Comparison Of Safety And Advantages Of Subxiphoid Uniportal Video-assisted Thoracic Surgery And Intercostal Video-assisted Thoracic Surgery For Lung Resection: A Systematic Review And Meta-analysis

Background: Subxiphoid uniportal video-assisted thoracoscopic surgery(SU-VATS)has been gradually applied in thoracic surgery.However,whether SU-VATS is beneficial for lung surgery is still unclear.We aimed to assess the safety and advantages of SU-VATS in lung surgery.Methods: PubMed,Web of Science,Cochrane Library,Embase,and CNKI were searched for eligible articles through September 2022.The data analysis was performed with Review Manager 5.4 software.Jadad scale was used to evaluate the methodological quality of included studies.The Cochrane collaboration tool was used to assess the risk of bias.Result: This meta-analysis was based on 13 studies and included a total of 2716 patients with lung surgery.Compared with the intercostal group,there was a statistically significant difference in the SU-VATS group regarding VAS at 24 or 48 hours(SMD =-2.11;95%CI:-2.76 to-1.45;P < 0.00001;SMD =-1.31;95%CI:-1.91 to-0.71;P < 0.0001),incision problems(OR = 0.42;95%CI: 0.22 to 0.77;P = 0.006),pulmonary complications(OR =0.38;95%CI: 0.17 to 0.85;P = 0.02),operative time(SMD = 0.93;95% CI: 0.41 to 1.44;P = 0.0004),and arrhythmia(OR = 3.33;95%CI: 2.00 to 5.55,P < 0.00001).The subxiphoid group was more advantaged in terms of VAS scores as well as incision problems and pulmonary complications.However,the subxiphoid group had a longer operative time and a higher incidence of arrhythmias than the conventional intercostal group.There was no statistically significant difference in pulmonary air leakage(OR =1.03;95%CI: 0.61 to 1.76;P = 0.90),intraoperative blood loss(SMD =-0.31;95%CI:-0.89 to 0.27;P = 0.30),length of postoperative drainage(SMD =-0.07;95%CI:-0.21 to0.07;P = 0.35),length of hospital stays(SMD =-0.45;95%CI:-1.32 to 0.42;P = 0.31),and thoracic drainage(SMD =-0.37;95%CI:-1.03 to 0.29;P = 0.28).Conclusion: SU-VATS reduces postoperative pain,incision problems,and pulmonary complications.Although it increases the operation time and the incidence of arrhythmia,it is still safe and feasible to use SU-VATS in lung surgery,which can replace traditional thoracoscopic surgery.