Uniportal vs. multiportal thoracoscopic segmentectomy: a north American study

Ilitch Diaz-Gutierrez; Charles Antoine Menier; Félix H Savoie-White; Jesse E Doyle; Qi Wang; Rafael S Andrade; Paula Ugalde Figueroa

doi:10.21037/jtd-22-780

Uniportal vs. multiportal thoracoscopic segmentectomy: a north American study

J Thorac Dis. 2023 Feb 28;15(2):335-347. doi: 10.21037/jtd-22-780. Epub 2023 Feb 13.

Authors

Ilitch Diaz-Gutierrez¹, Charles Antoine Menier², Félix H Savoie-White², Jesse E Doyle³, Qi Wang⁴, Rafael S Andrade⁵, Paula Ugalde Figueroa⁶

Affiliations

¹ Department of Surgery, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, MN, USA.
² Université Laval, Québec City, QC, Canada.
³ Ross University School of Medicine, Miramar, FL, USA.
⁴ Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA.
⁵ Department of Surgery and Chief, Division of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, MN, USA.
⁶ Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard University, Boston, MA, USA.

Abstract

Background: Uniportal video-assisted thoracoscopic surgery (VATS) segmentectomy is gaining worldwide acceptance, but experience in North America is still limited. We report a North American multicenter comparison of uniportal vs. multiportal VATS segmentectomy.

Methods: We performed an institutional review board-exempt retrospective chart review on prospectively collected databases at two North American centers, from January 2012 to December 2020. We included all VATS segmentectomy patients and excluded emergent cases (n=1), patients with incomplete records (n=2), and segmentectomy performed in conjunction with another type of lung resection (n=1). We recorded patient demographics, perioperative data, 30-day postoperative complications and compared outcomes between cohorts. We provided descriptive statistics for each group. We calculated propensity score matching and paired patients 1:1. We defined P values less than 0.05 as statistically significant.

Results: We performed a total of 423 VATS segmentectomies, 181 uniportal (42.7%) vs. 242 multiportal (57.2%). Indications for surgery were primary lung cancer (n=339), metastatic (n=41), benign disease (n=40), and other (n=3). We staged 85.1% of patients preoperatively with positron emission tomography-computed tomography (PET-CT) scan according to National Comprehensive Cancer Network (NCCN) guidelines. Propensity score matching generated 156 patients on each group. Operating time was significantly lower in the uniportal group compared to multiportal (130 vs. 161 min respectively, P<0.001). We found no difference in estimated blood loss, Clavien-Dindo class III-IV complications, conversion to thoracotomy, R0 resection rate, nodal upstaging, hospital length of stay, 30-day readmission or mortality.

Conclusions: Our experience from two North American centers indicates that, in experienced hands, postoperative outcomes after uniportal and multiportal VATS segmentectomy are comparable.

Keywords: Uniportal; multiportal; segmentectomy; thoracoscopic; video-assisted thoracoscopic surgery (VATS).

Grants and funding

UL1 TR002494/TR/NCATS NIH HHS/United States