Uniportal Versus Multiportal Video-Assisted Thoracoscopic Lobectomy for Lung Cancer: An Updated Meta-analysis

Abstract

Objective We reviewed the available literature on patients with lung cancer undergoing either uniportal (UVATS) or multiport video-assisted thoracoscopic surgery (MVATS). Methods Original research studies that evaluated perioperative and long-term outcomes of UVATS versus MVATS were identified, from January 1990 to April 2020. The perioperative, along with the oncologic and long-term survival outcomes, were calculated according to either a fixed or a random effect model, appropriately. The Q statistics and I2 statistic were used to test for heterogeneity among the studies. Results Twenty studies were included, incorporating a total of 1,469 patients treated with UVATS and 3,231 treated with MVATS. The incidence of complications was lower in patients treated with UVATS [OR: 0.76 (95% CI 0.62, 0.93); p = 0.008]. The chest tube duration was significantly lower in the UVATS group (WMD: − 0.63 [95% CI − 1.03, − 0.23]; p = 0.002). Length of hospital stay (L.O.S.) was also lower in the UVATS patient group (WMD: − 0.54 [− 0.94, − 0.13]; p = 0.009), along with postoperative pain [WMD: − 0.57 (95% CI − 0.97, − 0.18); p = 0.004]. No significant differences were found regarding the mean operative time (M.O.T.), mean blood loss, the number of resected lymph nodes, the 30-day mortality, along with the survival at 1 and 3 years postoperatively. Conclusions The present meta-analysis indicates that UVATS is associated with enhanced outcomes in patients undergoing surgery for lung cancer. Well-designed, randomized studies, comparing UVATS to MVATS, are necessary to further assess their long-term clinical outcomes.

Single utility port approach in robot‐assisted sleeve segmentectomy for bronchial carcinoid tumor

“…1,2 Furthermore, surgical techniques with fewer incisions, especially the uniportal technique, are associated with less chest pain. [6][7][8] We therefore performed a single utility port robot-assisted right S6 sleeve segmentectomy with three robotic arms, which can further reduce the excess surgical trauma caused by another port or more ports, and simultaneously preserve more functional lung tissues. To the best of our knowledge, this is the first report on robot-assisted sleeve segmentectomy with the single utility port approach.…”

“…[3][4][5] Surgical techniques with fewer incisions, especially the uniportal technique, are associated with less chest pain. [6][7][8] Here, we describe an aged patient with decreased pulmonary function whose carcinoid tumor invaded the bronchus originating of the right superior segment (S6), who underwent robot-assisted right S6 sleeve segmentectomy via the single utility port approach with three robotic arms.…”

Controlling bleeding during uniportal thoracoscopic major pulmonary resection

“…Our team started to use "uniportal thoracoscopic major pulmonary resection" in February 2019. The uniportal thoracoscopic approach is considered minimally invasive and has several advantages, including low postoperative pain, few morbidities, short-duration postoperative chest drainage, short hospitalization periods, rapid postoperative recovery, and relatively low medical costs [4][5][6][7] . Magouliotis et al [8] demonstrated more favorable short-term oncological results of a uniportal compared to multiportal approach for thoracic malignancies in their review article, although the long-term outcomes were unclear.…”

Acupuncture against chronic postsurgical pain in non-small cell lung cancer patients

“…The conventional multiportal VATL with several incisions was alternated to triportal, and recently biportal, or even uniportal VATL. [ 9 , 10 ]…”