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. 2022 Sep;14(9):3154-3166.
doi: 10.21037/jtd-22-6.

Decreased postoperative complications, neuropathic pain and epidural anesthesia-free effect of uniportal video-assisted thoracoscopic anatomical lung resection: a single-center initial experience of 100 cases

Takahiro Homma  1   2 , Yoshifumi Shimada  1 , Keitaro Tanabe  1
Affiliations

Decreased postoperative complications, neuropathic pain and epidural anesthesia-free effect of uniportal video-assisted thoracoscopic anatomical lung resection: a single-center initial experience of 100 cases

Takahiro Homma et al. J Thorac Dis. 2022 Sep.

Abstract

Background: We aimed to analyze perioperative complications, postoperative neuropathic pain, and the necessity of epidural anesthesia in uniportal video-assisted thoracoscopic surgery (U-VATS) compared to conventional multiportal VATS (M-VATS) for anatomical lung resection.

Methods: This retrospective study included all patients who underwent elective VATS lobectomy and segmentectomy between April 2016 and December 2019. The exclusion criteria were as follows: age ≤19 years, planned thoracotomy, re-operation in thoracic surgery, median sternotomy, robot-assisted thoracic surgery, simultaneous resection of extrathoracic organs, locally invasive lung tumor with bronchoplasty or angioplasty, past or current neuropathic pain, and a large tumor with a minimum diameter ≥5 cm. M-VATS had 4 ports approach. U-VATS port positions were placed by extending the thoracoscope port of M-VATS.

Results: U-VATS patients showed significant differences compared to M-VATS patients: smaller intraoperative bleeding (1 vs. 30 mL; P=0.0010), shorter operative time (141 vs. 183 min; P<0.0001), post-hospitalization (5 vs. 8 days; P=0.0002), fewer complications (23.9% vs. 40.9%; P=0.048), less acute pain, less postoperative neuropathic pain (32.4% vs. 52.1%; P=0.027) and shorter duration of neuropathic pain (30 vs. 60 days; P=0.041). For the postoperative neuropathic pain and pain score until postoperative day 5, there were no differences between the groups with and without epidural anesthesia.

Conclusions: As a single-center initial experience, U-VATS lobectomy and segmentectomy seemed safe and minimally invasive based on not only postoperative neuropathic pain and complications but also time management. U-VATS would provide better pain control, without epidural anesthesia.

Keywords: Uniportal; lung resection; neuropathic pain; time management; video-assisted thoracoscopic surgery (VATS).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-6/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Port placements in U-VATS and M-VATS. U-VATS port positions were placed by extending thoracoscope port of M-VATS forward. U-VATS, uniportal video-assisted thoracoscopic surgery; M-VATS, conventional multiportal video-assisted thoracoscopic surgery.
Figure 2
Figure 2
Patient selection flowchart. M-VATS, conventional multiportal video-assisted thoracoscopic surgery; U-VATS, uniportal video-assisted thoracoscopic surgery.
See this image and copyright information in PMC

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