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Objectives: Preoperative selection bias led to the inability to generalize the proposed benefit of subxiphoid uniportal video-assisted thoracoscopic surgery (SVATS) as having less postoperative pain than uniportal intercostal VATS. So, we conducted this prospective, single-blinded, randomized controlled trial to investigate the hypothesis that SVATS may have less early postoperative pain than UVATS in patients who undergo major lung resection for early-stage lung cancer., Methodsa Total of: 262 patients were randomly allocated between 2 groups (each with 131 patients), the first being the UVATS group and the second being the SVATS group. The values indicated on the numerical rating scale (NRS) of pain were collected at 24 h and 48 h during rest and during coughing. In addition, different perioperative variables were analysed and compared between the 2 groups., Results: Multiple linear regression analysis showed that the type of surgical approach was a significant predictor of the postoperative NRS values. The postoperative NRS pain values were significantly lower in the SVATS group after 24 h during rest and coughing and after 48 h during coughing. Postoperatively, patients in the SVATS group got out of bed significantly earlier [16.37 (2.54) vs 18.05 (3.29) h, p < 0.001]. The SVATS group showed a significantly higher rate of intraoperative arrhythmia [20 (15.3%) vs 3 (2.3%) patients, p = 0.03]., Conclusions: SVATS major pulmonary resection in early-stage lung cancer is associated with less early postoperative pain than the UVATS approach. Operating on patients with cardiac problems using the SVATS approach is still a limiting factor for randomization due to the potential compression on the heart with resulting arrhythmia., Clinical Trial Registration: The trial was registered under clinical trials.gov Identifier: NCT03331588. https://clinicaltrials.gov/ct2/show/NCT03331588., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Objectives: Subxiphoid uniportal video-assisted thoracoscopic segmentectomy (SU-VATs) has been widely adopted because it is associated with better postoperative pain scores. Nevertheless, it also has had some limitations that have gradually been decreasing. Therefore, our goal was to evaluate the change in perioperative results with SU-VATs as the learning curve developed to outline the current status and the points that should be of future concern., Methods: Three hundred patients who underwent SU-VATs from September 2014 to May 2018 were divided chronologically into 2 groups; group 1 comprised the first 150 cases and group 2 comprised the last 150 cases. Different perioperative variables were analysed and compared between the 2 groups. In addition, the cumulative sum analysis and multivariable logistic regression were conducted to identify the cut-off point and predictors of significant improvement in operative time., Results: The cumulative sum analysis showed significant improvement in the operative time after the 148th case. Group 2 showed a statistically significant decrease in operative time (104.3 ± 36.7 vs 132 ± 43.1 min; P < 0.001), amount of operative blood loss [50 (80 ml) vs 100 (50 ml); P < 0.001], chest drain duration (2.6 ± 1.6 vs 3.2 ± 1.4 days; P = 0.004) and hospital stay (3.7 ± 1.7 vs 4.2 ± 1.7 days; P = 0.008). The number of dissected lymph nodes was significantly higher in the second group [11 (4) vs 9 (4); P < 0.001]., Conclusions: Limitations of SU-VATs are being overcome by the improvement in the learning curve and in the expertise of the surgeons. Our future concerns should focus on examining the long-term survival rate, the oncological efficacy and the effect on quality of life., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: Subxiphoid uniportal video-assisted thoracoscopic surgery (SVATS) is more technically challenging than intercostal uniportal video-assisted thoracoscopic surgery (UVATS), especially in more complex procedures such as segmentectomy. We therefore aimed to investigate the worthiness of undertaking the more demanding subxiphoid approach in patients who had undergone anatomical segmentectomy for stage IA non-small cell lung cancer (NSCLC)., Methods: A total of 491 patients were included in our study who had undergone anatomical segmentectomy for stage IA non-small cell lung cancer from September 2014 to April 2018. They were divided into two groups; 278 patients in the UVATS group and 213 patients in the SVATS group. Different perioperative variables, postoperative pain, quality of life and cost were analyzed and compared between both groups., Results: The SVATS group showed a significantly longer operative time (P = 0.007) and more operative blood loss than the intercostal group (P = 0.004). There was no significant difference between both groups regarding postoperative drainage, duration of chest tube, postoperative hospital stay, operative conversion or postoperative complications. The SVATS group showed a significantly lower pain score postoperatively (P < 0.001). In addition, the SVATS group showed a significantly better postoperative quality of life score along the first postoperative year (P < 0.001). UVATS segmentectomy appeared to be significantly cheaper than SVATS segmentectomy (P < 0.001)., Conclusions: SVATS segmentectomy for stage IA lung cancer is a safe procedure that is worth proceeding with as it is associated with better postoperative pain and better quality of life in the first postoperative year. Further studies are recommended to evaluate the actual cost-effectiveness of SVATS segmentectomy., Key Points: • Significant findings of the study Subxiphoid uniportal approach for pulmonary segmentectomy is safe and feasible approach. It has better postoperative pain and better quality of life than the uniportal intercostal approach; however, it is more expensive. • What this study adds Subxiphoid uniportal approach for pulmonary segmentectomy gives a better quality of life in Chinese patients than the intercostal approach; however, it is more expensive., (© 2020 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.)