Effectiveness of chest tube placement via the utility incision in uniportal video-assisted thoracoscopic surgery lobectomy on residual pleural effusion

Introduction: The optimal placement of chest drains after uniportal lobectomy remains a subject of debate, despite the widespread adoption of this minimally invasive approach. This study aimed to compare post-operative pleural effusion between two different chest drain placements: through the utility incision (uniportal video-assisted thoracoscopic surgery [U-VATS]) and through a separate port (triportal VATS [T-VATS]) in patients undergoing pulmonary lobectomy. Patients and Methods: We conducted a retrospective, single-center study including 214 consecutive patients who underwent lobectomy for NSCLC (January 2019–December 2024). Patients were divided into two groups: U-VATS group ( n = 107), with a 24-Fr drain placed through the utility incision; T-VATS group ( n = 107), with a 28-Fr drain inserted through the camera port. Demographic data, tumor characteristics and perioperative details were collected. The primary outcome was the residual pleural effusion evaluated on chest X-ray (CXR) before discharge, using the Blackmore scoring system. Secondary outcomes included chest tube duration, hospital stay and post-operative complications. Results: Baseline characteristics were comparable between groups. The U-VATS group exhibited significantly less pleural effusion on immediate post-operative and 3 rd -day chest radiographs ( P < 0.001 for both), while no difference was observed at discharge ( P = 0.45). Chest tube duration was significantly shorter in the U-VATS group (mean 3 vs. 5 days, P = 0.004) despite the use of smaller-diameter drains. There were no differences in complications or post-operative length of stay. Conclusions: Chest tube placement through the utility incision in U-VATS lobectomy ensures effective post-operative pleural fluid management without requiring alternative or additional drainage strategies.