Uniportal, Video-Assisted Thoracic Surgery in Over 300 Consecutive Patients with Varying Pathologies

Background: Uniportal (as opposed to three-portal) minimally invasive, video-assisted thoracic surgery (VATS) has received gaining international attention. In Germany, adoption of this technique has been slow thus far. We report our experience with uniportal VATS.

Methods: We assessed 312 consecutive patients having undergone uniportal VATS between January 2015 and August 2018. We analyzed indications, conversions, complications, and outcomes. The procedures were performed by one 3cm skin incision with minimal rib spreading on either side of the thorax as required by the underlying pathology.

Results: Mean age was 62 ± 16 years, 56% were male. There was a wide variety of pathologies, consisting mainly out of bronchial carcinoma (43%), pleural effusion (11%), pneumothorax (6%), pulmonary metastases (6%), empyema (8%), and various combined malignant and benign conditions in the remaining quarter of patients. Duration of the procedure was 67 ± 42 minutes. The operative goal was achieved in 98% of cases, with the need to convert to open thoracotomy in 2%. There was one chest tube placed per operated side, which could be removed on postoperative day 1 in 91% of the cases. Surgical revision was required in 4% of cases for persistent pneumothorax, hemato or sero-pneumothorax. There was one wound infection requiring revision. Mobilization was started shortly after extubation and need for pain medication was comparatively low. In-hospital mortality was 1%.

Conclusion: Uniportal VATS represents a safe, minimally invasive technique, which allows to perform a wide variety of procedures with one small incision and limited need for rib spreading. The result is faster mobilization and less pain for the patient in addition to an excellent cosmetic result.