In minor and major thoracic procedures is uniport superior to multiport video-assisted thoracoscopic surgery?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: Are there differences in outcomes in uniport compared with multiport video-assisted thoracoscopic surgery? Altogether, 45 papers were found using the reported search, of which 8 papers represent the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type and level of evidence of publication, relevant outcomes and results of these papers are tabulated. Two studies (272 patients) compared outcomes for lobectomy. One study found pain control was significantly better in uniportal (P < 0.01) with earlier mobilization (P < 0.05), and decreased hospital stay by half a day (P < 0.05). The chest drain volume was less, and consequently the number of days the chest drain remained in situ decreased by 1 day (P < 0.05). The second study looking at lobectomies failed to find any differences between the two techniques. For minor thoracic procedures (pneumothorax, peripheral lung nodules, thymic tumours, lung biopsies, sympathectomies and mediastinal cystectomies), 3 papers (117 patients) showed a statistically significant reduction in pain score during inpatient stay, and 1 paper showed a reduction in pain score day 0 postoperatively, however, no difference in pain score days 1 and 3 postoperatively. Two papers (n = 91) showed no difference in the reported pain scores; however, the patients in the uniportal group experienced less paraesthesia postoperatively. Patients in the uniportal group in this study also had reduced in-hospital stay (P = 0.03), and this led to a reduction in inpatient costs (P = 0.03). Four other studies, however, did not find any significant difference in duration of hospital stay. Pain scores are lower in uniportal VATS, most studies however do not demonstrate differences in other outcomes including analgesic use, duration of chest tube drainage, length of hospital stay or other thoracic complications. We conclude that, although uniport access may offer improved pain scores, the current evidence reveals no differences in most postoperative outcomes between uniport and multiport approaches to VATS in either minor or major thoracic procedures.