Single-port VATS reduces hospital stay and pain compared to multi-port VATS in primary spontaneous pneumothorax patients

ObjectiveThis meta-analysis evaluates the perioperative safety and comparative efficacy of single-port versus multi-port video-assisted thoracoscopic surgery (VATS) for bullous lung resection in patients with primary spontaneous pneumothorax.MethodsA systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted through August 2025 to identify cohort studies comparing single-port (conventional or modified) versus multi-port (double-/triple-port) VATS. Data synthesis was performed using Stata 17.0 with random-effects models to account for inter-study heterogeneity.ResultsThirteen cohort studies (1,151 patients) were included. Single-port VATS was associated with significantly reduced hospital stay [mean difference (MD) = 0.246 days; 95% CI, 0.075–0.416] and a reduction in postoperative pain (MD = 1.100; 95% CI, 0.528–1.671) compared with multi-port VATS. The incidence of chest wall paresthesia was also lower (risk ratio = 0.580; 95% CI, 0.432–0.779). No significant differences were observed in operative time, chest tube duration, stapler use, complications, or recurrence. Subgroup analysis showed that the abbreviated hospital stay was primarily driven by conventional single-port techniques, whereas modified techniques showed no significant difference.ConclusionSingle-port VATS for bullous lung resection is associated with accelerated recovery, attenuated postoperative pain, and a lower incidence of neurological sequelae compared to multi-port VATS, without increasing operative time, complication, or recurrence rates. It represents a safe and feasible alternative, although further randomized trials are needed to establish superiority.