Three-year Experience on 477 Patients Undergoing Uniportal Video-Assisted Thoracoscopic Surgery.

INTRODUCTION: Uniportal video-assisted thoracic surgery (VATS) technique has been described both for diagnostic and therapeutic indications. Outcomes after uniportal VATS have never been reported in Portuguese large series. We review the safety and efficiency of our initial experience with uniportal VATS.

METHODS: In a retrospective study of prospectively collected data, 477 uniportal VATS procedures were analyzed between June 2014 and June 2017. All procedures were performed without rib spreading. Patients' demographic data, preoperative and postoperative management as well as results were analyzed.

RESULTS: The mean age of patients was 47,9 years (range, 10 to 86), and 155 (32,5%) patients were female. The uniportal VATS procedures included 156 (32,7%) anatomical major lung resections, 80 (16,8%) one or multiple wedge resections, 172 (36,1%) blebectomies and/ or pleurectomies, 24 (5%) mediastinal lesions, 16 (3,3%) empyema drainage and decortications and other indications in 29 (6,1%) cases. Median operative ime and surgical drainage for uniportal VATS for anatomical major lung resections was 95 minutes (range, 40 to 245) and 100 ml (range, 0 to 650), respectively. Conversion to either 2 or 3 port VATS or mini-thoracotomy was necessary in 7.1% of the surgeries, often due to adhesions, incomplete lung collapse or bleeding. The chest drain was removed after a median of 3 days (range, 0 to 34). Median hospital stay was 3 days (range, 1 to 41). Postoperative complication rate was 12,4% mainly due to prolonged air leak 8,4% (n=40). There was no perioperative mortality.

CONCLUSION: Uniportal VATS is a feasible and safe technique for various indications in thoracic surgery. The perioperative results are promising. Excellent results with minimal morbidity and short hospital stay are amongst its strong points. It can be performed by thoracic surgeons experienced in the postero-lateral thoracotomy approach.