Single Versus Two-Port Video-Assisted Thoracoscopic Segmentectomy for Pulmonary Nodules - A Case Series Analysis

Background The application of single-port video-assisted thoracoscopic surgery (VATS) segmentectomy is still controversial, and there is a lack of comparative study between single-port and two-port VATS segmentectomy. This study compared the perioperative results between single-port and two-port VATS segmentectomy. Method The data of patients who underwent VATS segmentectomy in the Department of Thoracic Surgery, Daping Hospital, Army Medical University from February 2017 to July 2021 in the same surgical team were collected. The patients were divided into single-port VATS group and two-port VATS group. The perioperative results of the two groups were compared. Results A total of 341 cases of VATS segmentectomy were enrolled, including 106 males and 235 females, with an average age of 55.07±10.75 years, of which 175 cases (175/341, 51.32%) were in the two-port VATS group and 166 cases (166/341, 48.68%) were in single-port VATS group. Both groups were well balanced for gender, age, smoking history, body mass index, preoperative pulmonary function, Carlson comorbidity index, tumor size, tumor location, and histological type. R0 resection was achieved in all cases in both groups, and there was no death within 30 days after surgery. Patients in the single-port VATS group had less intraoperative blood loss [90 (50,110) ml vs. 100 (70,120) ml, p =0.02], shorter thoracic drainage duration [3 (2,4) days vs. 3 (2,5) days, p =0.013], less total amount of thoracic drainage fluid [320 (240,450) ml vs. 380 (270,520) ml, p =0.003], shorter postoperative hospital stay [5 (4,7) days vs. 6 (4,8) days, p <0.001], lower visual analogue score of pain during the follow-up period ( P <0.05) and higher quality of life score ( P <0.05). There were no significant differences between the two groups in lymph node resection, conversion to thoracotomy, and postoperative complications. Conclusion Single-port VATS segmentectomy is safe and feasible for pulmonary nodules. It can significantly reduce intraoperative blood loss, enhance postoperative recovery, relieve postoperative pain, and improve long-term quality of life. It was comparable to that of two-port VATS in lymph node resection, postoperative drainage, and complications. Additional research is needed to understand basal segmentectomy of the lower lobe.