Full Report Single Versus Multi-Incisional Video-Assisted Thoracic Surgery: A Systematic Review and Meta-analysis Ahmed A. Abouarab, MD, 1, * Mohamed Rahouma, MD, 2, * Mohamed Kamel, MD, 2 Galal Ghaly, MD, 2 and Abdelrahman Mohamed, MD 2 Abstract Background: Video-Assisted Thoracic Surgery (VATS) is conventionally performed through multiple small incisions (C-VATS). Recent studies have reported encouraging results with the single-incision VATS (S-VATS) over the conventional technique. However, these studies were either small in size, unfocused, nonuniform, retrospective, lacking follow-up information, or focused on pain. We aim to validate previously reported results in a single large meta-analysis, including only the best evidence studies available. Methods: Systematic review of the PubMed archive was conducted to include only full English articles with Newcastle Ottawa Scale score q7. The primary outcome was the complications rate while secondary outcomes were operative time, resected lymph nodes (LNs), chest tube duration, estimated blood loss, length of post- operative stay (LOS), and postoperative pain on day 1 after surgery. Odds ratio and standard mean difference were used as effect estimates. Random model and leave-one-out analysis were used. Results: A total of 39 studies were included with 4635 patients (1686 S-VATS versus 2949 C-VATS). S-VATS has resulted in significantly less postoperative pain (P < .001), blood loss (P = .006), LOS (P < .001), and chest tube duration (P < .001). In lung cancer patients, the number of retrieved LNs was similar to that of C-VATS (P > .05). Subgroup comparison of the rate of complications between lung resections versus other intrathoracic procedures, lung cancer versus pneumothorax, and lung cancer versus other lung-only lesions did not show any significant differences between the groups. Conclusion: Performing S-VATS technique has shown superior postoperative outcomes over the C-VATS technique in the treatment of thoracic disorders. Substantial benefit was confirmed in terms of less postoperative pain, blood loss, drainage time, and postoperative hospital stay. Keywords: single/one/uniportal VATS, video-assisted thoracic surgery, conventional VATS, multiportal VATS, multi-incisional VATS Introduction V ideo-assisted thoracic surgery (VATS) had been successfully implemented in treating different thoracic diseases and had been established as a reliable alternative to open thoracic surgery with many benefits for patients. 1–3 Traditionally, VATS was performed through multiple small incisions, commonly three or four incisions. 4 Uniportal min- imally invasive surgeries were successful in different body organs, for example, cholecystectomies and colectomies. 5,6 Recent advancements in the field of biotechnology have en- abled the manufacture of cameras that allow a better visual perspective and instruments with high degree of precision and flexibility to mimic open thoracic surgical techniques. 4,7 This has facilitated the conduction of complex thoracic procedures using VATS technique through a single port, largely mini- mizing operative trauma to the patients. Many individual studies have shown various benefits to utilizing this technique over the conventional multiportal technique. Most of these studies were small in size, unfocused, not uniform, retrospective, or missing important follow-up information. Earlier meta-analyses published about this topic were focused on minor thoracic surgeries or postoperative pain. Some included abstracts and scientific posters, articles published in other languages, or included small number of studies. 8 1 Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama. 2 Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt. *Both these authors contributed equally to this work. JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 00, Number 00, 2017 ª Mary Ann Liebert, Inc. DOI: 10.1089/lap.2017.0446 1 Downloaded by Gothenburg University Library from online.liebertpub.com at 11/10/17. For personal use only.