Clinical application of the closed inflation method in pulmonary segmentectomy: A retrospective propensity...

Pulmonary segmentectomy is widely adopted for early-stage lung cancer. However, the conventional inflation-deflation method is often time-consuming. To address the limitation, we propose a novel closed inflation technique involving targeted bronchial occlusion followed by selective inflation. This approach improves operative efficiency and provides a cost-effective, equipment-free alternative for accurate intersegmental plane delineation.

In this single-center, retrospective study (February 2019-November 2021), 260 patients undergoing pulmonary segmentectomy were assigned to either the inflation-deflation group (n = 86) or the closed inflation group (n = 174). Propensity score matching (PSM) at a 1:1 ratio yielded 53 matched pairs. We systematically recorded and analyzed perioperative metrics, intersegmental plane clarity, and patient survival status.

After matching, the closed inflation group demonstrated significantly improved surgical efficiency compared with the inflation-deflation group. The mean surgical duration was 127.4 min (95% CI, 120.6-134.1) versus 144.0 min (95% CI, 133.6-154.4), P = 0.030. Although no statistically significant differences were observed in other perioperative parameters, the closed inflation group exhibited reduced variability. Clarity of the intersegmental plane was comparable. At long-term follow-up in May 2024, 104 of 106 patients were alive, with survival ranging from 2.5 to 5.2 years. Two deaths occurred from unrelated malignancies, and no recurrence or metastasis was observed.

The closed inflation technique is a cost-effective, equipment-independent method that enhances operative efficiency without compromising perioperative safety. Owing to its simplicity, reproducibility, and minimal resource requirements, it represents a viable alternative for institutions lacking access to advanced imaging technologies or dye-based systems.