Uniportal versus multiportal thoracoscopic lobectomy: Ergonomic evaluation and perioperative outcomes from a randomized and controlled trial

Abstract

Background: To compare perioperative outcomes and surgeon physical and mental stress when performing lobectomy through uniportal and multiportal video-assisted thoracoscopic surgery (VATS) on patients with non-small-cell lung cancer (NSCLC).

Methods: Patients aged 41 to 73 years with resectable NSCLC were randomly assigned via a computer-generated randomisation sequence to receive either uniportal VATS (UVATS) or multiportal VATS (MVATS) lobectomy and lymphadenectomy between December 2015 and October 2016. Overall, we randomly assigned 35 patients to the UVATS and 34 to the MVATS group. Patients and the investigators undertaking interventions, assessing short-term outcomes, performing ergonomic evaluations, and analyzing data were not masked to group assignment.

Results: Patient demographics of the 2 groups were comparable. The ergonomic evaluation considered eye blink rate and the NASA Task Load Index (NASA-TLX), better results were observed in UVATS than in MVATS. The operative time, number of lymph nodes harvested, chest tube duration, length of hospital stay, and lung function were not significantly different between the groups. Compared with MVATS lobectomy, UVATS lobectomy was associated with less intraoperative blood loss and less volume of total drainage in the 24 hours. No conversion, no reoperation, and no in-hospital mortality occurred in either group.

Conclusions: UVATS lobectomy is a safe and programmable technique with some better perioperative outcomes and ergonomic results than MVATS. Further studies based on large numbers of patients and with long-term follow-up are required to confirm its benefits towards patients.

Trial registration: ClinicalTrials.gov ID:NCT02462356. Registered May 27, 2015.

Conflict of interest statement

The authors declare that they have no competing interests.

The authors have no conflicts of interest to disclose.

Figures

Figure 1

Flow chart of the study. VATS = video-assissted thoracic surgery.

Figure 2

A and B: The designed surgical instruments with double articulate and long curve suction for uniportal video-assisted thoracoscopic surgery. C: A 30°, 10-mm high definition camera thoracoscope was placed at the posterior part of the incision during most of operative time (a transfusion tube binds the thoracoscope fixed by a clamp for relieving the tiredness), and other instruments were placed at the anterior side. D: A 3.5 cm incision was made at the fifth intercostal space that between the anterior axillary line and posterior axillary line, and a 24F chest tube was placed at posterior part of incision.

Figure 3

The surgeon with harmonic in right hand and suction in left hand in the mediastinal lymph nodes dissection period. A: 2R and 4R lymph nodes dissection. B: 7R lymph nodes dissection. C: 7L lymph nodes dissection. D: 4L lymph nodes dissection.