{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:21Z","timestamp":1787028621510,"version":"build-2736575974"},"reference-count":14,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T00:00:00Z","timestamp":1646352000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Two-port (2P) and three-port (3P) video-assisted thoracoscopic surgery (VATS) are well-established surgical methods for the treatment of complicated spontaneous pneumothorax (SP). However, a comparison between both techniques, in terms of clinical outcomes in patients with secondary spontaneous pneumothorax (SSP), is unreported. The aim of this study was to evaluate and compare postoperative pain, as well as clinical outcome, following 2P and 3P VATS for SSP in our institution. Methods: Between January 2008 and December 2020, we retrospectively analyzed the data of 115 SSP patients treated by VATS in our institution. Fifty-two patients underwent 2P-VATS, while 63 patients were treated by 3P-VATS. The total dose of analgesic use per stay (opioid and non-opioid), length of hospital stay (LOS), operation time, total area of pleurectomy, recurrence rates and postoperative complications were compared between both groups. Results: The 3P-VATS group had a significantly higher total dose of analgesic use compared with the 2P-VATS patients. The LOS and mean operation time were significantly shorter in the 2P-VATS group. A larger area of pleurectomy was resected using 3P-VATS compared to 2P-VATS. The postoperative complications and recurrence of SSP during a median follow-up period of 76.5 months were similar in both groups. Conclusion: 2P-VATS is a safe surgical technique. It is associated with a short LOS and less postoperative pain, and, thus, low analgesic use.<\/jats:p>","DOI":"10.3390\/jcm11051404","type":"journal-article","created":{"date-parts":[[2022,3,6]],"date-time":"2022-03-06T20:38:16Z","timestamp":1646599096000},"page":"1404","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Postoperative Pain and Clinical Outcome Following Two- and Three-Port Video-Assisted Thoracoscopic Surgery for Secondary Spontaneous Pneumothorax"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7341-5798","authenticated-orcid":false,"given":"Stephen","family":"Fung","sequence":"first","affiliation":[{"name":"Department of Surgery, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kefah","family":"Jaber","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Kivilis","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Rehders","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Schauer","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levent","family":"Dizdar","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram-Trudo","family":"Knoefel","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, 40225 Duesseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1159\/000490179","article-title":"Management of Spontaneous Pneumothorax and Post-Interventional Pneumothorax: German S3 Guideline","volume":"97","author":"Schnell","year":"2019","journal-title":"Respiration"},{"key":"ref_2","first-page":"1379","article-title":"Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974","volume":"120","author":"Melton","year":"1979","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"ii18","DOI":"10.1136\/thx.2010.136986","article-title":"Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010","volume":"65","author":"MacDuff","year":"2010","journal-title":"Thorax"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1183\/09031936.00219214","article-title":"ERS task force statement: Diagnosis and treatment of primary spontaneous pneumothorax","volume":"46","author":"Tschopp","year":"2015","journal-title":"Eur. Respir. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1093\/ejcts\/ezv256","article-title":"Results of surgical treatment for secondary spontaneous pneumothorax according to underlying diseases","volume":"49","author":"Ichinose","year":"2016","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S2109","DOI":"10.21037\/jtd.2018.06.94","article-title":"Multidisciplinary team approach for complicated pneumothorax","volume":"10","author":"Sano","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Fung, S., Ashmawy, H., Safi, S., Schauer, A., Rehders, A., Dizdar, L., Fluegen, G., and Knoefel, W.T. (2021). Two-port versus three-port video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: Feasibility, postoperative outcome and long-term recurrence rates. BMC Surg., 21.","DOI":"10.1186\/s12893-021-01426-6"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1510\/icvts.2007.165712","article-title":"Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax: Clinical and economic analysis in comparison to the traditional approach","volume":"7","author":"Salati","year":"2008","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1055\/s-0038-1629909","article-title":"Which is the Best Minimal Invasive Approach for the Treatment of Spontaneous Pneumothorax? Uniport, Two, or Three Ports: A Prospective Randomized Trail","volume":"66","author":"Kutluk","year":"2018","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2924","DOI":"10.21037\/jtd.2016.10.56","article-title":"Does 11.5 mm guided single port surgery has clinical advantage than multi-port thoracoscopic surgery in spontaneous pneumothorax?","volume":"8","author":"Jeon","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/1749-8090-8-153","article-title":"Pain following thoracoscopic surgery: Retrospective analysis between single-incision and three-port video-assisted thoracoscopic surgery","volume":"8","author":"Tamura","year":"2013","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"384","DOI":"10.5090\/kjtcs.2014.47.4.384","article-title":"Early outcomes of single-port video-assisted thoracic surgery for primary spontaneous pneumothorax","volume":"47","author":"Kang","year":"2014","journal-title":"Korean J. Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.2214\/ajr.165.5.7572489","article-title":"Quantification of pneumothorax size on chest radiographs using interpleural distances: Regression analysis based on volume measurements from helical CT","volume":"165","author":"Collins","year":"1995","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ejcts.2005.02.039","article-title":"Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: Comparison of post-operative pain and residual paraesthesia","volume":"28","author":"Jutley","year":"2005","journal-title":"Eur. J. Cardio-Thorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/5\/1404\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:31:47Z","timestamp":1760135507000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/5\/1404"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,4]]},"references-count":14,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["jcm11051404"],"URL":"https:\/\/doi.org\/10.3390\/jcm11051404","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,4]]}}}