Uniportal video-assisted thoracoscopic surgery for lung cancer- current practices and outcomes: a narrative review

Background and Objective: Compared with open surgery, video-assisted thoracic surgery (VATS) is a superior approach to perform lobectomy in early-stage lung cancer patients. Originally described and adopted using 3 ports, VATS has evolved such that a single-port approach can be used, though this approach has only been popular in Europe and Asia. While long-term oncologic data on uniportal-VATS (U-VATS) is still scarce, data on surgical outcomes, pain management, and short-term postoperative outcomes demonstrate that U-VATS is not inferior to multiportal VATS. Our objective was to review the outcomes of lobectomy performed using U-VATS and describe our institutional experience, highlighting current practices that may facilitate adoption of U-VATS. Methods: We conducted PubMed and Google Scholar searches for articles published from 2000-2021 using specific keywords (lung cancer, VATS, U-VATS, uniportal thoracic surgery). All articles in English were reviewed to elaborate this manuscript; randomized clinical trials, meta-analyses, and multicenter studies were prioritized and read in full. Also, we described our institutional practices for performing U-VATS with an Enhanced Recovery Protocol. Key Content and Findings: Our literature review examines the different clinical outcomes of U-VATS before, during, and after surgery. This was done comparing literature findings to our own published and personal experiences. Also, limitations as to why this surgical approach is not widely used in North America is briefly discussed. Conclusions: According to this non-systematic review of the literature, U-VATS offers less invasiveness, reduced production of immunomodulatory chemokines, and fewer early postoperative complications while delivering the same oncological outcomes as multiportal VATS. As the adoption of the U-VATS grows globally, a higher level of evidence is awaited to support widespread adoption of this technique.