Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax - A propensity matched bicentric study

Dania Nachira, Mahmoud Ismail, Elisa Meacci, Edoardo Zanfrini, Amedeo Iaffaldano, Marc Swierzy, Julianna Englisch, Svea Faber, Ramin Raul Ossami Saidy, Maria Letizia Vita, Venanzio Porziella, Jens C. Rueckert, Stefano Margaritora

Research output: Contribution to journalArticle

Abstract

Background: The role of triportal video-assisted thoracoscopic surgery (VATS) is widely recognized for the treatment of primary spontaneous pneumothorax (PSP). The aim of this study was to assess the effectiveness and the potential advantages of uniportal VATS (U-VATS) for the treatment of PSP compared with triportal VATS. Methods: A total of 104 triportal (n=39) and uniportal (n=65) VATS procedures where performed for the treatment of PSP in two University hospitals. The prospectively collected data of postoperative outcomes were retrospectively reviewed and a 1:1 propensity score matching analysis was performed to compare the two VATS approaches. Results: No major adverse events occurred after operation. Compared with triportal-VATS, Uniportal-VATS showed the same effectiveness in terms of risk of recurrence (null in both groups), post-operative complications (P=1.000) and operating time (66.04±16.92 vs. 74.57±21.38 min, P=0.141). However, there was a statistically significant difference in favor of uniportal-VATS in terms of necessity of further access [0 vs. 7 (30.4%), P=0.004], chest tube duration (4.39±1.41 vs. 6.32±0.94 days, P<<0.001), postoperative hospital stay (4.78±1.31 vs. 6.61±1.67 days, P<<0.001), visual analogue pain score (VAS) at 24 hours (3.45±1.41 vs. 6.44±2.45, P<<0.001), number of patients who had pain after chest drain removal [1 (4.3%) vs. 16 (69.6%), P<<0.001], VAS after drainage removal (0.11±0.47 vs. 2.74±2.25, P<<0.001), postoperative pain duration (2.50±1.20 vs. 14.82±37.41 days, P<<0.001), pain killers intake (0.75±1.06 vs. 7.53±3.96 days, P=0.001), chronic paresthesia (level scale: 0 to 2; 0 vs. 0.52±0.66, P<<0.001), chronic neuralgia (0 vs. 0.43±0.59, P<<0.001) and cosmetic results (level scale: 0 to 3; 2.91±0.28 vs. 2.00±0.77, P<<0.001). Conclusions: U-VATS is feasible and safe and may be a less invasive alternative to triportal VATS for the treatment of PSP because of its effectiveness in reducing postoperative pain, paresthesia, hospital stay and in improving cosmetic results.

Original languageEnglish
Pages (from-to)S3712-S3719
JournalJournal of Thoracic Disease
Volume10
DOIs
Publication statusPublished - Nov 1 2018

Fingerprint

Video-Assisted Thoracic Surgery
Pneumothorax
Therapeutics
Paresthesia
Postoperative Pain
Pain
Cosmetics
Length of Stay
Chest Tubes
Propensity Score
Neuralgia
Chest Pain
Drainage

Keywords

  • Pleurectomy
  • Pneumothorax
  • Triportal video-assisted thoracic surgery (triportal VATS)
  • Uniportal VATS (U-VATS)

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax - A propensity matched bicentric study. / Nachira, Dania; Ismail, Mahmoud; Meacci, Elisa; Zanfrini, Edoardo; Iaffaldano, Amedeo; Swierzy, Marc; Englisch, Julianna; Faber, Svea; Saidy, Ramin Raul Ossami; Vita, Maria Letizia; Porziella, Venanzio; Rueckert, Jens C.; Margaritora, Stefano.

In: Journal of Thoracic Disease, Vol. 10, 01.11.2018, p. S3712-S3719.

Research output: Contribution to journalArticle

Nachira, D, Ismail, M, Meacci, E, Zanfrini, E, Iaffaldano, A, Swierzy, M, Englisch, J, Faber, S, Saidy, RRO, Vita, ML, Porziella, V, Rueckert, JC & Margaritora, S 2018, 'Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax - A propensity matched bicentric study', Journal of Thoracic Disease, vol. 10, pp. S3712-S3719. https://doi.org/10.21037/jtd.2018.04.124
Nachira, Dania ; Ismail, Mahmoud ; Meacci, Elisa ; Zanfrini, Edoardo ; Iaffaldano, Amedeo ; Swierzy, Marc ; Englisch, Julianna ; Faber, Svea ; Saidy, Ramin Raul Ossami ; Vita, Maria Letizia ; Porziella, Venanzio ; Rueckert, Jens C. ; Margaritora, Stefano. / Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax - A propensity matched bicentric study. In: Journal of Thoracic Disease. 2018 ; Vol. 10. pp. S3712-S3719.
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abstract = "Background: The role of triportal video-assisted thoracoscopic surgery (VATS) is widely recognized for the treatment of primary spontaneous pneumothorax (PSP). The aim of this study was to assess the effectiveness and the potential advantages of uniportal VATS (U-VATS) for the treatment of PSP compared with triportal VATS. Methods: A total of 104 triportal (n=39) and uniportal (n=65) VATS procedures where performed for the treatment of PSP in two University hospitals. The prospectively collected data of postoperative outcomes were retrospectively reviewed and a 1:1 propensity score matching analysis was performed to compare the two VATS approaches. Results: No major adverse events occurred after operation. Compared with triportal-VATS, Uniportal-VATS showed the same effectiveness in terms of risk of recurrence (null in both groups), post-operative complications (P=1.000) and operating time (66.04±16.92 vs. 74.57±21.38 min, P=0.141). However, there was a statistically significant difference in favor of uniportal-VATS in terms of necessity of further access [0 vs. 7 (30.4{\%}), P=0.004], chest tube duration (4.39±1.41 vs. 6.32±0.94 days, P<<0.001), postoperative hospital stay (4.78±1.31 vs. 6.61±1.67 days, P<<0.001), visual analogue pain score (VAS) at 24 hours (3.45±1.41 vs. 6.44±2.45, P<<0.001), number of patients who had pain after chest drain removal [1 (4.3{\%}) vs. 16 (69.6{\%}), P<<0.001], VAS after drainage removal (0.11±0.47 vs. 2.74±2.25, P<<0.001), postoperative pain duration (2.50±1.20 vs. 14.82±37.41 days, P<<0.001), pain killers intake (0.75±1.06 vs. 7.53±3.96 days, P=0.001), chronic paresthesia (level scale: 0 to 2; 0 vs. 0.52±0.66, P<<0.001), chronic neuralgia (0 vs. 0.43±0.59, P<<0.001) and cosmetic results (level scale: 0 to 3; 2.91±0.28 vs. 2.00±0.77, P<<0.001). Conclusions: U-VATS is feasible and safe and may be a less invasive alternative to triportal VATS for the treatment of PSP because of its effectiveness in reducing postoperative pain, paresthesia, hospital stay and in improving cosmetic results.",
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author = "Dania Nachira and Mahmoud Ismail and Elisa Meacci and Edoardo Zanfrini and Amedeo Iaffaldano and Marc Swierzy and Julianna Englisch and Svea Faber and Saidy, {Ramin Raul Ossami} and Vita, {Maria Letizia} and Venanzio Porziella and Rueckert, {Jens C.} and Stefano Margaritora",
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TY - JOUR

T1 - Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax - A propensity matched bicentric study

AU - Nachira, Dania

AU - Ismail, Mahmoud

AU - Meacci, Elisa

AU - Zanfrini, Edoardo

AU - Iaffaldano, Amedeo

AU - Swierzy, Marc

AU - Englisch, Julianna

AU - Faber, Svea

AU - Saidy, Ramin Raul Ossami

AU - Vita, Maria Letizia

AU - Porziella, Venanzio

AU - Rueckert, Jens C.

AU - Margaritora, Stefano

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: The role of triportal video-assisted thoracoscopic surgery (VATS) is widely recognized for the treatment of primary spontaneous pneumothorax (PSP). The aim of this study was to assess the effectiveness and the potential advantages of uniportal VATS (U-VATS) for the treatment of PSP compared with triportal VATS. Methods: A total of 104 triportal (n=39) and uniportal (n=65) VATS procedures where performed for the treatment of PSP in two University hospitals. The prospectively collected data of postoperative outcomes were retrospectively reviewed and a 1:1 propensity score matching analysis was performed to compare the two VATS approaches. Results: No major adverse events occurred after operation. Compared with triportal-VATS, Uniportal-VATS showed the same effectiveness in terms of risk of recurrence (null in both groups), post-operative complications (P=1.000) and operating time (66.04±16.92 vs. 74.57±21.38 min, P=0.141). However, there was a statistically significant difference in favor of uniportal-VATS in terms of necessity of further access [0 vs. 7 (30.4%), P=0.004], chest tube duration (4.39±1.41 vs. 6.32±0.94 days, P<<0.001), postoperative hospital stay (4.78±1.31 vs. 6.61±1.67 days, P<<0.001), visual analogue pain score (VAS) at 24 hours (3.45±1.41 vs. 6.44±2.45, P<<0.001), number of patients who had pain after chest drain removal [1 (4.3%) vs. 16 (69.6%), P<<0.001], VAS after drainage removal (0.11±0.47 vs. 2.74±2.25, P<<0.001), postoperative pain duration (2.50±1.20 vs. 14.82±37.41 days, P<<0.001), pain killers intake (0.75±1.06 vs. 7.53±3.96 days, P=0.001), chronic paresthesia (level scale: 0 to 2; 0 vs. 0.52±0.66, P<<0.001), chronic neuralgia (0 vs. 0.43±0.59, P<<0.001) and cosmetic results (level scale: 0 to 3; 2.91±0.28 vs. 2.00±0.77, P<<0.001). Conclusions: U-VATS is feasible and safe and may be a less invasive alternative to triportal VATS for the treatment of PSP because of its effectiveness in reducing postoperative pain, paresthesia, hospital stay and in improving cosmetic results.

AB - Background: The role of triportal video-assisted thoracoscopic surgery (VATS) is widely recognized for the treatment of primary spontaneous pneumothorax (PSP). The aim of this study was to assess the effectiveness and the potential advantages of uniportal VATS (U-VATS) for the treatment of PSP compared with triportal VATS. Methods: A total of 104 triportal (n=39) and uniportal (n=65) VATS procedures where performed for the treatment of PSP in two University hospitals. The prospectively collected data of postoperative outcomes were retrospectively reviewed and a 1:1 propensity score matching analysis was performed to compare the two VATS approaches. Results: No major adverse events occurred after operation. Compared with triportal-VATS, Uniportal-VATS showed the same effectiveness in terms of risk of recurrence (null in both groups), post-operative complications (P=1.000) and operating time (66.04±16.92 vs. 74.57±21.38 min, P=0.141). However, there was a statistically significant difference in favor of uniportal-VATS in terms of necessity of further access [0 vs. 7 (30.4%), P=0.004], chest tube duration (4.39±1.41 vs. 6.32±0.94 days, P<<0.001), postoperative hospital stay (4.78±1.31 vs. 6.61±1.67 days, P<<0.001), visual analogue pain score (VAS) at 24 hours (3.45±1.41 vs. 6.44±2.45, P<<0.001), number of patients who had pain after chest drain removal [1 (4.3%) vs. 16 (69.6%), P<<0.001], VAS after drainage removal (0.11±0.47 vs. 2.74±2.25, P<<0.001), postoperative pain duration (2.50±1.20 vs. 14.82±37.41 days, P<<0.001), pain killers intake (0.75±1.06 vs. 7.53±3.96 days, P=0.001), chronic paresthesia (level scale: 0 to 2; 0 vs. 0.52±0.66, P<<0.001), chronic neuralgia (0 vs. 0.43±0.59, P<<0.001) and cosmetic results (level scale: 0 to 3; 2.91±0.28 vs. 2.00±0.77, P<<0.001). Conclusions: U-VATS is feasible and safe and may be a less invasive alternative to triportal VATS for the treatment of PSP because of its effectiveness in reducing postoperative pain, paresthesia, hospital stay and in improving cosmetic results.

KW - Pleurectomy

KW - Pneumothorax

KW - Triportal video-assisted thoracic surgery (triportal VATS)

KW - Uniportal VATS (U-VATS)

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