Subxiphoid vs intercostal single-incision video-assisted thoracoscopic surgery for spontaneous pneumothorax: A randomised controlled trial.

Introduction: The conventional video-assisted thoracoscopic surgery (VATS) is performed through the intercostals incisions. In this study, we reported our current experience of thoracoscopic surgery using a subxiphoid single-incision and compared it with the intercostal uniport VATS in the operation time and postoperative pain for spontaneous pneumothorax.

Methods: From July 2014 to September 2015, 43 consecutive patients with spontaneous pneumothorax underwent the unilateral or bilateral bullectomy vie VATS. Among these, 22 patients were treated by the subxiphoid single-incision VATS, and 21 patients were treated using the conventional intercostals uniport VATS. The duration of operation, hospital stay days and inpatient pain scores were compared between each group.

Results: The postoperative pain scores on postoperative days (POD) 0, 1, 2 and 3 were significantly lower for patients who underwent the subxiphoid single-incision VATS than those who underwent the intercostal uniport VATS (p < 0.05). However, the subxiphoid single-incision VATS needed longer surgical time than the intercostal uniport VATS (p < 0.001).

Discussion: The subxiphoid uniport VATS could decrease the postoperative pain and was safe and effective for performing the unilateral or bilateral bullectomy, but, demanded longer surgical time comparing with the intercostal uniport VATS.

Conclusions: Subxiphoid single-incision VATS, as a new method for bullectomy, could provide a good choice of the incision position for these young patients with spontaneous pneumothorax.