Beyond the ports: outcomes in uni-port vs. multi-port video assisted thoracoscopic surgery (VATS) lung resections

BACKGROUND:
Video-assisted thoracoscopic surgery (VATS) has become the preferred minimally invasive approach for thoracic surgical procedures, with potential advantages over traditional thoracotomy. Perioperative and long-term outcomes between uni-port (U-VATS) versus multi-port (M-VATS) techniques remains under investigation.


OBJECTIVES:
To compare U-VATS and M-VATS in terms of operative outcomes, complications, and oncological parameters.


DESIGN:
Retrospective cohort study


SETTING:
Single tertiary referral center, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia


PATIENTS AND METHODS:
Adult patients aged 18–75 years who underwent VATS lung resection between January 2015 and September 2024 were included. Pediatric patients and those undergoing open techniques were excluded. Collected data included sociodemographic, preoperative, intraoperative, and postoperative variables. Statistical analysis used t-test, Mann-Whitney U, Chi-square, and multivariate logistic regression.


MAIN OUTCOME MEASURES:
Operative time, blood loss, lymph node dissection, postoperative complications, hospital stay, mortality, and recurrence.


SAMPLE SIZE:
194 patients (103 U-VATS, 91 M-VATS)


RESULTS:

Baseline characteristics were similar between groups. U-VATS was associated with longer operative time, [mean (SD) 210.0 (110.4) vs. 154.2 (69.9) min,
P
<.001] and greater blood loss [416.7 (392.2) vs. 150.0 (76.4) ml,
P
=.034]. Malignant lymph node involvement was higher in U-VATS (39.8% vs. 19.8%,
P
=.021), with more lymph node stations sampled. Anatomical resections were more common in U-VATS (31.1% vs. 13.2%,
P
=.005). Complication rates were low, with pneumonia (4.4%) as the most frequent in M-VATS and prolonged air leak (2.9%) in U-VATS. Thirty-day mortality was comparable (17.5% vs. 15.4%). Multivariate analysis showed M-VATS was associated with dissecting more lymph nodes (odds ratio, OR: 1.223; 95% confidence interval, CI: 1.019–1.468;
P
=.030), while anatomical resections were more likely with U-VATS (OR: 0.40; 95% CI: 0.180–0.740;
P
=.006).



CONCLUSIONS:
Both U-VATS and M-VATS are safe for lung resections. U-VATS is more commonly used for anatomical resections and allows broader lymph node station sampling, supporting its expanding role in thoracic surgery.


LIMITATIONS:
Single-center retrospective design, relatively small sample, and incomplete lymph node documentation.