Uniportal Video-Assisted Thoracic Surgery (uVATS) has emerged in recent years as a hugely popular evolution of minimally invasive thoracic surgery for lung lobectomy, promising less surgical access trauma than conventional ‘multiportal’ VATS (mVATS). Thoracic surgeons today are now facing a difficult decision: if I am already performing mVATS lobectomy well, should I switch over to uVATS? A systematic review was conducted to address the PICO question: For adult patients with lung cancer receiving lobectomy with curative intent, is the uVATS approach any different from the mVATS approach in terms of safety, surgical outcomes, and oncological efficacy? A final selection of 24 papers comparing uVATS and mVATS was reviewed. The overall quality of the comparative papers was low to moderate, with most consisting of retrospective case series. They indicate that if one is already performing mVATS lobectomy, it is possible to transition to uVATS safely—albeit after appropriate training is obtained (evidence quality low, weak recommendation). However, the current evidence does not yield conclusive proof of superiority for uVATS over mVATS across a range of surgical outcome measures, and hence it is perhaps not yet advised that those already performing mVATS lobectomy should necessarily transition to uVATS at this time (evidence quality very low, weak recommendation).
