Clinical efficacy and safety of different video-assisted thoracoscopic surgery approaches for bullous lung resection: a systematic review and meta-analysis.

OBJECTIVE

This meta-analysis evaluates the perioperative safety and comparative efficacy of single-port versus multi-port video-assisted thoracoscopic surgery (VATS) for bullous lung resection in patients with primary spontaneous pneumothorax.

METHODS

A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted through August 2025 to identify cohort studies comparing single-port (conventional or modified) versus multi-port (double-/triple-port) VATS. Data synthesis was performed using Stata 17.0 with random-effects models to account for inter-study heterogeneity.

RESULTS

Thirteen cohort studies (1,151 patients) were included. Single-port VATS was associated with significantly reduced hospital stay [mean difference (MD) = 0.246 days; 95% CI, 0.075-0.416] and a reduction in postoperative pain (MD = 1.100; 95% CI, 0.528-1.671) compared with multi-port VATS. The incidence of chest wall paresthesia was also lower (risk ratio = 0.580; 95% CI, 0.432-0.779). No significant differences were observed in operative time, chest tube duration, stapler use, complications, or recurrence. Subgroup analysis showed that the abbreviated hospital stay was primarily driven by conventional single-port techniques, whereas modified techniques showed no significant difference.

CONCLUSION

Single-port VATS for bullous lung resection is associated with accelerated recovery, attenuated postoperative pain, and a lower incidence of neurological sequelae compared to multi-port VATS, without increasing operative time, complication, or recurrence rates. It represents a safe and feasible alternative, although further randomized trials are needed to establish superiority.