Objective To systematically evaluate the efficacy and safety of single-port thoracoscopic surgery (SPTS) in the treatment of spontaneous pneumothorax. Methods Computer searches were conducted in PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, WanFang, and the Chinese Medical Association databases to collect randomized controlled trials (RCTs) and cohort studies on the comparison of efficacy and safety of SPTS and three-port thoracoscopic surgery (TPTS) for the treatment of spontaneous pneumothorax from their inception to March 2024. The Cochrane RCT bias risk assessment tool and the Newcastle-Ottawa Scale (NOS) were used to assess the quality of RCT and cohort study, respectively. Meta-analysis was performed using RevMan 5.4.1. ResultsA total of 68 studies were included, comprising 23 RCTs and 45 cohort studies with a total of 5403 patients. The NOS scores of the cohort studies were 7-8 points. Meta-analysis results showed that compared with TPTS, SPTS had less intraoperative blood loss [SMD=?1.58, 95%CI (?1.93, ?1.22), P<0.001], shorter postoperative hospital stay [SMD=?1.05, 95%CI (?1.29, ?0.82), P<0.001], shorter postoperative drainage tube placement time [SMD=?0.75, 95%CI (?1.00, ?0.50), P<0.001], fewer postoperative complications [OR=0.34, 95%CI (0.26, 0.45), P<0.001], fewer postoperative recurrences [OR=0.48, 95%CI (0.32, 0.72), P<0.001], and less pain at 24, 48, and 72 h postoperatively [SMD=?1.71, 95%CI (?2.13, ?1.30), P<0.001; SMD=?1.70, 95%CI (?2.35, ?1.06), P<0.001; SMD=?1.72, 95%CI (?2.16, ?1.29), P<0.001]. Conclusion SPTS is safe and effective in the treatment of spontaneous pneumothorax with high clinical value and can be further promoted in clinical practice. Considering the limitations in the number and quality of included studies, researches with larger sample sizes and higher quality are needed to validate the above conclusions.
ObjectiveTo compare the differences in clinical outcomes of artificial pneumothorax-assisted three-port, two-port, and uniportal thoracoscopic surgeries for the treatment of mediastinal tumors. Methods A retrospective analysis was conducted on clinical data of patients who underwent mediastinal tumor surgery in the Department of Thoracic Surgery at the General Hospital of Northern Theater Command from September 2020 to November 2024. Patients were divided into three groups based on the surgical approach: an artificial pneumothorax-assisted three-port thoracoscopy group, a two-port thoracoscopy group, and a uniportal thoracoscopy group. Perioperative data including operation time, intraoperative blood loss, postoperative hospital stay, chest tube indwelling rate, postoperative drainage volume, chest tube duration, and postoperative pain visual analogue scale (VAS) scores were compared among the three groups. Results A total of 308 patients were included. The artificial pneumothorax-assisted three-port thoracoscopy group comprised 75 patients [29 males, 46 females; median age: 57 (IQR: 47, 62) years]. The two-port thoracoscopy group included 127 patients [49 males, 78 females; median age: 52 (IQR: 43, 60) years], and the uniportal thoracoscopy group included 106 patients [48 males, 58 females; median age: 52.5 (IQR: 42, 62) years]. The operation time in the artificial pneumothorax-assisted three-port thoracoscopy group [74 (62, 99) min] was significantly shorter than that in the two-port thoracoscopy group [91 (71, 118) min] and the uniportal thoracoscopy group [90 (68, 110) min] (P<0.05). Intraoperative blood loss [30 (20, 75) mL] was also significantly less than that in the two-port thoracoscopy group [55 (30, 105) mL] and the uniportal thoracoscopy group [55 (30, 100) mL] (P<0.05). Regarding postoperative recovery, the length of hospital stay in the artificial pneumothorax-assisted three-port thoracoscopy group [2 (2, 4) days] was shorter than that in the two-port thoracoscopy group [3 (2, 5) days] and the uniportal thoracoscopy group [3 (3, 6) days] (P<0.05). On postoperative day 1 (POD1), the VAS score in the artificial pneumothorax-assisted three-port thoracoscopy group [4 (3, 4) points] was lower than that in the two-port thoracoscopy group [4 (3, 5) points] and the uniportal thoracoscopy group [4 (3, 5) points] (P<0.05). The chest tube indwelling rate (52.0%) was significantly lower than that in the two-port thoracoscopy group (92.9%) and the uniportal thoracoscopy group (84.9%) (P<0.05). POD1 chest tube drainage volume [80 (0, 105) mL] and chest tube duration [1 (0, 2) days] were also significantly less or shorter than those in the two-port thoracoscopy group [110 (80, 150) mL, 2 (1, 2) days] and the uniportal thoracoscopy group [100 (50, 150) mL, 1 (1, 2) days], respectively (P<0.05). Conclusion All three different surgical approaches for mediastinal tumors are safe and effective. Artificial pneumothorax-assisted three-port thoracoscopic surgery demonstrates comprehensive advantages in terms of operation time, intraoperative blood loss, and postoperative recovery.