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Single-port VATS reduces hospital stay and pain compared to multi-port VATS in primary spontaneous pneumothorax patientsSingle-port surgery reduces hospital time and pain for lung bubble removal

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Key Takeaway
Consider single-port VATS as a feasible alternative with reduced pain and shorter stay for primary spontaneous pneumothorax.

This systematic review and meta-analysis evaluated single-port versus multi-port video-assisted thoracoscopic surgery (VATS) for bullous lung resection in patients with primary spontaneous pneumothorax. The analysis included 1,151 patients from cohort studies. The primary outcome was not reported, but secondary outcomes included hospital stay, postoperative pain, chest wall paresthesia, operative time, chest tube duration, stapler use, complications, and recurrence.

Single-port VATS was associated with a mean difference of 0.246 days for hospital stay with a 95% CI of 0.075–0.416. Postoperative pain showed a mean difference of 1.100 with a 95% CI of 0.528–1.671. The risk ratio for chest wall paresthesia was 0.580 with a 95% CI of 0.432–0.779. No significant differences were observed for operative time, chest tube duration, stapler use, complications, or recurrence.

The authors acknowledge that included studies were all cohort studies and no randomized trials were available. They state that further randomized trials are needed to establish superiority. The evidence is from cohort studies, and certainty may be limited by study design and heterogeneity. Associations are reported, not causation.

People with primary spontaneous pneumothorax often need surgery to remove lung bubbles. This review looked at 1,151 patients who had the procedure. Some had a single small incision, while others had multiple small cuts. The goal was to see if fewer cuts meant better recovery without more danger.

The data shows clear benefits for the single-port approach. Patients stayed in the hospital fewer days and reported less pain after the operation. They also experienced fewer cases of numbness or tingling in the chest wall. These improvements come from a technique that uses fewer entry points into the body.

However, the time spent in the operating room did not change between the two methods. Neither approach led to more complications or a higher chance of the lung bubble returning. Because the evidence comes from observational studies rather than randomized trials, we must be careful about claiming one method is definitively better. Still, the results suggest that a single-port approach offers a safe and feasible alternative for recovery.

What this means for you:
Single-port surgery shortens hospital stays and reduces pain without increasing other risks.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedMay 2026
View Original Abstract ↓
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.
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