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R. Young et al. / Interactive CardioVascular and Thoracic Surgery Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery. ISMICS 2013 Prague Czech Republic, Conference Publication: (var.pagings). 8;145–6.
eComment. Re: Is uniport thoracoscopic surgery less painful than multiple port approaches? Authors: Omer Uz and Ugur Kucuk Department of Cardiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey doi: 10.1093/icvts/ivu455 © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. We have read the article of Young et al. entitled “Is uniport thoracoscopic surgery less painful than multiple port approaches?” with great interest [1]. The authors evaluated whether a uniport (single-port) or multiport technique convey benefit in terms of postoperative pain in patients undergoing video-assisted thoracoscopic surgery (VATS). They reported that uniportal VATS may have a small beneficial effect on early postoperative pain. We appreciate the authors’ efforts on conducting this valuable study. However, we have some reservation on the analysis of the data. When we look at the studies mentioned in the article, we see that patient groups are heterogeneous in terms of primary diseases (primary spontaneous pneumothorax, peripheral lung nodules and thymic tumours, sympathectomy for palmar hyperhidrosis, etc.). Furthermore, postoperative pain is affected by several factors. Among these factors, the entrance site and size of incision, degree of cautery damage, and tension over the wound can be listed. Therefore, we think that to objectively evaluate the results authors should have considered these factors. Conflict of interest: none declared. Reference [1] Young R, McElnay P, Leslie R, West D. Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact CardioVasc Thorac Surg 2015;20:409–14.
eReply. Re: Is uniport thoracoscopic surgery less painful than multiple port approaches? Authors: Douglas West, Rebekah Young, Philip McElnay and Rebecca Leslie University Hospitals Bristol, Bristol, UK doi: 10.1093/icvts/ivv003 © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. We thank Uz and Kucuk for their interest in our recent BET review of the current evidence for uniport versus multiport thoracoscopic surgery as a determinant of postoperative pain [1, 2]. Single port thoracoscopic approaches are increasingly popular. They are now used for major lung resection as well as smaller procedures. We therefore felt a review of the evidence to be topical. Uz and Kucuk quite rightly point out that the studies we have identified in the literature are heterogeneous and subject to bias from the factors they list, amongst others. We share these concerns, and made this clear in our manuscript. No study was graded above evidence level 2b in our table of evidence. In our conclusion we state "all the studies were small, non-randomized and unblinded, and therefore susceptible to various forms of bias". We further concluded that "higher quality prospective randomized studies are needed before single port can be recommended as less painful than multiport thoracoscopic surgery". It was quite reasonable to summarize the available published evidence on a subject of increasing interest to chest surgeons worldwide. Our review has identified, we hope, a need for better quality prospective studies to clarify the role of the uniport approach. We are sorry if our article did not communicate this to Uz and Kucuk, as we believe that we share with them a similar assessment of the limited published evidence to date. Conflict of interest: none declared. References [1] Uz O, Kucuk U. eComment. Re.: Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact CardioVasc Thorac Surg 2015;20:414. [2] Young R, McElnay P, Leslie R, West D. Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact CardioVasc Thorac Surg 2015;20:409–14.
R. Young et al. / Interactive CardioVascular and Thoracic Surgery Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery. ISMICS 2013 Prague Czech Republic, Conference Publication: (var.pagings). 8;145–6.
eComment. Re: Is uniport thoracoscopic surgery less painful than multiple port approaches? Authors: Omer Uz and Ugur Kucuk Department of Cardiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey doi: 10.1093/icvts/ivu455 © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. We have read the article of Young et al. entitled “Is uniport thoracoscopic surgery less painful than multiple port approaches?” with great interest [1]. The authors evaluated whether a uniport (single-port) or multiport technique convey benefit in terms of postoperative pain in patients undergoing video-assisted thoracoscopic surgery (VATS). They reported that uniportal VATS may have a small beneficial effect on early postoperative pain. We appreciate the authors’ efforts on conducting this valuable study. However, we have some reservation on the analysis of the data. When we look at the studies mentioned in the article, we see that patient groups are heterogeneous in terms of primary diseases (primary spontaneous pneumothorax, peripheral lung nodules and thymic tumours, sympathectomy for palmar hyperhidrosis, etc.). Furthermore, postoperative pain is affected by several factors. Among these factors, the entrance site and size of incision, degree of cautery damage, and tension over the wound can be listed. Therefore, we think that to objectively evaluate the results authors should have considered these factors. Conflict of interest: none declared. Reference [1] Young R, McElnay P, Leslie R, West D. Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact CardioVasc Thorac Surg 2015;20:409–14.
eReply. Re: Is uniport thoracoscopic surgery less painful than multiple port approaches? Authors: Douglas West, Rebekah Young, Philip McElnay and Rebecca Leslie University Hospitals Bristol, Bristol, UK doi: 10.1093/icvts/ivv003 © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. We thank Uz and Kucuk for their interest in our recent BET review of the current evidence for uniport versus multiport thoracoscopic surgery as a determinant of postoperative pain [1, 2]. Single port thoracoscopic approaches are increasingly popular. They are now used for major lung resection as well as smaller procedures. We therefore felt a review of the evidence to be topical. Uz and Kucuk quite rightly point out that the studies we have identified in the literature are heterogeneous and subject to bias from the factors they list, amongst others. We share these concerns, and made this clear in our manuscript. No study was graded above evidence level 2b in our table of evidence. In our conclusion we state "all the studies were small, non-randomized and unblinded, and therefore susceptible to various forms of bias". We further concluded that "higher quality prospective randomized studies are needed before single port can be recommended as less painful than multiport thoracoscopic surgery". It was quite reasonable to summarize the available published evidence on a subject of increasing interest to chest surgeons worldwide. Our review has identified, we hope, a need for better quality prospective studies to clarify the role of the uniport approach. We are sorry if our article did not communicate this to Uz and Kucuk, as we believe that we share with them a similar assessment of the limited published evidence to date. Conflict of interest: none declared. References [1] Uz O, Kucuk U. eComment. Re.: Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact CardioVasc Thorac Surg 2015;20:414. [2] Young R, McElnay P, Leslie R, West D. Is uniport thoracoscopic surgery less painful than multiple port approaches? Interact CardioVasc Thorac Surg 2015;20:409–14.
