Surgical Safety of Uniportal versus Multiportal VATS Segmentectomy during Institutional Adoption: Differential Impact by Lobar Location.

PURPOSE: This study aimed to compare surgical safety outcomes of uniportal and multiportal video-assisted thoracoscopic surgery (uVATS and mVATS) segmentectomy during institutional adoption, focusing on differences according to lobar location. METHODS: We retrospectively analyzed 117 patients who underwent thoracoscopic segmentectomy between 2019 and 2024 (uVATS, 49; mVATS, 68). Outcomes included intraoperative pulmonary vessel injury and major postoperative complications, along with operative time, blood loss, and length of hospital stay. Inverse probability of treatment weighting was applied, and analyses were performed overall and stratified by lobe. RESULTS: Pulmonary vessel injury occurred in 12 patients (10.3%), and grade ≥III complications in 10 (8.5%). After adjustment, uVATS showed a higher incidence of vascular injury than mVATS overall (22.8% vs. 5.5%; p = 0.006). No statistically significant differences were observed in upper-lobe segmentectomy. In lower-lobe segmentectomy, uVATS showed higher rates of vascular injury (44.8% vs. 2.2%; p <0.001) and grade ≥III complications (18.8% vs. 0%; p = 0.005). CONCLUSIONS: No statistically significant differences were observed between uVATS and mVATS in upper-lobe segmentectomy. However, during the institutional adoption phase, careful consideration is warranted when performing lower-lobe segmentectomy with uVATS due to a higher incidence of complications related to surgical safety.