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, 張淼, 劉東, 等. 傳統三孔、單操作孔及單孔VATS在治療年輕患者自發性氣胸中的比較分析. 現代儀器與醫療, 2014, 6(1):27-29.
10.	梁柱, 陳捷, 林立堯, 等. 單孔與三孔法電視胸腔鏡手術治療原發性自發性氣胸的效果比較. 廣東醫學院學報, 2013, 4(3):379-380.
11.	黃立志, 曹慶東. 單孔胸腔鏡手術與傳統胸腔鏡手術治療自發性氣胸療效的對比研究.寧夏醫科大學學報, 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.	車國衛, 劉倫旭. 單孔電視胸腔鏡手術臨床應用的現狀與進展. 中國胸心血管外科雜志, 2012, 1(2):181-184.
17.	曹慶東, 高雪峰, 李曉劍, 等. 單孔胸腔鏡手術的臨床應用. 中華胸心血管外科雜志, 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.	吳正國, 農文貴, 陶宏發, 等. 單孔胸腔鏡治療自發性氣胸. 中國微創外科雜志, 2014, 4(2):338-339.
20.	溫佳新, 初向陽. 單孔胸腔鏡手術在自發性氣胸治療中的應用. 中國內鏡雜志, 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, 張淼, 劉東, 等. 傳統三孔、單操作孔及單孔VATS在治療年輕患者自發性氣胸中的比較分析. 現代儀器與醫療, 2014, 6(1):27-29.
10. 梁柱, 陳捷, 林立堯, 等. 單孔與三孔法電視胸腔鏡手術治療原發性自發性氣胸的效果比較. 廣東醫學院學報, 2013, 4(3):379-380.
11. 黃立志, 曹慶東. 單孔胸腔鏡手術與傳統胸腔鏡手術治療自發性氣胸療效的對比研究.寧夏醫科大學學報, 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. 車國衛, 劉倫旭. 單孔電視胸腔鏡手術臨床應用的現狀與進展. 中國胸心血管外科雜志, 2012, 1(2):181-184.
17. 曹慶東, 高雪峰, 李曉劍, 等. 單孔胸腔鏡手術的臨床應用. 中華胸心血管外科雜志, 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. 吳正國, 農文貴, 陶宏發, 等. 單孔胸腔鏡治療自發性氣胸. 中國微創外科雜志, 2014, 4(2):338-339.
20. 溫佳新, 初向陽. 單孔胸腔鏡手術在自發性氣胸治療中的應用. 中國內鏡雜志, 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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