Subxiphoid uniportal video-assisted thoracoscopic surgery: a scoping review of technical evolution, clinical applications, and future perspectives
Year: 2026
Type: article
Abstract: Background: Subxiphoid uniportal video-assisted thoracoscopic surgery (SU-VATS) has attracted increasing attention as a minimally invasive strategy that avoids intercostal nerve damage, a frequent drawback of conventional intercostal VATS. This scoping review maps the existing literature to answer three questions: how the technique has evolved, for which thoracic procedures it has been applied and with what outcomes, and what innovations and evidence gaps will shape its future. Methods: PubMed was searched from January 2010 through 6 June 2026 (primary search) and the search strategy was refined and re-executed on 6 September 2026 to verify the selection process, using combinations of "subxiphoid", "infrasternal", "uniport*", "single-port", "single-incision", "VATS", and "thoracoscopic" terms, supplemented by backward citation searching. Two authors independently screened records and charted the data; 71 studies were included. Results: SU-VATS has been employed across a broad spectrum of thoracic operations: lobectomy, segmentectomy, thymectomy for anterior mediastinal pathology, bilateral pulmonary resection, and thoracic sympathectomy. In most comparisons-almost all observational and unblinded-SU-VATS was associated with lower postoperative pain ratings [visual analogue scale (VAS)/numeric rating scale (NRS)] than intercostal uniportal VATS (IU-VATS), although one study reported greater incisional discomfort after bilateral procedures. A distinctive benefit is management of bilateral disease through one incision without repositioning. Nonetheless, SU-VATS entails a longer learning curve, extended operative times during early adoption, and greater difficulty accessing upper lobe or posterior mediastinal targets. Recent innovations-including sternal elevation devices, articulating instruments, three-dimensional (3D) thoracoscopy, indocyanine green (ICG) fluorescence, and robotic platforms-have been introduced to address these spatial constraints. Conclusions: SU-VATS constitutes a meaningful addition to the minimally invasive thoracic surgeon's toolkit, with observational comparisons suggesting advantages in analgesia and bilateral operability. Current data support its safety and feasibility for appropriately selected cases, but oncologic equivalence has not been established, and multicenter randomized trials with standardized endpoints are required to define its optimal position. Evidence strength differs by procedure-most substantial for thymectomy and least mature for sympathectomy. Robotic systems and image-based navigation are expected to broaden its indications further.
Source: Journal of Thoracic Disease
Authors: Shanlei Wang, Zheng Song
Institutions: Shandong University, Weihai Municipal Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7221780680