The state of uniportal video-assisted thoracoscopic surgery in North America: a survey of thoracic surgeons.

backgroundIn recent years, there has been an exponential growth in the research and development of uniportal video-assisted thoracoscopic surgery (VATS). In the context of the 2017 Annual Asian Single-Port VATS Symposium held in Shanghai, China, we sought to describe current the state of uniportal VATS in North America and explore factors that could influence future adoption.

methodsIn March 2017, a five-question survey was distributed to North American Thoracic Surgeons in order to obtain their opinion regarding the uniportal VATS approach to pulmonary resection. Responses were summarized and statistical comparisons of categorical variables were performed using Fisher's exact test.

resultsThe estimated response rate to the survey was 16.5% (99/600). The majority of respondents were experienced surgeons with 41.4% (41/99) having been in practice 11-20 years. The majority (70%; 69/99) of surgeons had never performed a uniportal VATS procedure. When surgeons were asked to state what could potentially convince them to adopt uniportal VATS, scientific evidence of superiority (86%; 85/99) and/or of superior ergonomics (39%; 39/99), attendance to focused conferences with a practical simulation component (38%; 38/99), and the availability of surgical proctorship (9%; 9/99) were the most commonly selected responses.

conclusionsThis survey is the first of its kind to provide a glimpse into the status of the uniportal VATS in North America. The responses suggest that there are few early adopters of this approach as compared to other parts of the world. The lack of perceived advantages to uniportal VATS and the need for more comparative evidence to other established approaches appear to be major obstacles to more widespread adoption in North America.