Tidal Volume Discrepancy for Air Leak Detection in Thoracoscopic Lung Resection in Smokers

Prolonged air leakage (PAL) is a common postoperative complication after lung resection. The conventional air leak test, widely used to detect intraoperative air leaks, is limited to restricted thoracic space during lung inflation, which may result in undetected leaks, and fragile lung parenchyma may allow new air leaks to develop during chest closure. This study evaluated the efficacy of tidal volume discrepancy monitoring for intraoperative air leak detection during video-assisted thoracoscopic surgery anatomical lung resection (lobectomy and segmentectomy).

We retrospectively reviewed 310 patients with a smoking history who underwent video-assisted thoracoscopic surgery anatomical lung resection for non-small cell lung cancer. Since May 2020, a new intraoperative air leak assessment method was implemented. After the conventional air leak test, bilateral lung ventilation was continued until chest closure, with continuous monitoring of inspired and expired tidal volumes. A sustained discrepancy >20 mL per breath prompted further intrathoracic inspection and repair.

PAL occurred in 4.1% of patients in the new method group, significantly lower than 10.9% in the conventional method group (P = .0205). Multivariate analysis identified the evaluation method and presence of intrathoracic adhesion as independent predictors of PAL. Importantly, all procedures were completed thoracoscopically, including a substantial number of segmentectomies.

Intraoperative evaluation of intraoperative air leaks using tidal volume discrepancies is a reliable and effective method to detect air leaks and reduce PAL incidence in video-assisted thoracoscopic surgery anatomical lung resections.