Optimizing peripheral lung nodule resection: benefits of CO₂-infused micro-port VATS over single-port VATS

Video-assisted thoracoscopic surgery (VATS) wedge resection is a common approach for peripheral lung nodules. Single-port video-assisted thoracic surgery (SP-VATS) is currently recognized as the optimal approach for performing wedge resection of peripheral lung nodules. However, rapid collapse of the lung during VATS and minimize invasiveness remain hot topics of discussion, we performed lung wedge resection combining CO₂-infused micro-port VATS (CO₂-MP-VATS). This study aimed to identify the advantages of CO₂-MP-VATS in peripheral lung nodules wedge resection compared to SP-VATS.

This retrospective study enrolled 186 CO₂-MP-VATS patients and 201 SP-VATS patients between July 2022 and September 2023. The 1:1 Propensity Score Matching (PSM) was conducted to balance the baseline differences between the two groups. Primary outcomes included intraoperative blood loss, operative time, hospital stays and postoperative pain et al. measured by the Visual Analog Scale (VAS), and post-surgery complications within 1 month. The t-test, Wilcoxon-Mann-Whitney U-test, Chi-square test, and Fisher's exact test were performed to evaluate the differences between the two groups.

After matching, 153 pairs of patients with similar baseline characteristics were included in the further analysis (p > 0.05). Compared to SP-VATS, CO₂-MP-VATS was associated with lower postoperative bleeding volumes, shorter operative times, fewer requirements for chest tube drainage, lower VAS pain scores, and less postoperative pleural effusion (p < 0.05). It was noted that no significant differences were observed between the two groups in intraoperative anesthetic monitoring parameters (p > 0.05).

CO₂-MP-VATS is safe and feasible for peripheral lung nodules wedge resection compared to SP-VATS.