Transition from multiple port to single port video-assisted thoracoscopic anatomic pulmonary resection: early experience and comparison of perioperative outcomes

Background: Single port thoracoscopy is an approach aimed at minimizing trauma to the chest wall during lung resection. The objectives of this study were to describe early experience in the transition from multiple port video-assisted thoracic surgery (VATS) to single port surgery (S-VATS) and to compare perioperative outcomes between approaches. Methods: Consecutive anatomic lung resections using S-VATS were reviewed and compared to a historical, prospective cohort of multiple port VATS cases. Outcomes analysis was focused on the use of operating room resources and postoperative recovery. Results: Over 12 months, 50 S-VATS procedures were completed by one surgeon and compared to an equal number of VATS patients. The groups were similar in age, gender, BMI, comorbidity, tumor size and pulmonary function. There was no statistically significant difference in operative time. All tumors were completely resected (R0) and the median number of lymph nodes evaluated pathologically was equivalent {S-VATS = 7 [4-10]; VATS = 7 [4-10]; P = 0.92}. There was no significant difference in conversion rate {S-VATS = 2 (4%); VATS = 1 (2%); P = 0.56}. The median length of stay was similar in both groups {S-VATS = 4 [3-7]; VATS = 4 [3-7]; P = 0.99}. There was no mortality and no significant difference in the rate of major complications {S-VATS = 10/50 [20%]; VATS = 5/50 [10%]; P = 0.26}. There was no difference in patient reported pain as measured by a visual analog scale at 24 hours {S-VATS = 4 [2-5]; VATS = 4 [3-5]; P = 0.63}. Conclusions: Early experience in the transition from multiple port VATS to S-VATS lung resection indicates that safety, efficiency and surgical quality are preserved. More long-term data are required. Alternative approaches to perform thoracoscopic lung resection should be carefully evaluated and compared to established minimally invasive techniques.