Surg Today. 2026 Jul 8. doi: 10.1007/s00595-026-03398-7. Online ahead of print.
ABSTRACT
PURPOSE: We evaluated the perioperative outcomes and learning process during the introduction of uniportal video-assisted thoracoscopic surgery (uVATS) at a university hospital.
METHODS: uVATS was initiated by two experienced thoracic surgeons using a safety-oriented, stepwise approach with a flexible team rotation. We retrospectively reviewed 83 consecutive patients (84 lesions) who underwent uVATS between October 2020 and December 2024 for clinically node-negative primary lung cancer or metastatic lung tumors. Learning patterns were analyzed using the cumulative sum (CUSUM) of the operative time.
RESULTS: The procedures included 46 lobectomies and 38 segmentectomies (23 complex). No conversion to thoracotomy occurred; four cases (4.8%) required conversion to multiportal VATS (mVATS) owing to lymph node dissection difficulty. The median operative time was 174 min, and reoperation was performed in two patients (2.4%). Among the 84 lesions, 76 were primary lung cancers, and eight were non-primary lesions. Among the primary lung cancer cases, the median tumor size was 19.0 mm. Most patients had early stage disease, including stage 0 (n = 5), stage IA1 (n = 17), stage IA2 (n = 19), stage IA3 (n = 14), and stage IB (n = 12), whereas a smaller proportion had more advanced disease (stage IIA, n = 2; stage IIB, n = 4; stage IIIA, n = 3). During a median follow-up period of 2.6 years, tumor recurrence was observed in five patients, including two cases of local recurrence. A CUSUM analysis did not demonstrate a distinct early learning phase, and operative performance remained relatively stable from the initial cases.
CONCLUSIONS: uVATS was safely introduced without any early performance deterioration, likely reflecting the transfer of skills from prior open and mVATS experience.
PMID:42420671 | DOI:10.1007/s00595-026-03398-7
