Comparison of subcutaneous tunnel-assisted periareolar incision versus conventional uniportal video-assisted thoracoscopic surgery (VATS) for pulmonary nodules: A prospective, randomized, controlled trial.

Introduction: Recent investigations into subcutaneous tunneled periareolar incisions for thoracoscopic pulmonary resection have established procedural safety and feasibility. Nevertheless, a critical gap persists in prospective evidence. To address this, we conducted a prospective controlled trial comparing perioperative complications and incisional cosmetic outcomes between single-port pulmonary resection performed via subcutaneous tunneled periareolar approaches versus conventional lateral thoracic approaches.

Materials and methods: 174 patients were randomized 1:1 to either the subcutaneous tunnel periareolar incision group or the conventional single-port group. All demographic, perioperative and follow-up data were prospectively collected and analyzed according to the standardized protocol.

Results: Neither group required intraoperative conversion to multi-port or open chest surgery. Operative duration was significantly longer in the periareolar incision group (P < 0.05). No statistically significant difference in postoperative complications was observed between the cohorts (P = 0.686). Compared to the conventional single-port approach, the periareolar incision group exhibited significantly reduced rates of clinically significant pain. The results of POSAS scale showed that the scar evaluation results were better in the periareolar incision group. Incisional cosmesis satisfaction was significantly higher in female patients who underwent periareolar incision than in those who underwent conventional single-port approach (P < 0.001), while there was no similar finding in male patients (P = 0.222). All patients reported minimal or no alterations in nipple sensitivity, with no significant functional impact on daily activities.

Conclusion: The subcutaneous tunneled periareolar approach for single-port thoracoscopic resection demonstrates equivalent safety to conventional VATS while conferring superior cosmetic outcomes.