Initial results of implementing uniportal video-assisted thoracoscopic lobectomy at Dong Nai General Hospital

Abstract

Introduction: Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy is a minimally invasive technique that offers advantages such as reduced postoperative pain and improved cosmetic outcomes. In Vietnam, this technique remains limited and is mainly performed in major hospitals, while Dong Nai General Hospital has not yet implemented it. This study evaluates its feasibility and early outcomes at this institution.

Methods: A case series was conducted from March 2025 to September 2025 on 14 patients at the Thoracic Surgery Department, Dong Nai General Hospital. Inclusion criteria: age 18–75, NSCLC stage IA–IIIA, or benign lesions with surgical indication for lobectomy. The procedure was performed through a 3–4 cm incision using a 30-degree camera and specialized instruments. Data on operative duration, complications, and recovery were collected prospectively.

Results: The mean age was 62.64 ± 9.25 (range 40–75), with males accounting for 57% (8/14 cases) and a smoking rate of 71%. Most cases involved pulmonary tumors (12/14), with an average size of 31.46 ± 8.5 mm, predominantly located in the outer one-third of the pulmonary lobe (71%). The right lung was involved in 78.6%, with the upper lobe most commonly resected (9 cases). The mean incision length was 3.5 ± 0.5 cm. Interlobar fissure grade according to Lea was primarily grade 1–2 (70%). The mean operative time was 155 ± 55 minutes (70–240 minutes), with the learning curve stabilizing after 10 cases (reduction from 180 to 130 minutes). Lymph node dissection was successful in most operations, with an average of 3–4 stations per case (3A, 4R, 7, 8, 9, 10, 11). Intraoperative complications occurred in 14.3% (2 cases—managed by thoracoscopic control of bleeding and conversion to biportal approach due to difficult anatomy), with no conversions to thoracotomy. Postoperative outcomes: VAS pain score 3.8 ± 0.9 (3–6), chest tube duration 3.5 ± 2.1 days (1–12 days), hospital stay 5.2 ± 3.06 days (2–14 days), prolonged air leak self-limited in 14.3% (2 cases), with no reoperations and 0% mortality.

Conclusion: Uniportal VATS is feasible, safe, and effective at Dong Nai General Hospital, although further time and increased case volume are needed for refinement. This technique shows promise and potential for expansion to other provincial-level hospitals.