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Uniportal Video-Assisted Thoracoscopic Approach to Lung Resection Offers Shorter Operative Duration than Multiportal Technique in the Veteran Population
Timothy J. Holleran1, Michael A. Napolitano1, Andrew D. Sparks2, Jared L. Antevil1, Gregory D. Trachiotis1
1Department of Cardiothoracic Surgery and Heart Center, Veterans Affairs Medical Center, Washington, DC, USA, 2Department of Surgery, George Washington University Hospital, Washington, DC, USA

Background: Uniportal Video-Assisted Thoracoscopic Surgery (U-VATS) has previously demonstrated improved post-operative outcomes compared to multiportal VATS (M-VATS). Shorter operative time has rarely been described, and never analyzed in veterans. Our objective was to compare operative time and post-operative outcomes between these approaches for lung resection in veterans.
METHODS: Patients with VATS lung resections at Veterans Affairs Medical Centers (VAMC) between 2008-2018 were retrospectively identified via Veterans Affairs Surgical Quality Improvement Program (VASQIP) database, and divided into U-VATS (cases performed by single surgeon), and M-VATS cohorts (cases at other VAMCs). Demographics and outcomes were compared via multivariate analysis. Operative time was the primary outcome. Trends in U-VATS operative time and cumulative operative volume were analyzed.
RESULTS: 8,212 patients underwent VATS lung resection from 2008-2018. 176 (2.1%) and 8,036 (97.9%) cases comprised the U-VATS and M-VATS arms, respectively. U-VATS demonstrated shorter operative time (1.7 vs. 3.1 hours), increased surgical site infection rate (2.8% vs. 0.8%) and length of stay (6 vs. 5 days) via multivariate analysis (all p-values < 0.001). U-VATS operative time showed downward temporal trend (Spearman’s Rho -0.474). Greatest decrease in operative time (2.8 to 1.8 hours) corresponded with increased cumulative volume of U-VATS resections from 25 to 44 cases.
CONCLUSIONS: U-VATS offered shorter operative duration in veterans compared to M-VATS, validating its technical advantages. Operative time decreased as cumulative operative volume increased, demonstrating a learning curve. We did not observe superior outcomes in other metrics. Future studies should prospectively compare these techniques to link decreased operative time with improved outcomes.


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