Advances in vagus nerve management strategies in thoracoscopic lung resections: a narrative review

The vagus nerve (VN) is a critical component of the parasympathetic nervous system, playing a pivotal role in respiratory, cardiovascular, and digestive functions. Its management during thoracoscopic lung resections is essential to minimize postoperative complications such as cough and arrhythmias. This review aims to explore advancements in VN management strategies-including preservation, neuromonitoring, and nerve block-and their impact on surgical outcomes and long-term recovery.

A literature search was conducted in PubMed, China National Knowledge Infrastructure (CNKI), and Google Scholar databases for studies published between January 2010 and March 2025. The search used Medical Subject Headings (MeSH) terms and free-text keywords such as "vagus nerve", "thoracoscopic lung resections", "intraoperative monitoring", and "postoperative complications", combined with Boolean operators. Inclusion criteria focused on original full-text articles in English or Chinese evaluating VN management in thoracoscopic lung surgery. Exclusion criteria included animal studies, case reports, and non-peer-reviewed publications.

The preservation of the pulmonary branch of the VN has been shown to significantly reduce postoperative cough and facilitate recovery. However, some studies suggest that a highly selective severance strategy might be more effective. The development of continuous intraoperative nerve monitoring has improved procedure safety and reduced complications. VN block offers advantages in non-intubated thoracoscopic surgery by suppressing cough reflexes and enhancing patient comfort.

While the preservation of the VN branches appears beneficial, the optimal strategy for VN management during thoracoscopic lung resection remains a subject of ongoing research. Future studies should aim to clarify the mechanisms by which VN management affects postoperative outcomes and establish evidence-based guidelines for clinical practice, potentially improving surgical safety and patient recovery.