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Published on: November 10, 2023
Mastering the maze: navigating prolonged air leak in thoracic surgery
Clarissa Uslenghi1, Luca Bertolaccini1, Monica Casiraghi1,2
1Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Journal of Visualized Surgery
|June 3, 2026
Summary
Prolonged air leak (PAL) after thoracic surgery, often an alveolar-pleural fistula (APF), complicates recovery. Strategies include intraoperative detection, digital chest drains, and interventions like autologous blood patching to improve patient outcomes.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Surgical Complications
Background:
- Prolonged air leak (PAL) is a significant complication in thoracic surgery, leading to alveolar-pleural fistula (APF).
- Risk factors include smoking and specific surgical techniques like segmentectomies, necessitating preoperative assessment.
- PAL negatively impacts patient recovery, quality of life, and increases healthcare costs.
Purpose of the Study:
- To review current challenges and strategies for managing prolonged air leak (PAL) in thoracic surgery.
- To highlight the impact of PAL on patient outcomes and healthcare expenditure.
- To discuss advancements in PAL detection and management, particularly in visualised thoracic surgery.
Main Methods:
- Review of existing literature on prolonged air leak (PAL) in thoracic surgery.
- Analysis of intraoperative techniques for PAL detection and management, including submersion tests and near-infrared fluorescence imaging.
- Evaluation of postoperative management strategies, chest drainage systems, and long-term interventions such as autologous blood patching.
Main Results:
- Standardizing intraoperative management through consensus initiatives and employing aerostatic interventions show promise in reducing PAL incidence.
- Digital chest drains offer enhanced monitoring and precision in postoperative management.
- Autologous blood patching is identified as a cost-effective intervention for long-term PAL management.
Conclusions:
- Addressing PAL requires a comprehensive, individualized approach due to its multifactorial nature.
- Visualised thoracic surgery techniques, while beneficial, still face challenges with PAL, necessitating advanced intraoperative management.
- Continued research and collaborative efforts are crucial for optimizing patient outcomes and reducing healthcare costs associated with PAL.
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