Surgical outcomes for single-port VATS for pneumothorax: a narrative review

Background and Objective: Although the recurrence rate is higher than that of thoracotomy, video-assisted thoracic surgery (VATS) has now become the standard treatment method for spontaneous pneumothorax (SP) because of superior perioperative outcomes such as pain, paresthesia, hospital stay and cosmesis. Many thoracic surgeons are adopting single-port VATS as a less invasive method for treating SP. However, the safety and efficacy of single-portal VATS has not yet been established compared to conventional three-port VATS for SP. Methods: We performed a review of randomized and non-randomized studies of surgical results of single-portal VATS. We searched the PubMed/MEDLINE from its inception to September 2022 to compare single-port VATS and multi-port VATS for SP. The perioperative outcomes including pain, paresthesia, and recurrence were analyzed in the searched 17 literatures. Key Content and Findings: Operative time was slightly longer in single-port VATS in two articles but it was related to the learning curve period. There was no significant difference in two meta-analysis studies. Chest tube drainage durations were also not different or in both single and three-port VATS in most studies. However, the meta-analysis demonstrated a shorter hospital stay in single-port VATS. Acute pain score and paresthesia were better in single-port VATS in most of the articles which we reviewed. Patients who underwent single-port VATS had higher satisfaction levels than those who underwent three-port VATS. There was no significant difference in the recurrence rate in both minimally invasive methods. Conclusions: In many studies, postoperative outcomes were feasible in single-port VATS. Pain, paresthesia and satisfaction were better in single-port VATS compared to three-port VATS. The safety and feasibility of single-port VATS for SP were not inferior to conventional three-port VATS.