{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:45Z","timestamp":1787028645191,"version":"build-2736575974"},"reference-count":21,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T00:00:00Z","timestamp":1705017600000},"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>Objectives: The aim of this study is to evaluate if the efficacy and safety of chest tube placement are influenced by the level of intercostal space insertion (uniportal VATS vs. biportal VATS) or by the type of drain employed (standard vs. smart coaxial drain). Methods: Data on patients who underwent either uniportal or biportal VATS upper lobectomies with lymphadenectomy were prospectively collected in three European centers. The uniportal VATS group with a 28 Fr standard chest tube (U-VATS standard) was compared with the uniportal VATS group with a 28 Fr smart drain (U-VATS smart), and U-VATS smart was also compared with biportal VATS with a 28 Fr smart drain inserted in the VIII intercostal space (Bi-VATS smart). Results: When comparing the U-VATS standard group with the U-VATS smart, a higher fluid output was recorded in the U-VATS smart (p: 0.004) in the III post-operative day (p.o.) and overall (p: 0.027), with a lower 90-day re-admission in the U-VATS smart (p: 0.04). The Bi-VATS smart group compared to U-VATS smart showed a higher fluid output in the I p.o. (p &lt; 0.001), with no difference in total fluid amount or hospitalization. The Bi-VATS smart recorded a lower incidence (p &lt; 0.001) of residual pleural space or effusion (p: 0.004) at chest X-rays prior to drain removal but a higher level of pain and chronic intercostal neuralgia (p: 0.03). Conclusions: Chest tube insertion through the same incision space in uniportal VATS seems to be safe and effective. Smart drains can improve the fluid output in uniportal VATS, as if the drainage were inserted in a lower space (i.e., biportal VATS), but with less discomfort.<\/jats:p>","DOI":"10.3390\/jcm13020430","type":"journal-article","created":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T07:47:16Z","timestamp":1705045636000},"page":"430","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Are the Efficacy and Safety of Chest Tubes in Uniportal Video-Assisted Thoracic Surgery Related to the Level of Intercostal Space Insertion or to the Drain Type? A Prospective Multicenter Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2937-9678","authenticated-orcid":false,"given":"Dania","family":"Nachira","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione Policlinico Universitario \u201cA.Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6267-0099","authenticated-orcid":false,"given":"Pietro","family":"Bertoglio","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Ismail","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Klinikum Ernst von Bergmann, Academic Hospital of the Charit\u00e9-Universit\u00e4tsmedizin, Humboldt University Berlin, 14467 Potsdam, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Giulio","family":"Napolitano","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione Policlinico Universitario \u201cA.Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Calabrese","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione Policlinico Universitario \u201cA.Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6399-9171","authenticated-orcid":false,"given":"Khrystyna","family":"Kuzmych","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione Policlinico Universitario \u201cA.Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5563-0331","authenticated-orcid":false,"given":"Maria Teresa","family":"Congedo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione Policlinico Universitario \u201cA.Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4654-1577","authenticated-orcid":false,"given":"Carolina","family":"Sassorossi","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione Policlinico Universitario \u201cA.Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Meacci","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione Policlinico Universitario \u201cA.Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Petracca Ciavarella","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione Policlinico Universitario \u201cA.Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3807-6911","authenticated-orcid":false,"given":"Marco","family":"Chiappetta","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione Policlinico Universitario \u201cA.Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9383-5554","authenticated-orcid":false,"given":"Filippo","family":"Lococo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione Policlinico Universitario \u201cA.Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4890-2578","authenticated-orcid":false,"given":"Piergiorgio","family":"Solli","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Margaritora","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fondazione Policlinico Universitario \u201cA.Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,12]]},"reference":[{"key":"ref_1","unstructured":"Shields, T.W., Locicero, J., Ponn, R.B., and Rusch, V.W. 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