LAUSR

Over the past 10 years, the medical literature on pulmonary resection has seen the appearance of multiple articles describing new thoracic surgery techniques. One of the most controversial is the single-port or uniportal approach. In this technique, unlike conventional video assisted thoracoscopic surgery (VATS), only 1 incision measuring about 5–6 cm is made, with no additional incisions for the introduction of optical or other surgical instruments. The current debate centers on whether surgery performed via a single incision provides real clinical benefit to the patient, compared with the conventional procedure, consisting of one main incision plus 1 or 2 smaller ones (measuring less than 1 cm). The first step in demonstrating the superiority of a particular approach is to collect and compare measurable and reproducible variables. Variables such as surgical time or conversion rate to open surgery are measurable, but not reproducible, since they depend largely on the personal skill and circumstances of the surgeon who performs the operation. Length of hospital stay or time with pleural drains are inappropriate because they are easily manipulated, except in randomized studies in which the criteria for discharge and removal of drains are standardized and the treating physician does not know which type of procedure was performed. Other variables such as 30-day mortality, disease-free survival, postoperative pain, or complication rate are more appropriate. However, only comparable cases can be compared, so randomization is used in prospective studies and case-matching in retrospective analyses, applying any of the available statistical techniques. In any case, parameters selected for analysis should represent real clinical advantages for the patient and not reflect a desperate search for P-values lower than .05 among a long list of variables. One particular example of this is a recent article1 in which the authors conclude that patients undergoing lung resection under sedation without muscle relaxation or tracheal intubation need less postoperative fasting time than those who were anesthetized using muscle relaxation and intubation. Obviously, a longer postoperative fasting period will not be required if the patient has not been anesthetized. This article is a clear example of the fact that research objectives are sometimes established after the results have been revealed.