Uniportal Video-Assisted Thoracoscopic Lung Resection: A Single-Surgeon Experience and Comparison with Multiportal Technique in the Veteran Population.

MedStar author(s):
Citation: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 32(2):149-157, 2022 Feb.PMID: 33533673Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Lung Neoplasms | *Surgeons | *Veterans | Humans | Lung | Lung Neoplasms/su [Surgery] | Pneumonectomy | Retrospective Studies | Thoracic Surgery, Video-AssistedYear: 2022Local holdings: Available online through MWHC library: 2000 - 2010, Available in print through MWHC library:1999-2007ISSN:
  • 1092-6429
Name of journal: Journal of laparoendoscopic & advanced surgical techniques. Part AAbstract: Background: Uniportal video-assisted thoracoscopic surgery (VATS) has been shown to offer improved postoperative outcomes compared with multiportal technique. Shorter operative time has rarely been described. Our objective was to compare operative time and clinical outcomes between uniportal and multiportal VATS approaches for lung resection. Methods: This is a retrospective review of patients that underwent video-assisted thoracoscopic lung resection at United States Veterans Affairs centers between 2008 and 2018 using the Veteran Affairs Surgical Quality Improvement Program. Cases were assigned to uniportal (single surgeon) or multiportal cohorts. Multivariable analysis of clinical outcomes was performed, adjusting for preoperative confounding covariates. Temporal trend in operative time in uniportal cohort was analyzed in the context of cumulative operative volume using Spearman's rank correlation coefficient, rho (rho). Results: In total, 8,212 cases were selected from 2008 to 2018 at Veterans Affairs centers: 176 (2.1%) uniportal and 8036 (97.9%) multiportal cases. Uniportal cohort was significantly associated with shorter operative time (1.7 hours versus 3.1 hours, P < .001), higher adjusted odds of surgical site infection (adjusted odds ratio = 2.76; P = .005), and longer length of stay (6 days versus 5 days; P = .04). Uniportal cohort operative time decreased over time (rho = -0.474), with most significant change corresponding with increased cumulative operative volume from 25 to 44 cases. Conclusions: Uniportal technique offered shorter operative duration in veterans compared with multiportal approach, validating its technical advantages. Operative time decreased as cumulative operative volume increased, demonstrating a learning curve. Future studies should prospectively investigate any association between operative time and clinical outcomes after thoracoscopic lung resection.All authors: Antevil JL, Holleran TJ, Napolitano MA, Sparks AD, Trachiotis GDOriginally published: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2021 Feb 03Fiscal year: FY2021Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-02-18
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 33533673 Available 33533673

Available online through MWHC library: 2000 - 2010, Available in print through MWHC library:1999-2007

Background: Uniportal video-assisted thoracoscopic surgery (VATS) has been shown to offer improved postoperative outcomes compared with multiportal technique. Shorter operative time has rarely been described. Our objective was to compare operative time and clinical outcomes between uniportal and multiportal VATS approaches for lung resection. Methods: This is a retrospective review of patients that underwent video-assisted thoracoscopic lung resection at United States Veterans Affairs centers between 2008 and 2018 using the Veteran Affairs Surgical Quality Improvement Program. Cases were assigned to uniportal (single surgeon) or multiportal cohorts. Multivariable analysis of clinical outcomes was performed, adjusting for preoperative confounding covariates. Temporal trend in operative time in uniportal cohort was analyzed in the context of cumulative operative volume using Spearman's rank correlation coefficient, rho (rho). Results: In total, 8,212 cases were selected from 2008 to 2018 at Veterans Affairs centers: 176 (2.1%) uniportal and 8036 (97.9%) multiportal cases. Uniportal cohort was significantly associated with shorter operative time (1.7 hours versus 3.1 hours, P < .001), higher adjusted odds of surgical site infection (adjusted odds ratio = 2.76; P = .005), and longer length of stay (6 days versus 5 days; P = .04). Uniportal cohort operative time decreased over time (rho = -0.474), with most significant change corresponding with increased cumulative operative volume from 25 to 44 cases. Conclusions: Uniportal technique offered shorter operative duration in veterans compared with multiportal approach, validating its technical advantages. Operative time decreased as cumulative operative volume increased, demonstrating a learning curve. Future studies should prospectively investigate any association between operative time and clinical outcomes after thoracoscopic lung resection.

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