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Eur J Cardiothorac Surg 2005;28:43-46
© 2005 Elsevier Science NL
Price Thomas Unit, Department of Thoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Herries Road, S5 7AU Sheffield, UK
Received 18 December 2004; received in revised form 24 February 2005; accepted 28 February 2005.
* Corresponding author. Tel.: +44 114 236 3399; fax: +44 114 261 0350. (Email: gaetano.rocco{at}btopenworld.com).
Objective: VATS using the conventional three ports is currently the technique of choice for blebectomy/bullectomy for spontaneous pneumothorax. However, the procedure has recently been shown to have neurological complications related to the port sites. Uniportal VATS has recently been proposed as an alternative to conventional three-port VATS. It is anticipated that the single incision will predispose to a lower incidence of neurological complications. Methods: We report our initial single surgeon experience of uniportal VATS (n=16) and provide a comparison of post-operative pain and residual paraesthesia to conventional three-port procedures (n=19) for the same pathology. Results: In both groups, the pneumothorax pathology was principally primary. There was no difference between the groups in terms of age, spirometry, tissue resected, drainage time and inpatient stay. A difference was, however, noted in inpatient pain scores. The uniportal group had a lower median score of 0.4 (visual analogue range 0–4) while the three-port technique reported 0.8 (P=0.06, Mann–Whitney test). The maximum score trend was similar (1.4 vs. 2.6, respectively, P<0.001, Mann–Whitney test). Follow-up for uniportal and three-port VATS averaged 9.4±6.6 and 32.1±9.9 months, respectively. One patient in the three-port group had a pneumothorax recurrence. Three-port VATS also had a higher residual pain score (0.5) compared to uniportal VATS (0.3). Of clinical significance was the incidence of neurological complications. Eighty-six percent of uniportal patients reported no symptoms. The remaining experienced only mild ‘numbness’ or ‘swelling’. However, in the three-port group, only 42% reported no symptoms. A similar number experienced ‘numbness’. Two females described sexual dysfunction due to altered breast sensitivity. Seventeen percent (2/12) reported ‘pins and needles’. Conclusions: Uniportal VATS appears to be tolerable, safe and efficient in treating spontaneous pneumothorax in our series. Moreover, post-operative pain and paraesthesia incidence was lower than three-port VATS. Prospective randomised trials are important to evaluate this technique.
Key Words: Uniportal • VATS • Pain • Paraesthesia • Spontaneous pneumothorax
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