Skip to main content
SpringerLink
Log in

Uniportal Versus Multiportal VATS Lobectomy

  • Chapter
  • First Online:
Difficult Decisions in Thoracic Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

  • 614 Accesses

Abstract

Uniportal Video-Assisted Thoracic Surgery (uVATS) has emerged in recent years as a hugely popular evolution of minimally invasive thoracic surgery for lung lobectomy, promising less surgical access trauma than conventional ‘multiportal’ VATS (mVATS). Thoracic surgeons today are now facing a difficult decision: if I am already performing mVATS lobectomy well, should I switch over to uVATS? A systematic review was conducted to address the PICO question: For adult patients with lung cancer receiving lobectomy with curative intent, is the uVATS approach any different from the mVATS approach in terms of safety, surgical outcomes, and oncological efficacy? A final selection of 24 papers comparing uVATS and mVATS was reviewed. The overall quality of the comparative papers was low to moderate, with most consisting of retrospective case series. They indicate that if one is already performing mVATS lobectomy, it is possible to transition to uVATS safely—albeit after appropriate training is obtained (evidence quality low, weak recommendation). However, the current evidence does not yield conclusive proof of superiority for uVATS over mVATS across a range of surgical outcome measures, and hence it is perhaps not yet advised that those already performing mVATS lobectomy should necessarily transition to uVATS at this time (evidence quality very low, weak recommendation).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Sihoe ADL, Yim APC. Video-assisted pulmonary resections. In: Patterson GA, Cooper JD, Deslauriers J, Lerut AEMR, Luketich JD, Rice TW, Pearson FG, editors. Thoracic surgery. 3rd ed. Philadelphia: Elsevier; 2008. p. 970–88.

    Google Scholar 

  2. Sihoe ADL. The evolution of VATS lobectomy. In: Cardoso P, editor. Topics in thoracic surgery. Rijeka: Intech; 2011. p. 181–210.

    Google Scholar 

  3. Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:e278S–313S.

    Article  CAS  Google Scholar 

  4. Sihoe ADL. The evolution of minimally invasive thoracic surgery: implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis. 2014;6(Suppl 6):S604–17. https://doi.org/10.3978/j.issn.2072-1439.2014.08.52.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sihoe DLA. Reasons not to perform uniportal VATS lobectomy. J Thorac Dis. 2016;8:S333–43.

    PubMed  PubMed Central  Google Scholar 

  6. Passlick B, Born C, Sienel W, Thetter O. Incidence of chronic pain after minimal invasive surgery for spontaneous pneumothorax. Eur J Cardiothorac Surg. 2001;19:355–9.

    Article  CAS  Google Scholar 

  7. Sihoe ADL, Au SS, Cheung ML, Chow IK, Chu KM, Law CY, Wan M, Yim APC. Incidence of chest wall paresthesia after video-assisted thoracic surgery for primary spontaneous pneumothorax. Eur J Cardiothorac Surg. 2004;25:1054–8.

    Article  Google Scholar 

  8. Sihoe DLA. Uniportal video-assisted thoracic surgery (VATS) lobectomy. Ann Cardiothorac Surg. 2016;5:133–44.

    Article  Google Scholar 

  9. Gonzalez D, Paradela M, Garcia J, de la Torre M. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg. 2011;12:514–5.

    Article  Google Scholar 

  10. Gonzalez-Rivas D, Paradela M, Fernandez R, Delgado M, Fieira E, Mendez L, Velasco C, de la Torre M. Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Ann Thorac Surg. 2013;95:426–32.

    Article  Google Scholar 

  11. Wang BY, Liu CY, Hsu PK, Shih CS, Liu CC. Single incision versus multiple incision thoracoscopic lobectomy and segmentectomy: a propensity matched analysis. Ann Surg. 2015;261:793–9.

    Article  Google Scholar 

  12. McElnay PJ, Molyneux M, Krishnadas R, Batchelor TJP, West D, Casali G. Pain and recovery are comparable after either uniportal and multiport video assisted thoracoscopic lobectomy: an observation study. Eur J Cardiothorac Surg. 2015;47:912–5.

    Article  Google Scholar 

  13. Chung JH, Choi YS, Cho JH, Kim HK, Kim J, Zo JI, et al. Uniportal video-assisted thoracoscopic lobectomy: an alternative to conventional thoracoscopic lobectomy in lung cancer surgery? Interact Cardiovasc Thorac Surg. 2015;20:813–9.

    Article  Google Scholar 

  14. Zhu Y, Liang M, Wu W, Zheng J, Zheng W, Guo Z, Zheng B, Xu G, Chen C. Preliminary results of single-port versus triple-port complete thoracoscopic lobectomy for non-small cell lung cancer. Ann Transl Med. 2015;3(7):92. https://doi.org/10.3978/j.issn.2305-5839.2015.03.47.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mu JW, Gao SG, Xue Q, Zhao J, Li N, Yang K, Su K, Yuan ZY, He J. A matched comparison study of uniportal versus triportal thoracoscopic lobectomy and sublobectomy for early-stage nonsmall cell lung cancer. Chin Med J (Engl). 2015;128:2731–5.

    Article  Google Scholar 

  16. Liu CC, Shih CS, Pennarun N, Cheng CT. Transition from a multiport technique to a single-port technique for lung cancer surgery: is lymph node dissection inferior using the single-port technique? Eur J Cardiothorac Surg. 2016;49:i64–72.

    Article  Google Scholar 

  17. Hirai K, Takeuchi S, Usuda J. Single-incision thoracoscopic surgery and conventional video-assisted thoracoscopic surgery: a retrospective comparative study of perioperative clinical outcomes. Eur J Cardiothorac Surg. 2016;49:i37–41.

    PubMed  Google Scholar 

  18. Chang JM, Kam KH, Yen YT, Huang WL, Chan W, Tseng YL, Wu MH, Lai WW, Gonzalez-Rivas D. From biportal to uniportal video-assisted thoracoscopic anatomical lung resection: a single-institute experience. Medicine. 2016;95(40):e5097.

    Article  Google Scholar 

  19. Shen Y, Wang H, Feng M, Xi Y, Tan L, Wang Q. Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study. Eur J Cardiothorac Surg. 2016;49:i48–53.

    PubMed  Google Scholar 

  20. Perna V, Carvajal AF, Torrecilla JA, Gigirey O. Uniportal video-assisted thoracoscopic lobectomy versus other video-assisted thoracoscopic lobectomy techniques: a randomized study. Eur J Cardiothorac Surg. 2016;50:411–5.

    Article  Google Scholar 

  21. French DG, Thompson C, Gilbert S. Transition from multiple port to single port video-assisted thoracoscopic anatomic pulmonary resection: early experience and comparison of perioperative outcomes. Ann Cardiothorac Surg. 2016;5:92–9. https://doi.org/10.21037/acs.2016.03.03.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hao Z, Cai Y, Fu S, Zhang N, Fu X. [Comparison study of post-operative pain and short-term quality of life between uniportal and three portal video-assisted thoracic surgery for radical lung cancer resection]. [Chinese] Chin J Lung Cancer. 2016;19:122–128.

    Google Scholar 

  23. Dai F, Meng S, Mei L, Guan C, Ma Z. Single-port video-assisted thoracic surgery in the treatment of non-small cell lung cancer: a propensity-matched comparative analysis. J Thorac Dis. 2016;8(10):2872–8. https://doi.org/10.21037/jtd.2016.10.27.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Han KN, Kim HK, Choi YH. Midterm outcomes of single port thoracoscopic surgery for major pulmonary resection. PLoS One. 2017;12:e0186857.

    Article  Google Scholar 

  25. Ke H, Liu Y, Zhou X, Xue Q. Anterior fissureless uniport vs. posterior intra-fissure triple-port thoracoscopic right upper lobectomy: a propensity-matched study. J Thorac Dis. 2017;9(10):3866–74. https://doi.org/10.21037/jtd.2017.09.61.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Heo W, Kang DK, Min HK, Jun HJ, Hwang YH. Feasibility and safety of single-port video-assisted thoracic surgery for primary lung cancer. Korean J Thorac Cardiovasc Surg. 2017;50:190–6.

    Article  Google Scholar 

  27. Song KS, Park CK, Kim JB. Efficacy of single-port video-assisted thoracoscopic surgery lobectomy compared with triple-port vats by propensity score matching. Korean J Thorac Cardiovasc Surg. 2017;50:339–45.

    Article  Google Scholar 

  28. Stamenovic D, Messerschmidt A, Jahn T, Schneider T. Initial experience with uniportal video-assisted thoracoscopic surgery for anatomical lung resections: a propensity score study and an observational assessment of the learning curve. Zentralbl Chir. 2018;143:84–9.

    Article  Google Scholar 

  29. Xu GW, Xiong R, Wu HR, Li CW, Xu SB, Xie MR. A prospective comparative study examining the impact of uniportal and three portal video-assisted thoracic surgery on short-term quality of life in lung cancer. Chin J Surg. 2018;56(6):452–7.

    CAS  PubMed  Google Scholar 

  30. Li CW, Xu MQ, Xu GW, et al. A comparative study of acute and chronic pain between single port and triple port video-assisted thoracic surgery for lung cancer. Chin J Lung Cancer. 2018;21(4):279–84.

    Google Scholar 

  31. Wang GX, Xiong R, Wu HR, et al. Short-term outcome of uniportal and three portal video-assisted thoracic surgery for patients with non-small cell lung cancer. Chin J Lung Cancer. 2018;21(12):896–901.

    Google Scholar 

  32. Liu Z, Yang R, Shao F. Comparison of postoperative pain and recovery between single-port and two-port thoracoscopic lobectomy for lung cancer. Thorac Cardiovasc Surg. 2019;67:142–6.

    Article  Google Scholar 

  33. Ko HJ, Chiang XH, Yang SM, Yang MC. Needlescopic-assisted thoracoscopic pulmonary anatomical lobectomy and segmentectomy for lung cancer: a bridge between multiportal and uniportal thoracoscopic surgery. Surg Today. 2019;49:49–55. https://doi.org/10.1007/s00595-018-1707-y.

    Article  PubMed  Google Scholar 

  34. Zhao R, Shi Z, Cheng S. Uniport video assisted thoracoscopic surgery (U-VATS) exhibits increased feasibility, non-inferior tolerance, and equal efficiency compared with multiport VATS and open thoracotomy in the elderly non-small cell lung cancer patients at early stage. Medicine. 2019;98(28):e16137. https://doi.org/10.1097/MD.0000000000016137.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Gonzalez-Rivas D, Damico TA, Jiang G, Sihoe A. Uniportal video-assisted thoracic surgery: a call for better evidence, not just more evidence. Eur J Cardiothorac Surg. 2016;50:416–7. https://doi.org/10.1093/ejcts/ezw187.

    Article  PubMed  Google Scholar 

  36. Sihoe ADL. Uniportal lung cancer surgery: state of the evidence. Ann Thorac Surg. 2019;107(3):962–72. https://doi.org/10.1016/j.athoracsur.2018.08.023.

    Article  PubMed  Google Scholar 

  37. Xie D, Wang HF, Fei K, Chen C, Zhao DP, Zhou X, Xie BX, Jiang L, Chen QK, Song N, Dai J, Jiang GN, Zhu YM. Single-port video-assisted thoracic surgery in 1063 cases: a single-institution experience. Eur J Cardiothorac Surg. 2016;49:i31–6.

    Article  Google Scholar 

  38. Wu CF, Fernandez R, de la Torre M, Delgado M, Fieira E, Wu CY, et al. Mid-term survival outcome of single-port video-assisted thoracoscopic anatomical lung resection: a two-centre experience. Eur J Cardiothorac Surg. 2018;54:252–9.

    Article  Google Scholar 

  39. Sandri A, Sihoe ADL, Salati M, Gonzalez-Rivas D, Brunelli A. Training in uniportal video-assisted thoracic surgery. Thorac Surg Clin. 2017;27(4):417–23. https://doi.org/10.1016/j.thorsurg.2017.06.010.

    Article  PubMed  Google Scholar 

  40. Sihoe ADL, Gonzalez-Rivas D, Yang TY, Zhu Y, Jiang G. High volume intensive training course: a new paradigm for video-assisted thoracoscopic surgery education. Interact Cardiovasc Thorac Surg. 2018;27(3):365–71. https://doi.org/10.1093/icvts/ivy038.

    Article  PubMed  Google Scholar 

  41. Sihoe AD, Lee TW, Wan IY, Thung KH, Yim AP. The use of gabapentin for post-operative and post-traumatic pain in thoracic surgery patients. Eur J Cardiothorac Surg. 2006;29:795–9.

    Article  Google Scholar 

  42. Sihoe AD, Manlulu AV, Lee TW, Thung KH, Yim AP. Pre-emptive local anesthesia for needlescopic video-assisted thoracic surgery: a randomised controlled trial. Eur J Cardiothorac Surg. 2007;31:103–8.

    Article  Google Scholar 

  43. Sihoe DLA, Yu SYP, Kam TH, Lee SY, Liu X. Adherence to a clinical pathway for video assisted thoracic surgery: predictors and clinical importance. Innovations. 2016;11:179–86.

    Article  Google Scholar 

  44. Zhang X, Yu Q, Lv D. The single-incision versus multiple-incision video-assisted thoracoscopic surgery in the treatment of lung cancer: a systematic review and meta-analysis. Indian J Cancer. 2017;54:291–300.

    Article  CAS  Google Scholar 

  45. Yang Z, Shen Z, Zhou Q, Huang Y. Single-incision versus multiport video-assisted thoracoscopic surgery in the treatment of lung cancer: a systematic review and meta-analysis. Acta Chir Belg. 2018;118(2):85–93. https://doi.org/10.1080/00015458.2017.1379800.

    Article  PubMed  Google Scholar 

  46. Abouarab AA, Rahouma M, Kamel M, Ghaly G, Mohamed A. Single versus multi-incisional video-assisted thoracic surgery: a systematic review and meta-analysis. J Laproendosc Adv Surg Techniques. 2018;28:174–85.

    Article  Google Scholar 

  47. Ng CSH, MacDonald JK, Gilbert S, Khan AZ, Kim YT, Louie BE, Marshall BM, Santos RS, Scarci M, Shargal Y, Fernando HC. Optimal approach to lobectomy for non-small cell lung cancer: systemic review and meta-analysis. Innovations. 2019;14(2):90–116. https://doi.org/10.1177/1556984519837027.

    Article  PubMed  Google Scholar 

  48. Bertolaccini L, Batirel H, Brunelli A, Gonzalez-Rivas D, Ismail M, Ucar AM, Ng CSH, Scarci M, Sihoe ADL, et al. Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019;56(2):224–9. https://doi.org/10.1093/ejcts/ezz133.

    Article  PubMed  Google Scholar 

  49. Sihoe DLA. Opportunities and challenges for thoracic surgery collaborations in China: a commentary. J Thorac Dis. 2016;8:S414–26.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gleneagles Hong Kong Hospital, Hong Kong, China

    Alan D. L. Sihoe

Authors
  1. Alan D. L. Sihoe
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Surgery, University of Chicago, Chicago, IL, USA

    Mark K. Ferguson

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sihoe, A.D.L. (2020). Uniportal Versus Multiportal VATS Lobectomy. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-47404-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-47404-1_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47403-4

  • Online ISBN: 978-3-030-47404-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation