Does Fissureless Videothoracoscopic Lobectomy Help for Postoperative Air Leak?

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Pulmonary Medicine

Background:

• Postoperative air leak is a frequent complication following pulmonary resections.
• Conventional fissure dissection in videothoracoscopic lobectomy can cause parenchymal damage and prolonged air leak (PAL), especially with fused fissures.
• Fissureless VATS lobectomy presents a potential alternative to mitigate PAL and reduce hospital stay.

Purpose of the Study:

• To compare the efficacy of fissureless versus conventional fissure dissection techniques in VATS lobectomy.
• To evaluate the impact of surgical technique on prolonged air leak (PAL), chest tube duration (CTD), and length of hospital stay (LOS).

Main Methods:

• Retrospective analysis of 103 consecutive patients undergoing VATS lobectomy.
• Patients were categorized based on the surgical technique: conventional fissure dissection or fissureless approach.
• Statistical analysis focused on prolonged air leak (PAL), chest tube duration (CTD), and length of hospital stay (LOS).

Main Results:

• Prolonged air leak (PAL) occurred in 20.4% of cases.
• Significant predictors for PAL included male sex, tumor size >24mm, and the conventional surgical technique.
• Patients undergoing fissureless VATS lobectomy experienced significantly shorter chest tube duration (median 3 days) and length of hospital stay (median 3 days) compared to the conventional group.

Conclusions:

• The fissureless technique is associated with a reduced incidence of prolonged air leak (PAL) in patients undergoing videothoracoscopic lobectomy.
• This technique also leads to decreased chest tube duration and length of hospital stay.
• Fissureless VATS lobectomy offers a promising approach for improving outcomes in pulmonary resections.