Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax-a propensity matched bicentric study

Background: The role of triportal video-assisted thoracoscopic surgery (VATS) is widely recognized for the treatment of primary spontaneous pneumothorax (PSP). The aim of this study was to assess the effectiveness and the potential advantages of uniportal VATS (U-VATS) for the treatment of PSP compared with triportal VATS. Methods: A total of 104 triportal (n=39) and uniportal (n=65) VATS procedures where performed for the treatment of PSP in two University hospitals. The prospectively collected data of postoperative outcomes were retrospectively reviewed and a 1:1 propensity score matching analysis was performed to compare the two VATS approaches. Results: No major adverse events occurred after operation. Compared with triportal-VATS, Uniportal-VATS showed the same effectiveness in terms of risk of recurrence (null in both groups), post-operative complications (P=1.000) and operating time (66.04 +/- 16.92 vs. 74.57 +/- 21.38 min, P=0.141). However, there was a statistically significant difference in favor of uniportal-VATS in terms of necessity of further access [0 vs. 7 (30.4%), P=0.004], chest tube duration (4.39 +/- 1.41 vs. 6.32 +/- 0.94 days, P << 0.001), postoperative hospital stay (4.78 +/- 1.31 vs. 6.61 +/- 1.67 days, P << 0.001), visual analogue pain score (VAS) at 24 hours (3.45 +/- 1.41 vs. 6.44 +/- 2.45, P << 0.001), number of patients who had pain after chest drain removal [1 (4.3%) vs. 16 (69.6%), P << 0.001], VAS after drainage removal (0.11 +/- 0.47 vs. 2.74 +/- 2.25, P << 0.001), postoperative pain duration (2.50 +/- 1.20 vs. 14.82 +/- 37.41 days, P << 0.001), pain killers intake (0.75 +/- 1.06 vs. 7.53 +/- 3.96 days, P=0.001), chronic paresthesia (level scale: 0 to 2; 0 vs. 0.52 +/- 0.66, P << 0.001), chronic neuralgia (0 vs. 0.43 +/- 0.59, P << 0.001) and cosmetic results (level scale: 0 to 3; 2.91 +/- 0.28 vs. 2.00 +/- 0.77, P << 0.001). Conclusions: U-VATS is feasible and safe and may be a less invasive alternative to triportal VATS for the treatment of PSP because of its effectiveness in reducing postoperative pain, paresthesia, hospital stay and in improving cosmetic results.