Preliminary experience in uniportal video-assisted thoracoscopic surgery (VATS)

Andrea Viti, Pietro Bertoglio, Alberto Terzi


Background: In recent years, technical evolution in the field of minimally invasive thoracic surgery has allowed a progressive reduction of invasiveness of major lung resection. The uniportal technique aims to decrease surgical trauma to a minimum, while ensuring a correct oncological procedure. We describe our initial approach to uniportal video-assisted thoracoscopic surgery (VATS).
Methods: A gradual approach to uniportal VATS was provided by means of specialized courses between 2016 and 2018. Dedicated instruments for uniportal VATS lobectomy (UVL) were made available in 2017. Uniportal VATS procedures between March 2017 and Lune 2018 were evaluated. Type of procedure, conversion rate to multiportal VATS or thoracotomy, post-operative complications and hospital stay were described.
Results: We performed 52 procedures (49 minor resections, 1 thymectomy for thymic hyperplasia, 2 lobectomies). Conversion to multiportal VATS was required in 15 cases (14 wedge resections, and 1 thymectomy). No major complications occurred intra- and post-operatively. Median post-operative stay was 3 days for wedge resection (range, 2–5 days) and 6 and 7 days for lobectomies.
Conclusions: Uniportal VATS proved to be a safe and feasible procedure even in the preliminary phase of learning. A structured approach, entailing intensive exposure in ultra-high-volume centers, specialized courses, employment of dedicated instrumentation may help surgeons overcoming initial difficulties.