Single-port laparoscopic versus multiple-port laparoscopic combined with thoracoscopic for McKeown esophagectomy: a randomized clinical trial.

BACKGROUP: The optimal number of abdominal ports for minimally invasive McKeown esophagectomy remains debated. This study aimed to determine whether single-port laparoscopy combined with thoracoscopy yields superior perioperative outcomes compared to conventional multiport laparoscopy combined with thoracoscopy. METHODS: Between October 2021 and December 2023, 147 patients were randomly assigned to single-port or multiport laparoscopic-assisted thoracoscopic surgery. Primary outcomes included operative time, intraoperative blood loss, postoperative pain, and lymph node yield; secondary outcomes comprised complications and recovery indicators. RESULTS: Total operative time was comparable between groups (P < . 05). The single-port group exhibited significantly lower total blood loss (60(15, 110) vs. 200(50, 250) mL, P < . 001) and shorter laparoscopic time (49 (39, 57) vs. 57 (45, 76) min, P = . 03). In patients with BMI > 25 kg/m2, these advantages were more pronounced (operative time: 54 ± 7 vs. 66 ± 12 min, P < . 01; blood loss: 11 ± 5 vs. 20 ± 7 mL, P < . 001). Pain scores were lower in the single-port group on postoperative day 3 (VAS 2. 45 ± 0. 42 vs. 2. 99 ± 0. 87, P < . 001). Lymph node yield was similar between groups. Complication rates and recovery indicators did not differ significantly. CONCLUSIONS: Compared with the multiport approach, single-port laparoscopy reduces blood loss, shortens operative time, and alleviates postoperative pain without compromising oncological efficacy or safety.