National clinical practice patterns of uniportal video-assisted thoracoscopic anatomical lung resections: nationwide population-based data from a clinical audit registry

Background and objectives: Uniportal video-assisted thoracoscopic surgery (VATS) is an accepted surgical technique for lung cancer surgery worldwide. However, data on national patterns of uniportal VATS lung cancer resections are lacking. This study assessed the implementation and clinical practice of uniportal VATS in the Netherlands compared to other surgical approaches. Methods: Data on anatomical lung resections performed for suspected lung cancer from January 2017 to December 2021 were collected from the Dutch Lung Cancer Audit for Surgery registry. Eligible procedures included those performed by uniportal VATS, multiportal VATS, robotic-assisted thoracoscopic surgery, or open surgery, excluding discontinued procedures or those performed in hospital registration years less than 20 resections. Results: The use of uniportal VATS increased from 13 % in 2017 to 21 % in 2021, with the number of hospitals using this technique rising from 30 % to 41 %, reaching a plateau in the last two years. In 2021, 429 resections using uniportal VATS were performed, demonstrating a superior median hospitalization of 4 days and a non- inferior complication rate of 27 % compared to other minimally invasive approaches. Conclusions: Uniportal VATS in the Netherlands reached a plateau in 2020 and 2021. This technique is particularly performed for the removal of early-stage tumors and has similar surgical outcomes as the other thoracoscopic approaches.