VATS lobectomy, a standardised approach?

The article by French and colleagues (1) published in Annals of Cardiothoracic Surgery has the merit of being the first published article on the transition from multiple port video-assisted thoracic surgery (VATS) to single port surgery (S-VATS) in minimally invasive anatomic pulmonary resections. The authors have carefully designed and conducted a comparative study to evaluate the safety and feasibility of this transition and to assess its impact on intraoperative and early postoperative outcomes. They add to the existing literature a series of 50 consecutive S-VATS anatomical lung resections which were compared to an equal, historical and prospective cohort of multiple port VATS cases; all of them were performed at the same institution and by the same surgeon. Its main clinical message is that the transition from multiple port VATS to S-VATS lung resection is safe, efficient and with good surgical quality. However they failed in their attempt to find differences in perioperative outcomes between approaches, specifically in patient reported pain in favor of S-VATS.