Postoperative Pain Reduction and Clinical Value of Uniportal Video-Assisted Thoracic Surgery: A Secondary Analysis of the J-RATSIG 01 Study

Abstract

BACKGROUND: The J-RATSIG 01 multi-institutional prospective study found robot-assisted thoracic surgery to be inferior to video-assisted thoracic surgery (VATS) in terms of postoperative pain. Because reducing the number of ports was linked to pain reduction, we conducted a secondary analysis comparing uniportal VATS (U-VATS) and multiportal VATS (M-VATS). METHODS: This analysis included 205 patients who underwent anatomical lung resection using VATS at 12 institutions. Postoperative pain was assessed using the numerical rating scale (NRS) and painDETECT questionnaire (PDQ) on postoperative days 10, 30, and 90. RESULTS: Ninety-five patients underwent U-VATS, and 110 underwent M-VATS. The U-VATS group had significantly shorter operation times, chest tube duration, and hospital stay than the M-VATS group (146 vs. 180 min, 2.1 vs. 2.6 days, 4.8 vs. 6.4 days, respectively). Analgesic use was also significantly lower in the U-VATS group at all postoperative phases (64% vs. 90%, 14% vs. 52%, and 1% vs. 15%, all P < .001). NRS scores were significantly lower in the U-VATS group on postoperative days 10 (1.2 vs. 1.9, P < .001) and 30 (0.7 vs. 1.5, P < .001). The PDQ scores were consistently lower in the U-VATS group at all postoperative phases (all P < .001). A multivariate analysis showed that U-VATS significantly reduced the odds of an NRS score of > 3 on postoperative days 10 and 30 (odds ratio: 0.26, 95% CI: 0.08-0.84; odds ratio: 0.09, 95% CI: 0.01-0.76). CONCLUSIONS: U-VATS significantly reduced postoperative pain and was associated with shorter operation times, chest tube duration, and hospitalization than M-VATS.