Initial experience with a novel 2-mm needle-type intracorporeal assembly forceps for periareolar video-assisted thoracoscopic surgery.

Background: Periareolar video-assisted thoracoscopic surgery (VATS) provides cosmetic advantages but poses technical challenges due to limited working space. The novel 2-mm needle-type intracorporeal assembly endoscopic forceps is designed to minimize incision size while retaining full surgical functionality. This study aimed to evaluate the feasibility, safety, and effectiveness of this novel endoscopic forceps in periareolar VATS.

Methods: This single-center retrospective observational study included patients who underwent periareolar VATS using either the 2-mm forceps or a conventional 5-mm grasper between January and December 2024. Outcomes included operative time, complications, visual analog scale (VAS) pain scores at 1 week and 1 month, patient and observer scar assessment scale (POSAS) scores at 6 months, and surgeon feedback. Patients were stratified as follows: 2-mm group (n = 78; uniportal 45, biportal 33) and a historical 5-mm control (n = 37; all uniportal) from the same team under identical indications and perioperative protocols. Because the control contained only uniportal cases, all between-group comparisons were prespecified for the uniportal subset (2 mm: 45 vs. 5 mm: 37); 2-mm biportal cases were summarized descriptively.

Results: A total of 115 periareolar VATS procedures were completed without severe complications or perioperative mortality. Instrument assembly and disassembly required 100 ± 28 s and 25 ± 11 s, respectively. The needle-type puncture sites required no suturing and showed minimal-to-virtually no scarring at follow-up. In the uniportal subset, the 2-mm group had significantly lower POSAS totals and early VAS scores than the 5-mm group, with comparable operative time and surgeon-reported difficulty. Three minor mammary gland injuries occurred overall (two in the 2-mm group and one in the 5-mm group), with no lasting sensory impairment.

Conclusions: The novel 2-mm intracorporeal forceps is safe and effective for periareolar VATS, significantly enhancing cosmetic outcomes and surgical efficiency, suggesting broad clinical application potential.