title: Pain and recovery are comparable after either uniportal or multiport video-assisted thoracoscopic lobectomy: an observation study.
abstract: OBJECTIVE
  Uniportal approaches to video-assisted thoracoscopic surgery (VATS) lobectomy have been described in significant series. Few comparison studies between the two techniques exist. The aim was to determine whether the uniportal technique had more favourable postoperative outcomes than the multiport technique.
  
  
  METHODS
  All VATS lobectomies undertaken at a single university hospital during August 2012 to December 2013 were studied. Patients with preoperative opiate use or chronic pain were excluded. Patients were divided into those with uniportal and multiport approaches for analysis. All continuous data were assessed for normality, and analysed with the Mann-Whitney U-tests or t-tests as appropriate. Categorical data were analysed by Fisher's exact or χ(2) test for trend as appropriate.
  
  
  RESULTS
  One hundred and twenty-nine VATS lobectomies were completed. Six were excluded and data were incomplete for 13, leaving 110 (15 uniportal, 95 multiport) for analysis. The demographics of the two groups were similar. There was no significant difference in the Thoracoscore or American Society of Anesthesiologists grades. The median morphine use in the first 24 postoperative hours was 19 mg in the uniportal group and 23 mg in the multiport group, P = 0.84. The median visual analogue pain score in the first 24 h was 0 in the uniportal group and 0 in the multiport group, P = 0.65. There was no difference in the duration of patient-controlled analgesia (P = 0.97), chest drain duration (P = 0.67) or hospital length of stay (P = 0.54). There was no inpatient mortality and no unplanned admission to critical care in either group.
  
  
  CONCLUSIONS
  Uniportal VATS lobectomy is safe, and there is no appreciable negative impact on the hospital stay or morbidity. Patient-reported pain and morphine use in the first 24 h was low with either technique. Larger prospective studies are needed to quantify any benefit to a particular approach for VATS lobectomy.
authors.affiliation: Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK pmcelnay@doctors.org.uk.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: McElnay
authors.affiliation: Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Mat
authors.initials: M
authors.lastname: Molyneux
authors.affiliation: Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Krishnadas
authors.affiliation: Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Timothy J P
authors.initials: TJ
authors.lastname: Batchelor
authors.affiliation: Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Douglas
authors.initials: D
authors.lastname: West
authors.affiliation: Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Casali
mesh_terms: D000368:Aged; D016058:Analgesia, Patient-Controlled; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology*; D011013:Pneumonectomy / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology
keywords: Carcinoma; Non-small-cell lung; Outcome assessment; Thoracic surgery; Video-assisted