Commentary on: “uniportal video-assisted thoracoscopic surgery: safety, efficacy and learning curve during the first 250 cases in Quebec, Canada”
The past two decades have seen video-assisted thoracoscopic surgery (VATS) become the preferred approach for the treatment of early stage lung cancer (1,2) (NCCN, ACCP). Traditionally performed through 2–4 small incisions, thoracoscopic resection by a single 3–4 cm incision, or uniportal VATS resections, gaining traction at many centers around the globe. The adoption of anatomic resection by a uniportal thoracoscopic approach is still in a relatively early, phase with champions and critics on both teams (3,4). Proponents of uniportal VATS lobectomy advocate that this approach is associated with decreased pain, paresthesias, and morbidity, when compared to a multiportal thoracoscopic approach, resulting in expedited recovery. Opponents of the uniportal approach intimate concerns of patient safety and a steep learning curve as a result of the technical requirements of having all instrumentation share the same incision, in addition to unresolved questions of oncologic adequacy.