Single-incision Video-assisted Thoracic Surgery versus Conventional Three-port Surgery for Primary Spontaneous Pneumothorax: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 YOUZhao-lei , LIDe-sheng , JULAITIAiniwaer , QIANKun-jie ,  ZHANGLi-wei

Department of Thoracic Surgery, the First Affiliated Hospital of XinJiang Medical University, Urumqi 830054, China;

Corresponding author：

ZHANGLi-wei, Email: zhangliwei@medmail.com.cn

Keywords：

Single-incision video-assisted thoracic surgery; Three-port video-assisted thoracic surgery; Spontaneous pneumothorax; Systematic review; Meta-analysis; Cohort Study

DOI：

10.7507/1672-2531.20150158

Video：

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Objective To systematically evaluate the effectiveness and safety of single-incision video-assisted thoracic surgery (VATS) versus conventional three-port VATS for primary spontaneous pneumothorax. Methods We searched databases including PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data from inception to Dec. 2014, to collect randomized controlled trials (RCTs) and cohort studies comparing single-incision VATS and conventional three-port VATS for primary spontaneous pneumothorax. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. Results A total of 8 cohort studies involving 483 patients were finally included. The results of meta-analysis showed that:Compared with conventional three-port VATS, single-incision VATS had shorter operation time (MD=-3.90, 95%CI -7.22 to -0.58, P=0.02), less amount of intraoperative bleeding (MD=-9.34, 95%CI -15.26 to -3.42, P=0.002), shorter chest drainage time (MD=-0.66, 95%CI -1.02 to -0.29, P=0.000 4), lower VAS score of 24h-postoperative pain (MD=-0.90, 95%CI -1.14 to -0.66, P<0.000 01) and lower incidence of postoperative paresthesia (OR=0.15, 95% CI 0.07 to 0.31, P<0.000 01). Meanwhile, there were no statistical differences between both groups in hospital stay (MD=-0.30, 95%CI -0.63 to 0.03, P=0.08) and the recurrence of pneumothorax (OR=0.68, 95%CI 0.25 to 1.83, P=0.53). Conclusion Current evidence shows, single-incision VATS is superior to conventional three-port VATS in the treatment of spontaneous pneumothorax. However, due to limited quality and quantity of included studies, more large-scale, high-quality studies are needed to verify the above conclusion.

Citation： YOUZhao-lei, LIDe-sheng, JULAITIAiniwaer, QIANKun-jie, ZHANGLi-wei. Single-incision Video-assisted Thoracic Surgery versus Conventional Three-port Surgery for Primary Spontaneous Pneumothorax: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(8): 945-950. doi: 10.7507/1672-2531.20150158 Copy

1.	Levi JF, Kleinmann P, Riquet M, et al. Percutaneous parietal pleurectomy for recurrent spontaneous pneumothorax. Lancet, 1990, 336 (8730):1577-1578.
2.	Migliore M. Efficacy and safety of single-trocar technique for minimally invasive surgery of the chest in the treatment of noncomplex pleural disease. J Thorac Cardiovasc Surg, 2003, 126 (5):1618-1623.
3.	Valeria S, Andrea S, Armando S. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax:clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thorac Surg, 2008, 7(1):63-64.
4.	Berlanga LA, Gigirey O. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax using a single-incision laparoscopic surgery port:a feasible and safe procedure. Surg Endosc, 2011, 25 (6):2044-2047.
5.	Avariable at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
6.	Chen PR, Chen CK, Lin YS, et al. Single-incision thoracoscopic surgery for primary spontaneous pneumothorax. J Cardiothorac Surg, 2011, 6:58.
7.	Kang DK, Min HK, Jun HJ, et al. Early outcomes of single-port video-assisted thoracic surgery for primary spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg, 2014, 47(4):384-388.
8.	Yang HC, Cho S, Jheon S. Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery. Surg Endosc, 2013, 27 (1):139-145.
9.	李存江, 张淼, 刘东, 等. 传统三孔、单操作孔及单孔VATS在治疗年轻患者自发性气胸中的比较分析. 现代仪器与医疗, 2014, 6(1):27-29.
10.	梁柱, 陈捷, 林立尧, 等. 单孔与三孔法电视胸腔镜手术治疗原发性自发性气胸的效果比较. 广东医学院学报, 2013, 4(3):379-380.
11.	黄立志, 曹庆东. 单孔胸腔镜手术与传统胸腔镜手术治疗自发性气胸疗效的对比研究.宁夏医科大学学报, 2014, 6(3):650-652.
12.	Jutley RS, Khalil MW, Rocco G. Uniportal vs standard three-port VATS technique for spontaneous pneumothorax:comparison of post-operative pain and residual paraesthesia. Eur J Cardiothorac Surg, 2005, 28(1):43-46.
13.	Salati M, Brunelli A, Rocco G. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax:clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thorac Surg, 2008, 7(1):63-66.
14.	Gonzalez-Rivas D, de la Torre M, Fernandez R, et al. Single-port video-assisted thoracoscopic left upper lobectomy. Interact Cardiovasc Thorac Surg, 2011, 13 (5):539-541.
15.	Rocco G, La Rocca A, Martucci N, et al. Awake single-access (uniportal) video-assisted thoracoscopic surgery for spontaneous pneumothorax. J Thorac Cardiovasc Surg, 2011, 142 (4):944-945.
16.	车国卫, 刘伦旭. 单孔电视胸腔镜手术临床应用的现状与进展. 中国胸心血管外科杂志, 2012, 1(2):181-184.
17.	曹庆东, 高雪峰, 李晓剑, 等. 单孔胸腔镜手术的临床应用. 中华胸心血管外科杂志, 2011, 27(9):546-548.
18.	Cardillo G, Carleo F, Carbone L, et al. Long-term lung function following videothoracoscopic talc poudrage for primary spontaneous recurrent pneumothorax. Eur J Cardiothorac Surg, 2007, 31(5):802-805.
19.	吴正国, 农文贵, 陶宏发, 等. 单孔胸腔镜治疗自发性气胸. 中国微创外科杂志, 2014, 4(2):338-339.
20.	温佳新, 初向阳. 单孔胸腔镜手术在自发性气胸治疗中的应用. 中国内镜杂志, 2012, 4(3):428-429.
21.	Chen C, Lee S, Chang H, et al. The adequacy of single-incisional thoracoscopic surgery as a first-line endoscopic approach for the management of recurrent primary spontaneous pneumothorax:a retrospective study. J Cardiothorac Surg, 2012, 7:99.
22.	Prasad R, Arthur LG, Timmapuri SJ, et al. Early experience with single-incision thoracoscopic surgery in the pediatric population. J Laparoendosc Adv Surg Tech A, 2011, 21(2):189-192.
23.	Castro OG, Gonzalez LB, Gomez ES. Single-port thoracoscopic surgery using the SILS tool as a novel method in the surgical treatment of pneumothorax. Arch Bronconeumol, 2011, 46(8):439-441.
24.	Sihoe AD, Au SS, Cheung ML, et al. Incidence of chest wall paresthesia after video-assisted thoracic surgery for primary spontaneous pneumothorax. Eur J Cardiothorac Surg, 2004, 25(6):1054-1058.
25.	Salati M, Brunelli A. Uniportal VATS for pneumothorax and interstitial lung disease. Thorac Dis, 2013, 5(3):217-220.
26.	Sihoe AD. The evolution of minimally invasive thoracic surgery:implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis, 2014, 6(6):604-617.

1. Levi JF, Kleinmann P, Riquet M, et al. Percutaneous parietal pleurectomy for recurrent spontaneous pneumothorax. Lancet, 1990, 336 (8730):1577-1578.
2. Migliore M. Efficacy and safety of single-trocar technique for minimally invasive surgery of the chest in the treatment of noncomplex pleural disease. J Thorac Cardiovasc Surg, 2003, 126 (5):1618-1623.
3. Valeria S, Andrea S, Armando S. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax:clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thorac Surg, 2008, 7(1):63-64.
4. Berlanga LA, Gigirey O. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax using a single-incision laparoscopic surgery port:a feasible and safe procedure. Surg Endosc, 2011, 25 (6):2044-2047.
5. Avariable at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
6. Chen PR, Chen CK, Lin YS, et al. Single-incision thoracoscopic surgery for primary spontaneous pneumothorax. J Cardiothorac Surg, 2011, 6:58.
7. Kang DK, Min HK, Jun HJ, et al. Early outcomes of single-port video-assisted thoracic surgery for primary spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg, 2014, 47(4):384-388.
8. Yang HC, Cho S, Jheon S. Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery. Surg Endosc, 2013, 27 (1):139-145.
9. 李存江, 张淼, 刘东, 等. 传统三孔、单操作孔及单孔VATS在治疗年轻患者自发性气胸中的比较分析. 现代仪器与医疗, 2014, 6(1):27-29.
10. 梁柱, 陈捷, 林立尧, 等. 单孔与三孔法电视胸腔镜手术治疗原发性自发性气胸的效果比较. 广东医学院学报, 2013, 4(3):379-380.
11. 黄立志, 曹庆东. 单孔胸腔镜手术与传统胸腔镜手术治疗自发性气胸疗效的对比研究.宁夏医科大学学报, 2014, 6(3):650-652.
12. Jutley RS, Khalil MW, Rocco G. Uniportal vs standard three-port VATS technique for spontaneous pneumothorax:comparison of post-operative pain and residual paraesthesia. Eur J Cardiothorac Surg, 2005, 28(1):43-46.
13. Salati M, Brunelli A, Rocco G. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax:clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thorac Surg, 2008, 7(1):63-66.
14. Gonzalez-Rivas D, de la Torre M, Fernandez R, et al. Single-port video-assisted thoracoscopic left upper lobectomy. Interact Cardiovasc Thorac Surg, 2011, 13 (5):539-541.
15. Rocco G, La Rocca A, Martucci N, et al. Awake single-access (uniportal) video-assisted thoracoscopic surgery for spontaneous pneumothorax. J Thorac Cardiovasc Surg, 2011, 142 (4):944-945.
16. 车国卫, 刘伦旭. 单孔电视胸腔镜手术临床应用的现状与进展. 中国胸心血管外科杂志, 2012, 1(2):181-184.
17. 曹庆东, 高雪峰, 李晓剑, 等. 单孔胸腔镜手术的临床应用. 中华胸心血管外科杂志, 2011, 27(9):546-548.
18. Cardillo G, Carleo F, Carbone L, et al. Long-term lung function following videothoracoscopic talc poudrage for primary spontaneous recurrent pneumothorax. Eur J Cardiothorac Surg, 2007, 31(5):802-805.
19. 吴正国, 农文贵, 陶宏发, 等. 单孔胸腔镜治疗自发性气胸. 中国微创外科杂志, 2014, 4(2):338-339.
20. 温佳新, 初向阳. 单孔胸腔镜手术在自发性气胸治疗中的应用. 中国内镜杂志, 2012, 4(3):428-429.
21. Chen C, Lee S, Chang H, et al. The adequacy of single-incisional thoracoscopic surgery as a first-line endoscopic approach for the management of recurrent primary spontaneous pneumothorax:a retrospective study. J Cardiothorac Surg, 2012, 7:99.
22. Prasad R, Arthur LG, Timmapuri SJ, et al. Early experience with single-incision thoracoscopic surgery in the pediatric population. J Laparoendosc Adv Surg Tech A, 2011, 21(2):189-192.
23. Castro OG, Gonzalez LB, Gomez ES. Single-port thoracoscopic surgery using the SILS tool as a novel method in the surgical treatment of pneumothorax. Arch Bronconeumol, 2011, 46(8):439-441.
24. Sihoe AD, Au SS, Cheung ML, et al. Incidence of chest wall paresthesia after video-assisted thoracic surgery for primary spontaneous pneumothorax. Eur J Cardiothorac Surg, 2004, 25(6):1054-1058.
25. Salati M, Brunelli A. Uniportal VATS for pneumothorax and interstitial lung disease. Thorac Dis, 2013, 5(3):217-220.
26. Sihoe AD. The evolution of minimally invasive thoracic surgery:implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis, 2014, 6(6):604-617.

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Single-incision Video-assisted Thoracic Surgery versus Conventional Three-port Surgery for Primary Spontaneous Pneumothorax: A Meta-analysis

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