Refined Video-assisted Thoracoscopic Left Upper Lobectomy: A Novel Surgical Modification (With Video)

Abstract Objective Two-port video-assisted thoracoscopic surgery (VATS) is a widely accepted minimally invasive surgical technique, known for its flexibility and minimal trauma. This study introduces a novel modification termed "single-incision surgery with additional ports" (SSAP), designed to refine the traditional two-port VATS by enhancing exposure and reducing lung lobe manipulation. Methods Between January 2022 and August 2025, a proficient surgical team at Fujian Provincial Hospital enrolled 235 patients who underwent VATS left upper lobectomy. After applying strict inclusion and exclusion criteria, 200 patients were included in the analysis. Of these, 58 patients received the SSAP technique, while 142 underwent two-port video-assisted thoracoscopic lobectomy (tpVL) as the control group. To ensure comparability and reduce selection bias, we employed a 2:1 propensity score matching (PSM) based on preoperative covariates that could potentially influence treatment allocation and outcomes. We analyzed the primary outcome indicators for both groups before and after matching, including operative time, intraoperative blood loss, number of lymph nodes, postoperative hospital stay, and postoperative complications. Results The SSAP demonstrated a significant reduction in postoperative hospital stay compared to tpVL, with a mean difference of -2 days (95%CI: -3 to -1, p < 0.05). Additionally, the rate of prolonged air leak was markedly lower in the SSAP (p < 0.05). Following PSM, the SSAP group's average postoperative hospital stay was significantly shorter than that of the tpVL, with a mean difference of -2 days (95%CI: -3 to -1, p < 0.05). Moreover, the incidence of prolonged air leak in the SSAP was significantly lower(p < 0.05). Conclusions The SSAP represents a safe and effective surgical option for patients, offering distinct advantages over traditional two-port VATS. These include improved operative field exposure and minimized lung lobe manipulation. The refined technique may contribute to better patient outcomes, as evidenced by reduced postoperative hospital stays and postoperative complications.