title: Uniportal Videothoracoscopic Surgery: Our Indications and Limits.
abstract: OBJECTIVE
  We present our experience with uniportal videothoracoscopic surgery (VATS-U), examining its indications, limits, and results.
  
  
  METHODS
  Since January 2009, 66 patients underwent VATS-U for the following indications: pneumothorax (n = 25), lung nodule (n = 15; n = 10 with preoperative radiolocalization), wedge biopsy (n = 15), hyperhidrosis (n = 10), and chest wall schwannoma (n = 1). The conversion rate to conventional video-assisted thoracic surgery (VATS), postoperative pain, complications, residual paraesthesia, and hospitalization were analyzed. Operative time, postoperative pain, and paraesthesia were retrospectively compared with a cohort of 172 cases of conventional multiportal VATS, performed in the same period.
  
  
  RESULTS
  Conversion to traditional VATS was necessary in two cases (pulmonary nodule, n = 1; pneumothorax, n = 1). The mean pain score was 0.8, the mean operation time was 42 minutes, and 10 patients had postoperative paraesthesia that lasted a mean of 7 days. No postoperative complications were reported, and the mean postoperative hospital stay was 3 days (range, 1-6 days). The comparison between the VATS-U and the standard multiportal VATS group showed in the VATS-U group a lower but not statistically significant pain score and paraesthesia as well as a lower and statistically significant operative time.
  
  
  CONCLUSIONS
  Uniportal videothoracoscopic surgery has a wide range of indications: lung apex resections and pleurodesis for spontaneous pneumothorax treatment; pulmonary nodule assessment with or without preoperative localization; lung biopsy for interstitial diseases; unilateral or bilateral sympathectomy to treat hyperhidrosis; benign chest wall tumor evaluation. The limits of this technique are linked to pleural adhesions or lung nodules in difficult positions. In our experience, VATS-U results in minimal postoperative pain, allowing for fast functional recovery and a consequent short hospital stay; thus, we suggest that VATS-U is a valid alternative to traditional multiportal VATS for indications beyond cosmetic benefits. Prospective randomized trials are necessary to validate the advantages of uniportal VATS.
authors.affiliation: From the European Center of Thoracic Research (CERT), Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gonfiotti
authors.forename: Massimo Osvaldo
authors.initials: MO
authors.lastname: Jaus
authors.forename: Daniel
authors.initials: D
authors.lastname: Barale
authors.forename: Domenico
authors.initials: D
authors.lastname: Viggiano
authors.forename: Natalia
authors.initials: N
authors.lastname: Battisti
authors.forename: Paolo
authors.initials: P
authors.lastname: Macchiarini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D008171:Lung Diseases / Q000601:surgery; D008875:Middle Aged; D009442:Neurilemmoma / Q000601:surgery; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology; D011030:Pneumothorax / Q000601:surgery; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D035441:Thoracic Wall / Q000601:surgery; D055815:Young Adult