Simultaneous Uniportal Video-Assisted Thoracic Surgery of Bilateral Pulmonary Nodules

Abstract Background: Surgical resection is an appropriate treatment option for synchronous bilateral pulmonary nodules with ground-glass opacities. The applicability of simultaneous uniportal video-assisted thoracic surgery is not fully understood. We evaluated the experience in performing such surgeries at our hospital and the associated postoperative complications.Methods: Clinical data of 35 patients who underwent simultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery at our hospital were reviewed retrospectively. Results: Simultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery was performed for 35 patients (15 men, 20 women); 97 nodules were operated on, and the average nodule diameter was 11.4 mm (range, 1-38 mm). Computerized tomography showed that most nodules had ground-glass opacity (52/97, 53.6%); solid nodules (24/97, 24.7%) and nodules with mixed ground-glass opacity (21/97, 21.7%) were noted. Surgical resection included lobar-sublobar resection (11/35, 31.4%) and sublobar-sublobar resection (24/35, 68.6%). Wound infection and postoperative 30-day mortality were not observed. Pneumonia was the major postoperative complication, with a higher incidence in the lobar-sublobar group (6/35, 17.1%) than in the sublobar-sublobar group (4/35, 11.4%; P = 0.021). Pneumonia did not correlate with operative time (mean, 262.3±108.1 vs. 261.9±87.5 min, P = 0.991), duration of chest drainage (mean, 7.0±4.0 vs 5.4±2.1 days, P = 0.124), and postoperative hospital stay (mean, 10.2±3.6 vs 10.2±6.4 days, P = 0.978). The mean follow-up time was 8 (range, 3-22) months. Recurrence of primary lung cancer or mortality was not noted at the final follow-up. Conclusions: Simultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery is feasible and safe for appropriate patients. Simultaneous lobar-sublobar pulmonary resection for bilateral nodules can increase the risk of developing pneumonia.