Evaluation of the safety of drainless uniportal video-assisted thoracoscopic surgery for the treatment of primary spontaneous pneumothorax: a two-institution retrospective study.

Background: Uniportal video-assisted thoracoscopic surgery (U-VATS) offers good cosmetic outcomes with minimal pain for the treatment of primary spontaneous pneumothorax (PSP). Moreover, the early removal of postoperative chest drains reduces postoperative pain and hospitalization duration for patients with PSP. We aimed to investigate the safety and feasibility of drainless U-VATS in patients with PSP and compare postoperative outcomes between specialists and residents. Methods: We retrospectively analyzed data obtained from the medical records of consecutive patients diagnosed with PSP who underwent surgery at Yamagata Prefectural Central Hospital and Tokyo Metropolitan Bokutoh Hospital between April 2023 and March 2024. Yamagata Prefectural Central Hospital and Tokyo Metropolitan Bokutoh Hospital initiated the drainless protocol in April and July 2023, respectively. All surgeries were performed using the U-VATS approach with a 1.8-2.0-cm incision. Results: We retrospectively reviewed the medical records of 54 patients who underwent U-VATS according to the protocol. Postoperative repeated drainage was not required for any patient. The median postoperative length of hospital stay was 1 day. No multiport conversions were required. The specialists performed significantly better than the residents based on operative time; however, the other perioperative outcomes were not significantly different. Conclusions: Protocol-compliant drainless surgery for PSP is safe and feasible. The results from the two institutions suggest that residents can adequately perform U-VATS for spontaneous pneumothorax with perioperative outcomes comparable to those of specialists.