title: Single-incision thoracoscopic surgery and conventional video-assisted thoracoscopic surgery: a retrospective comparative study of perioperative clinical outcomes†.
abstract: OBJECTIVE
  To assess the feasibility, safety and postoperative wound pain of single-incision thoracoscopic surgery (SITS) for Stage I lung cancer in patients who had previously undergone surgery compared with conventional video-assisted thoracoscopic surgery (c-VATS).
  
  
  METHODS
  Lobectomy by SITS (60) and c-VATS (20) was performed for Stage I lung cancer between 2011 and 2014. In SITS, an ∼ 5-cm small incision was placed at the fourth or fifth intercostal space from the anterior to posterior axillary line. C-VATS was performed via three or four ports using trocars only. The evaluation items were general operative outcomes, pain stress using the Numeric Rating scale (NRS) on postoperative days 3, 7 and 30, and some pathological symptoms related to the neuropathic wound pain through the operative course. The number of days of use of analgesic agents was also evaluated for 1 month after surgery.
  
  
  RESULTS
  SITS showed similar perioperative outcomes (postoperative hospital stay, blood loss, surgical time, drainage duration, creatine phosphokinase (CPKmax), creactive protein (CRPmax) and frequency of postoperative complications) to those of c-VATS. Additionally, the average NRS in SITS decreased on postoperative days 7 and 30 (Day 7: 2.4 ± 0.4 vs 4.2 ± 0.3, P = 0.041, Day 30: 1.7 ± 0.4 vs 3.3 ± 0.3, P = 0.038) and the number of days analgesic agents were administered was also reduced (SITS: 8.1 ± 0.9 vs c-VATS 13.1 ± 1.2 days, P = 0.045). The frequency of allodynia, hyperalgesia, hypaesthesia and numbness was significantly reduced in the SITS group.
  
  
  CONCLUSIONS
  Although conclusive evidence has not yet been obtained, SITS is more minimally invasive in regard to postoperative wound pain compared with c-VATS. This procedure should be considered as a treatment option for early-stage lung cancer.
authors.affiliation: Division of Thoracic Surgery, Nippon Medical School, Chiba Hokusoh Hospital, Inzai, Chiba, Japan ky-hirai@nms.ac.jp.
authors.forename: Kyoji
authors.initials: K
authors.lastname: Hirai
authors.affiliation: Division of Thoracic Surgery, Nippon Medical School, Chiba Hokusoh Hospital, Inzai, Chiba, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Takeuchi
authors.affiliation: Division of Thoracic Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Jitsuo
authors.initials: J
authors.lastname: Usuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: Lung cancer; Minimally invasive; Single-incision thoracoscopic surgery