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Transition from two-three port to uniportal approach in video-assisted thoracoscopic surgery lobectomy: a multicentre comparative study

Background: Minimal invasiveness is currently aimed in most surgical interventions. In thoracic surgery, video-assisted thoracoscopic surgery (VATS) lobectomies have become a standard, a step further is uniportal approach. The current study aimed to compare main indicators of VATS before and after switching to uniportal approach in five European thoracic surgery centres with previous two-three port VATS lobectomy experience. 
 Methods: Last 20 (consecutive) VATS lobectomies before implementing the uniportal approach were compared to first 20 (consecutive) uniportal VATS lobectomies in each centre. Data were extracted from medical records. Student’s t-test and Mann-Whitney U test were used for statistical analysis. 
 Results: Data from 100 multiportal VATS lobectomies were compared to 100 uniportal VATS lobectomies. The study groups did not differ in terms of age, gender, BMI, diagnosis, or lobe removed. There was no difference between study groups in terms of mean duration of the operation (148 vs. 148 min; P=0.81), mean intraoperative blood loss (113 vs. 134 mL; P=0.46), conversion to thoracotomy (6 vs. 6; P=1.00), mean duration of postoperative pleural drainage (3.6 vs. 4.5 days; P=0.12) or postoperative complications (P=0.95). Trend towards shorter mean duration of postoperative hospital stay was found in uniportal group (6.8 vs. 8.1 days; P=0.059). No in-hospital mortality occurred in either of the groups. 
 Conclusions: Transition from multi- to uniportal approach in VATS lobectomy did not prolong the operation, increase the rate of complications or conversion to thoracotomy. Postoperative hospital stay after uniportal lobectomy was shorter, although the difference did not reach statistical significance. There was no evidence of a learning curve while implementing uniportal VATS lobectomy.