Single-incision Video-Assisted Thoracic Surgery Versus Conventional Three-port Surgery For Primary Spontaneous Pneumothorax: A Systematic Review

Objective: To systematically evaluate the effectiveness of Single-Incision Video-Assisted Thoracic surgery versus conventional three-port VATS for primary spontaneous pneumothorax. Method: Databases including PUBMED,EMbase,The Cochrane Library,CBM,CNKI and wanfang data were searched to collect the randomized controlled trails(RCTs) and controlled clinical trials of comparing Single-Incision VATS and conventional three-port VATS for primary spontaneous pneumothorax,we also handsearched some Chinese journals.The retrieval time was from inception to December 2014.Data were extracted and evalued by two reviewers independently.Then meta-analysis was performed using RevMan5.3 software. Results: Eight cohort studies met the selection criteria,involving 483 participants.The meta-analyses showed that:Compared with conventional three-port VATS,Single-Incision VATS had shorter operation time[MD=-3.90,95%CI(-7.22,-0.58),P=0.02],lesser amount of intraoperative bleeding [MD=-9.34,95%CI(-15.26,-3.42),P=0.002],and shorter chest drainage time [MD=-0.66,95%CI(-1.02,-0.29),P =0.0004],Single-Incision VATS significantly reduced the pain in 24 hours after operation[MD=-0.90,95%CI(-1.14,-0.66),P<0.00001]and postoperative paresthesia[OR=0.15,95% CI(0.07,0.31),P<0.00001].Meanwhile, there were no statistical difference between the 2 groups in hospital stay[MD=-0.30,95%CI(-0.63,0.03),P=0.08] and the recurrence of pneumothorax[OR=0.68,95%CI(0.25,1.83),P=0.53]. Conclusion: Comparing with conventional three-port video-assisted thoracic surgery in the treatment of spontaneous pneumothorax,Single-Incision VATS has some advantages in certain aspects. However,for the quantity and quality limitation of the included studies and bias may exist due to NRCTs, above conclusion still requires to be further proved by more high quality RCTs.