anatomical resection for NSCLC: a meta-analysis

Yan

Han

Zhang

et al. 2020

Preprint

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Background Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); however, whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown. Methods We performed a systematic review of two databases (Pubmed and Web of Science) to search comparative studies of U-VATS and M-VATS anatomical pulmonary resection for NSCLC. Parameters of continuous variables (operative time, blood loss, number of resected lymph nodes, drainage duration, length of postoperative stay and pain in postoperative day 1(POD1)) or categorical variables (conversion rates) were retrieved to estimate the comparitiveoutcomes. A subgroup analysis stratified by study type (propensity-matched analysis& randomized-controlled trial versus non-propensity matched analysis) was performed. Result A total of 19 studies with 3809 patients were included in this meta-analysis. U-VATS was performed on 1747 patients, whereas the other 2062 patients underwent M-VATS. This meta-analysis showed that there was no significant difference in operative time (U-VATS: 146.48±55.07min versus M-VATS: 171.70±79.40min, P=0.81), blood loss (74.49±109.03mL versus 95.48±133.67mL, P=0.18), resected lymph nodes (17.28±9.46 versus 18.31±10.17, P=0.62), conversion rate (6.18% versus 4.34%, P=0.14), drainage duration (3.90±2.94 days versus 4.44±3.12 days, p=0.09), length of postoperative stay (6.16±4.40 days versus 6.45±4.80 days, P=0.22), and pain in POD1 (3.94±1.68 versus 3.59±2.76, p=0.07). Subgroup analysis showed the value of PSM&RCT group consistency with overall value. Conclusion This up-to-date meta-analysis shows that the perioperative outcomes of U-VATS and M-VATS anatomical pulmonary resection are equivalent. In addition, the differences in long-term outcomes of these two approaches are still unclear. Thoracic surgeons should pay more emphasize on providing high-quality and personalized surgical care for patients, to improve the survival ultimately.

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Outcomes of Uniportal vs Multiportal Video-Assisted Thoracoscopic Lobectomy

Cited by 34 publications

References 15 publications

The learning curve of thoracoscopic surgery in a single surgeon and successful implementation of uniportal approach

The learning curve of thoracoscopic surgery in a single surgeon and successful implementation of uniportal approach

Uniportal versus multiportal video-assisted thoracoscopic anatomical resection for NSCLC: a meta-analysis

Uniportal versus multiportal video-assisted thoracoscopic anatomical resection for NSCLC: a meta-analysis

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