BACKGROUND: With the present study we would like to share our experience on passing from uniportal video assisted thoracoscopic technique (U-VATS) to biportal technique for anatomical lung resections for the treatment of non-small cell lung cancer (NSCLC) with the intent to increase the trainees involvement and support learning. METHODS: In our institution we regularly perform single port anatomical lung resections since 2018. From January to September 2023, a single surgeon performed 20 consecutive cases of anatomical lung resection for NSCLC by biportal VATS (Copenhagen Anterior Approach). Both senior and junior trainees assisted. A five-task survey regarding the assistant perspective was provided to all the trainees. We subsequently analyzed and compared the survey results and surgical outcomes for both uniportal and biportal procedures performed by the same surgeon. RESULTS: Since 2018 two hundred and fifty patients underwent major lung resection for lung cancer using a mini-invasive thoracoscopic approach. A total of 55 patients were enrolled in this study; 35 were treated with U-VATS and 20 with Biportal VATS. Operation time (161.6±25.0 - 162.0±29.7 minutes; p=0.833), chest drainage indwelling time (5.8± 6.7 - 3.8±2.9 days; p=0.197), conversion to thoracotomy rate (5.7% - 5%; p=0.703) and complications rate (22.8% - 15%; p= 0.371) were comparable between the groups. No statistically significant difference in terms of post-operative pain was found (NRS scale mean values: 2.3±1.0 - 2.8±2.5; p=0.877). Regarding oncological characteristics, there were no significant differences in the histology, cancer staging, mediastinal nodal stations dissection, numbers of dissected N1, N2, and overall lymph nodes between uniportal and biportal groups. According to the assistant point of view, we found no statistically significant differences in terms of active engagement (p=0.059) and anatomic orientation (p=0.755). On the other hand, a judgment was given in favor of biportal approach in terms of ergonomics (p=0.003), feeling of adequacy (p=0.043) and camera mastering skills achievement (p=0.013). CONCLUSIONS: According to our data, a ‘’step backward’’ to the biportal approach for anatomic lung resections with the purpose to promote training is useful to ease the resident surgeons’ approach to VATS and doesn’t compromise surgical outcomes or oncological clearance efficacy.
LEGEND: Five-task survey results
