Single port surgery is the current trend in minimally invasive surgery. For lung cancer surgery, the adoption of extreme small wound is cautioned by the possibility of compromise of oncological clearance. However, as experience accumulate since the introduction of VATS surgery, the worry of delayed relapse or early recurrence is less of a concern. More and more surgeon believe in the reverse. With less immune suppressive effect of minimal access surgery, survival is prolonged for VAT operable lung cancer.
Recently I attend a workshop for the update of VATS in lung resection. Without expecting anything new to discover, the enthusiasm of speakers for VATS experience remains high despite coming along all those years of minimally invasive surgery. Yet they stress on the fact that only surgeon with a vision can push for limit of traditional belief and constraint.
So long as the surgeon believe in doing surgery with due care and good suprevision, pushing to the limit of two small wound then single uniport wound is best to achieve good recovery for same type of lung resection surgery. However, there is limit to everything. If it takes hours for the lung cancer to be removed when a slightly larger wound could allow swifter but not necessarily better clearance of tumour. One may not be too dogmatic to fight for shorter wound length.
Moreover, the reason of learning curve is not short for Uniport surgery.
From example of uniport laparoscopic cholesystectomy, the time will much vary with the inflammatory condition of the gallbladder. In occasional attempt, surgeon will take twice the usual time for difficult gallbladder.
I believe well trained surgeons do know the limit of his own and possiblitly of fatigue and psychological burden of prolonged surgery, they would convert at appropriate time. The imperative is patient's safety and the least of concern is surgeon's ego.
I applaud the skill and determination of surgeon pursing uniport VAT lobectomy. But I personally would select less than 10% of all operable lung cancer for such attempt.