Pain following thoracoscopic surgery: retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery

Masaya Tamura, Yosuke Shimizu, Yasuo Hashizume, Masaya Tamura, Yosuke Shimizu, Yasuo Hashizume

Abstract

Background: The current trend in thoracoscopic surgery is to use fewer ports to decrease postoperative pain, chest wall paresthesia, and duration of hospital stay. In this study we compared the results of our current experience with single-incision thoracoscopic surgery (SITS) and conventional three-port video-assisted thoracoscopic surgery (3P-VATS).

Methods: From October 2011 to August 2012, 37 consecutive patients underwent thoracoscopic surgery. This is a non-randomized retrospective study. Among these patients, 19 (SITS group) were treated using single port method (SITS), whereas 18 (3P-VATS group) were treated using the conventional three-port methods (3P-VATS). The surgical duration, number of resected lesions, duration of chest drainage, duration of hospital stay, inpatient pain scores, and patient satisfaction scores were compared between both groups.

Results: The mean age at surgery, indication, gender, body mass index, and the side involved were similar in both groups. The procedures performed in the SITS group were similar to those performed in the 3P-VATS group. The mean operative time was longer in the SITS group compared with the 3P-VATS group. Duration of postoperative drainage days and hospital stay was shorter in the SITS group compared with the 3P-VATS group, although these differences were not statistically significant. Pain scores on postoperative days 0,1, and 3 were significantly higher in patients who underwent 3P-VATS compared with those who underwent SITS (p = 0.012, 0.039, and 0.037, respectively). The SITS group reported higher patient satisfaction scores than the 3P-VATS group, patients in the 3P-VATS group tended to receive higher total doses of analgesics (NSAIDs) after surgery compared with those in the SITS group, although these differences were not statistically significant.

Conclusions: Our experience demonstrated that SITS decreased postoperative pain and resulted in higher patient satisfaction compared with the conventional three-port VATS. However, a prospective, randomized study is needed to confirm our preliminary findings. To overcome the technological limitations of SITS, the development of new instruments is needed.

Figures

Figure 1
Figure 1
Postoperative pain scores on a visual analogue scale according to the number of ports as a function of time after thoracoscopic surgery. Pain scores on postoperative days 0,1, and 3 were higher for patients who underwent three-port VATS than for those who underwent SITS (p = 0.012, 0.039 and 0.037, respectively).
Figure 2
Figure 2
External and intraoperative views during SITS.

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