Uniportal Versus Biportal VATS for Anatomical Lung Resections: Is Perioperative Safety Comparable and Postoperative Pain Reduced?

Introduction: Minimally invasive techniques are increasingly used in anatomical lung resections; however, the impact of different video-assisted thoracic surgery (VATS) port strategies on perioperative outcomes remains controversial. Evidence comparing uniportal and biportal VATS in terms of safety and postoperative pain is still limited. This study aimed to compare clinical and surgical outcomes of anatomical lung resections performed using uniportal and biportal VATS approaches. Methods Patients who underwent anatomical lung resection with minimally invasive techniques between January 2024 and September 2025 were retrospectively analyzed. Patients were grouped according to the surgical approach as uniportal VATS (U-VATS) or biportal VATS (B-VATS). Demographic data, comorbidities, operative variables, perioperative complications, conversion rates, postoperative pain scores, and length of hospital stay were compared. Results A total of 241 patients were included (131 U-VATS, 110 B-VATS). Age and sex distribution were similar between groups. Charlson comorbidity index scores, neoadjuvant treatment rates, and segmentectomy rates were significantly higher in the U-VATS group. Operative time, intraoperative and postoperative complications, conversion to thoracotomy, hospital stay, and 30- and 90-day mortality rates were comparable. Postoperative VAS pain scores on days 0, 3, and 14 were significantly lower in the U-VATS group. Conclusion Uniportal and biportal VATS provide similar perioperative safety in anatomical lung resections. U-VATS offers superior postoperative pain control and can be safely applied in patients with higher comorbidity burdens.