Does 11.5 mm guided single port surgery has clinical advantage than multi-port thoracoscopic surgery in spontaneous pneumothorax?

The definition of spontaneous pneumothorax (SP) is air accumulation in the pleural space and is a common disorder in young patients (1). Among multi-factorial causes of SP, the major one is the pleural bleb or bulla, usually located at the lung apex (2). Bullectomy is the most effective treatment which decreases the recurrence rate. Especially, video-assisted thoracoscopic surgery (VATS) has been considered as the first surgical option in SP because of less postoperative pain and early recovery (3). VATS with three-ports is a common practice of surgery for SP, using one port for thoracoscopy, another for lung grasping, and the other, the largest 11.5 or 12 mm port, for stapling devices (4). With increased experience, surgical skills, and advancement of instruments in VATS, single port VATS has been attempted in the field of thoracic surgery (5,6). Although the single port VATS has been expected to have benefits such as lesser postoperative pain and earlier recovery compared to the multi-port VATS, the clinical advantage is still unclear. Using one 2.5 cm incision with a wound protector or the SILS Port？ (Covidien, Norwalk, CT, USA) has been a common fashion for the single port VATS (7,8), and the incision was larger than the biggest incision of multi-port VATS, which made it possible to place several instruments. However, authors believed that the definition of single port VATS is to make the single incision not larger than the maximal port incision in conventional multi-port VATS