Single-port laparoscopic versus multiple-port laparoscopic combined with thoracoscopic for McKeown esophagectomy: a randomized clinical trial.

BACKGROUP: The optimal number of abdominal ports for minimally invasive McKeown esophagectomy remains debated. This study aimed to determine whether single-port laparoscopy combined with thoracoscopy yields superior perioperative outcomes compared to conventional multiport laparoscopy combined with thoracoscopy.

METHODS

Between October 2021 and December 2023, 147 patients were randomly assigned to single-port or multiport laparoscopic-assisted thoracoscopic surgery. Primary outcomes included operative time, intraoperative blood loss, postoperative pain, and lymph node yield; secondary outcomes comprised complications and recovery indicators.

RESULTS

Total operative time was comparable between groups (P < . 05). The single-port group exhibited significantly lower total blood loss (60(15, 110) vs. 200(50, 250) mL, P < . 001) and shorter laparoscopic time (49 (39, 57) vs. 57 (45, 76) min, P = . 03). In patients with BMI > 25 kg/m2, these advantages were more pronounced (operative time: 54 ± 7 vs. 66 ± 12 min, P < . 01; blood loss: 11 ± 5 vs. 20 ± 7 mL, P < . 001). Pain scores were lower in the single-port group on postoperative day 3 (VAS 2. 45 ± 0. 42 vs. 2. 99 ± 0. 87, P < . 001). Lymph node yield was similar between groups. Complication rates and recovery indicators did not differ significantly.

CONCLUSIONS

Compared with the multiport approach, single-port laparoscopy reduces blood loss, shortens operative time, and alleviates postoperative pain without compromising oncological efficacy or safety.