Uniportal and three-portal video-assisted thoracic surgery lobectomy: analysis of the Italian video-assisted thoracic surgery group database

Elisa Meacci, D Tosi, M Nosotti, G Bonitta, A Mazzucco, I Righi, P Mendogni, L Rosso, A Palleschi, G Rocco, R Crisci, M Mancuso, F Pernazza, M Refai, L Bortolotti, G Rizzardi, G Gargiulo, GP Dolci, R Perkmann, F ZaracaM Benvenuti, D Gavezzoli, R Cherchi, P Ferrari, F Mucilli, P Camplese, G Melloni, F Mazza, G Cavallesco, P Maniscalco, L Voltolini, A Gonfiotti, F Stella, D Argnani, GL Pariscenti, Lurilli, C Surrente, C Lopez, A Droghetti, M Giovanardi, C Breda, F Lo Giudice, M Alloisio, E Bottoni, L Spaggiari, R Gasparri, M Torre, A Rinaldo, M Nosotti, L Rosso, GP Negri, A Bandiera, A Stefani, P Natali, M Scarci, E Pirondini, C Curcio, D Amore, G Baietto, C Casadio, S Nicotra, A Dell'Amore, A Bertani, E Russo, L Ampollini, P Carbognani, F Puma, D Vinci, C Andreetti, C Poggi, G Cardillo, S Margaritora, L Luzzi, M Ghisalberti, R Crisci, G Zaccagna, P Lausi, F Guerrera, D Fontana, V Della Beffa, A Morelli, F Londero, A Imperatori, N Rotolo, A Terzi, A Viti, M Infante, C Benato

Research output: Contribution to journalArticle


OBJECTIVES: This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay.METHODS: This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale <= 3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy.RESULTS: Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P<0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62-3.21; P<0.001] and OR 2.58 (95% CI 1.74-3.83; P<0.001), respectively. The uniportal-VATS group had higher operative time (P<0.001), shorter chest drain permanence (P<0.001) and shorter length of stay (P<0.001).CONCLUSIONS: Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.
Original languageEnglish
Pages (from-to)714-721
Number of pages8
Publication statusPublished - 2019


  • Italian VATS Group
  • Lobectomy
  • Postoperative pain
  • Three-portal
  • Uniportal
  • Video-assisted thoracic surgery

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