The use of clips for ligation of segmental arteries in thoracoscopic surgery has not yet been validated in clinical studies and is currently authorized based primarily on technical specifications. Clips are advantageous in endoscopic surgery because they are easy to apply, time-efficient, and cost-effective. We evaluated our experience with vascular dissection in video-assisted thoracoscopic anatomic lung resection. We analyzed all VATS anatomic lung resections performed between 2012 and 2018 using our prospective patient registry. Pulmonary arteries were ligated using linear endoscopic staplers (Endo GIA TM 30-45mm, vascular medium [Medtronic] or Echelon Flex TM 45mm, GST 45D[Ethicon]), hand sutures (Premilene 5 - 0 or 4 - 0, 0.1-0.2mm [B. Braun], running suture or single stitch), or clips (Aesculap® DS Titanium Ligation Clips, medium-large and large). The primary endpoint was postoperative bleeding leading to re-exploration or blood transfusion. We identified patients after VATS lobectomy and segmentectomy (449 lobectomies, 296 segmentectomies). Staplers, hand sutures, and clips were used for pulmonary artery ligation in 369, 83, and 293 procedures, respectively. Eighteen bleeding events occurred (2.4%) : clips 8 (2.7%), stapler 6 (1.6%), suture 4 (5.0%). Seven patients received blood transfusions, and 11 underwent re-exploration. No clip failure leading to bleeding was observed. There was no significant difference among the three groups regarding bleeding or overall postoperative complications. Multivariable logistic regression showed no difference between the groups (clips vs. stapler OR 0.99, 95% CI 0.30-3.27, p = 0.99). Operative time was significantly shorter with staplers in lobectomy and with clips in segmentectomy compared with hand sutures. The estimated device cost showed a potential 80% reduction in direct device cost for clip use in comparison with stapler use. DS Titanium Ligation Clips appear to be a safe, fast, and cost-effective option for ligation of segmental pulmonary arteries during thoracoscopic anatomical lung resection.

A subaortic anomalous left brachiocephalic (innominate) vein is a rare systemic venous anomaly. Although usually asymptomatic, when it traverses the aortopulmonary window it may obscure the operative field and increase the risk of vascular injury during left upper mediastinal procedures, including station 4L lymph node dissection and exposure or control of the left pulmonary artery. A man in his seventies presented with a 4.2-cm solid mass in the left upper lobe (S3b) and an enlarged station 4L lymph node. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of station 4L demonstrated carcinoma consistent with non-small cell lung cancer (NSCLC). Given resectable single-station N2 disease and pre-existing interstitial lung disease with a usual interstitial pneumonia (UIP) pattern, a surgery-first strategy was selected. Preoperative contrast-enhanced computed tomography (CT) with three-dimensional reconstruction demonstrated an anomalous left brachiocephalic vein coursing along the left lateral side of the aortic arch and then beneath the aortic arch, superior to the left pulmonary artery, and crossing the aortopulmonary window before draining into the superior vena cava (Takada pattern b/c). Video-assisted thoracoscopic left upper lobectomy with systematic mediastinal lymph node dissection was performed. Early identification of the left vagus nerve enabled safe proximal tracing to the left recurrent laryngeal nerve. En bloc dissection of the station 4L and station 5 lymph node regions and left pulmonary artery management were completed without neural or vascular injury. The ductus arteriosus ligament (DL) could not be identified intraoperatively, suggesting a retroductal course (Takada pattern c). Preoperative identification of a subaortic anomalous left brachiocephalic vein on contrast-enhanced computed tomography (CT) with three-dimensional (3D) reconstruction, together with early identification of the vagus and recurrent laryngeal nerves and careful pulmonary artery management after establishing a safe dissection plane, may facilitate safe dissection in the aortopulmonary window and help prevent neural or vascular injury.

Uni-portal video-assisted thoracoscopic lobectomy (UVATS) has become a well-established technique; however, performing a complete lymphadenectomy, particularly the removal of lymph nodes located below the left hemithorax (LHLN), remains a challenging procedure. To our knowledge, there are limited reports addressing the use of pause ventilation during UVATS for LHLN dissection. In this study, we propose the application of pause ventilation for facilitating LHLN dissection under UVATS. Through transnasal humidified rapid-insufflation ventilatory exchange (THRIVE), we innovatively implemented an intermittent apnea technique during surgery, enabling UVATS dissection of the LHLN. This study details the surgical procedure and includes an accompanying operative video. The application of pause ventilation can promote LHLN dissection under UVATS. The use of pause ventilation for LHLN dissection in UVATS appears safe and feasible, providing clear exposure of key surrounding tissues and organs.

BackgroundBronchial blockers (BBs) manage airways during thoracoscopic lobectomy and isolate lungs by occluding the bronchus at the surgical site. However, intraoperative malpositioning remains a concern. We compared the performance of a new double-cuff BB (DcBB) with an additional cuff near the end of a single-cuff BB (ScBB) with that of ScBBs during thoracoscopic lobectomy.MethodsThis single-center, randomized, parallel, controlled clinical study enrolled 80 patients undergoing thoracoscopic lobectomy for lung cancer at Nanpi People’s Hospital. The patients were randomized into two groups (n = 40 each); DcBB (DcBB used during one-lung ventilation) and ScBB (ScBB used during one-lung ventilation). The primary outcomes were the incidence and number of BB malpositioning. Secondary outcomes time for BB placement and positioning, surgical duration, hypoxemia, incidence of adverse cardiovascular events, grades of lung collapse, surgeon satisfaction, tracheal wall damage assessed during bronchoscopy, contamination rates of the non-surgical lung lobe on the surgical site determined by bronchoscopy, radiographic incidence of pulmonary infiltration on postoperative day 1, and intraoperative blood gas values.ResultsThe incidence of malpositioning was significantly lower in the DcBB than the ScBB group (7.5% vs. 30%, P = 0.02). The incidence of malposition was significantly lower in the DcBB cohort (P = 0.002). However, positioning the DcBB required more time (32.28 ± 5.37 vs. 19.90 ± 4.16 sec, P < 0.001). Other secondary outcomes did not differ significantly.ConclusionsIn patients undergoing thoracoscopic lobectomy, the DcBB was associated with a lower incidence of malposition than the ScBB. The DcBB did not increase tracheal wall injury or cause significant adverse hemodynamic effects, and therefore may serve as a promising optional device for airway management during thoracoscopic lobectomy, particularly in clinical scenarios requiring high placement stability.Trial registrationthe Chinese Clinical Trial Registry ChiCTR2400086472

The improvements from minimally invasive surgery and Enhanced Recovery After Surgery (ERAS) protocols have enabled more octogenarians to be considered for curative treatment of early-stage lung cancer. However, evidence on short-term outcomes after ERAS-guided Video-Assisted Thoracoscopic Surgery (VATS) lobectomy in this age group remains limited. The aim was to evaluate perioperative outcomes and assess specific challenges in octogenarians undergoing VATS lobectomy following a well-established ERAS-protocol. We conducted a retrospective observational study of consecutive adults undergoing VATS lobectomy within an ERAS program from 2009 to 2024. All patients followed standardized care and followed an ERAS protocol. Patients aged ≥80years underwent an additional preoperative risk assessment. Among 4,602 patients, 335 (7.3%) were octogenarians (median age 82years, IQR 81-83). Median length of stay was one day longer among octogenarians (4 (IQR: 2-7) vs 3days (IQR: 2-6), p=0.004). Overall complication rates were comparable between octogenarians and younger patients, except for postoperative atrial fibrillation (octogenarians 12% vs 7.6%, p=0.012). Within 30days, 40 octogenarians (11.9%) were readmitted, most commonly for pneumonia (30%), pneumothorax (25%), and pleural effusion (20%). 30-day mortality was not statistically different between octogenarians and younger patients (octogenarians 1.8% vs 1.2%, p=0.29). The number of octogenarians undergoing VATS lobectomy has increased from 2.5% of all patients in 2009 to 11.7% in 2024. VATS lobectomy within an ERAS framework appears safe and feasible in carefully selected octogenarians, yielding acceptable short-term outcomes. Chronological age alone should not preclude surgical treatment.

BackgroundThe clinical benefit of dividing the inferior pulmonary ligament (IPL) during video-assisted thoracoscopic upper lobectomy (TUL) for early-stage lung cancer remains controversial. This study aimed to evaluate the association between IPL division during TUL and postoperative clinical outcomes.MethodsWe retrospectively analyzed 95 patients who underwent TUL between December 2020 and June 2025. Patients were assigned to an IPL-preservation group (Group P) or an IPL-division group (Group D). Group P included 50 patients (31 right-sided and 19 left-sided procedures), and Group D included 45 (29 right-sided and 16 left-sided procedures). Postoperative outcomes—including operative time, intraoperative blood loss, duration of postoperative air leak, chest tube duration, length of postoperative hospital stay, and changes in bronchial angle, lung volume, pulmonary function, and cough severity—were compared between groups. Bronchial angle and lung volume were measured using three-dimensional (3D) reconstructed chest computed tomography (CT) images. Cough severity and cough-related quality of life before and after surgery were assessed using the Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ-MC).ResultsBaseline characteristics were comparable between groups, with no statistically significant differences (all P > 0.05). IPL division was associated with a greater degree of postoperative bronchial angle change after left-sided surgery, reaching borderline significance at 3 months (68.1 ± 7.2° vs. 78.1 ± 7.8°, P = 0.046) and poorer 6-month outcomes, including smaller lung volume (3615 ± 475 mL vs. 3392 ± 489 mL, P = 0.027), a trend towards lower FEV1% (73.04 ± 9.36 vs. 69.06 ± 10.11, P = 0.049), lower DLCO (80.82 ± 10.35 vs. 76.06 ± 11.08, P = 0.033), and lower total LCQ-MC score (17.70 ± 1.72 vs. 16.98 ± 1.69, P = 0.042). No significant between-group differences were observed for other endpoints.ConclusionsIPL division did not demonstrate a clear benefit over IPL preservation. The findings suggest that IPL division may be associated with reduced postoperative lung volume, impaired recovery of diffusing capacity, greater displacement of the residual bronchus, and more severe chronic cough. However, particularly for outcomes with marginally significant P values, these results should be interpreted with caution due to multiple comparisons. These conclusions are hypothesis-generating and require confirmation in larger, prospective studies.

Dear Editor, We read with great interest the report on the POPPER randomized controlled trial, which evaluated a smartphone-based application for home symptom management and rehabilitation following thoracoscopic lobectomy[1]. The authors proposed an innovative digital intervention integrating a symptom alert system, exercise modules, and educational content, demonstrating statistically significant improvements in pulmonary function recovery and patient-reported outcomes. We commend the investigators for their timely contribution to postoperative digital care; however, several methodological and interpretative issues merit further discussion. Although the difference in pulmonary function recovery rate (PFRR) between the app group and the standard care group reached statistical significance (79.32% vs. 75.73%; P = 0.04), the absolute improvement of approximately 3.6% may not translate into a clinically meaningful benefit. The study did not define the minimal clinically important difference for PFRR, nor did it report outcomes beyond 30 days. Given the natural recovery trajectory after thoracoscopic surgery, the short-term improvement observed may reflect an early motivational effect rather than sustained physiological gains. In addition, the single-blind design, in which clinicians and nurses were aware of group allocation, introduces potential performance bias. Participants in the app group received more frequent guidance, monitoring, and contact through the alert system, which may have enhanced adherence and engagement independently of the app’s intrinsic efficacy. Thus, the observed effects might largely represent an attention or engagement bias rather than the true functional value of the digital platform itself. The inclusion criteria limited enrollment to relatively healthy individuals (ECOG 0–1, capable of performing spirometry and exercise), restricting generalizability to older, frail, or less tech-savvy patients – who in fact constitute a substantial proportion of the post-lobectomy population. The mean age of 61 years and the very high satisfaction rate (95.5%) suggest participants had a good level of digital literacy, a feature that may not be easily replicated in real-world practice, where many elderly patients still face barriers to smartphone use. Furthermore, excluding patients with prolonged hospital stays or postoperative complications may underestimate the challenges of implementing this intervention in more complex recovery scenarios. The authors reported that participants who triggered alerts exhibited higher exercise intensity and greater pulmonary recovery. However, this finding may be confounded, as more motivated individuals are naturally inclined to report symptoms and adhere to exercise regimens more diligently. The causal direction between symptom monitoring and rehabilitation remains unclear, whether monitoring promotes recovery or recovery itself encourages more reporting. Without time-series analysis, attributing functional improvement directly to the alert mechanism remains speculative. Although no app-related adverse events were reported, the app group showed a numerically higher rate of emergency department visits (8.8% vs. 2.9%), which, despite lacking statistical significance, warrants attention. Heightened symptom awareness could lead to unnecessary consultations, reflecting potential hypersensitivity rather than improved self-management. Moreover, the study did not assess cost-effectiveness, caregiver burden, or healthcare resource utilization – key dimensions for evaluating digital health interventions. The recovery trajectory after pulmonary lobectomy typically extends beyond 1 month, with pulmonary function and quality of life continuing to improve over 3–6 months[2]. Without long-term follow-up data, it remains uncertain whether the observed benefits persist, plateau, or diminish once the intervention ceases. Extending follow-up with repeated assessments of lung function and quality of life would greatly enhance the clinical validity of the findings. In summary, the POPPER trial represents a valuable step toward digital-assisted postoperative rehabilitation in thoracic surgery. Nevertheless, its short-term effects, methodological limitations, and interpretive ambiguities temper the strength of its conclusions. Future research should incorporate clinically meaningful endpoints, ensure blinded assessment and balanced follow-up, include more diverse patient populations, and evaluate cost-effectiveness and long-term outcomes to establish the sustained value of such digital interventions. Consistent with the 2025 TITAN Guidelines[3], our review fully adheres to these guidelines.

Hypoxemia is a common and clinically significant problem during one-lung ventilation (OLV). Prophylactic ventilation strategies to prevent OLV-associated hypoxemia and lung injury remain insufficiently defined. Patients scheduled for elective video-assisted thoracoscopic lung lobectomy or segmentectomy were enrolled and randomly assigned into a preconditioning group or a control group. After anesthesia induction, a visual double-lumen endotracheal tube was inserted. The preconditioning group underwent three cycles of OLV preconditioning protocol before surgery: 2min OLV → 2min two-lung ventilation (TLV) → 4min OLV → 4min TLV → 6min OLV → 6min TLV. The control group received conventional OLV only. Ventilation parameters: the tidal volume was set at 6 mL/kg during OLV and 8 mL/kg during TLV. Respiratory rate was adjusted to maintain an end-tidal carbon dioxide partial pressure of 35-45 mmHg. The primary outcome was the oxygenation index (arterial partial pressure of oxygen/fraction of inspired oxygen, PaO2/FiO2). Secondary outcomes included perioperative oxidative stress markers and the incidence of postoperative pulmonary complications (PPCs) within 7 days after surgery. Seventy-four patients were included in the final analysis. The oxygenation index decreased in both groups after initiation of OLV, reaching its lowest value at 30min. At this time point, the preconditioning group showed a significantly higher oxygenation index than the control group (209 ± 64 vs. 145 ± 43 mmHg, P < 0.001). No significant differences were observed between the two groups in perioperative superoxide dismutase (SOD) levels [168 ± 16 vs. 160 ± 21 U/mL, P = 0.302] or in the incidence of PPCs (10/38 vs. 16/36, P = 0.105). OLV preconditioning improved intraoperative oxygenation during thoracic surgery, but did not significantly affect perioperative oxidative stress or the incidence of PPCs. The study was retrospectively registered in the Chinese Clinical Trial Registry on April 8, 2021, ( http://www.chictr.org.cn , ChiCTR2100045203).

The limited duration of action of bupivacaine hydrochloride in thoracic paravertebral nerve block (TPVB) contributes to high rates of acute and chronic postsurgical pain (CPSP) following video-assisted thoracoscopic surgery (VATS). The efficacy of long-acting liposomal bupivacaine (LB) in VATS remains inconclusive. This randomized, double-blind trial involved 146 patients undergoing elective VATS, who received TPVB with either 20 ml of 0.887% liposomal bupivacaine (LB group) or 20 ml of 0.25% bupivacaine hydrochloride (B group). This study was registered with the Chinese Clinical Trial Registry on July 31, 2024. The primary outcome was the area under the curve (AUC) of numerical rating scale (NRS) pain scores over the first 72 h postoperatively. Secondary outcomes included NRS scores at 72 h and at 1, 3, and 6 months postoperatively; concentrations of inflammatory markers within 48 h postoperatively; analgesic consumption; patient-controlled intravenous analgesia (PCIA) presses; postoperative hospitalization duration; and the incidence of postoperative adverse reactions and complications. The AUC of NRS scores at rest and during movement was significantly lower in the LB group compared to the B group during the first 72 h postoperatively (P < 0.05). At 1 and 3 months postoperatively, the LB group showed significantly lower NRS scores and a 58% reduction in CPSP incidence (28.6% vs. 48.6%; P < 0.001). The LB group required fewer effective and total PCIA presses, as well as reduced supplemental analgesic doses during the first 48 postoperative hours (P < 0.01). Fewer complications, including subcutaneous emphysema and pneumonia, were observed in the LB group (P < 0.01). Additionally, inflammatory responses were attenuated, as indicated by decreased interleukin-1β levels within 48 h and lower C-reactive protein levels at 24 h (P < 0.05). No significant differences were observed between the groups in other secondary outcomes. Liposomal bupivacaine for TPVB significantly alleviated both acute and chronic postsurgical pain, reduced analgesic requirements, and did not increase pulmonary complications.

This study aimed to compare perioperative outcomes, lymphadenectomy quality, postoperative recovery, pulmonary function, and short-term oncologic results between robotic-assisted thoracoscopic surgery (RATS) and uniportal video-assisted thoracoscopic surgery (U-VATS) for early-stage non-small cell lung cancer (NSCLC). This retrospective cohort study included 231 consecutive patients with stage I-IIA NSCLC who underwent curative-intent anatomic lobectomy at our institution between January and December 2023. Based on the surgical approach, patients were assigned to either the RATS group (n = 105) or the U-VATS group (n = 126). All procedures were performed by the same experienced surgical team using standardized perioperative protocols. Clinical characteristics, intraoperative and postoperative parameters, pulmonary function, and 12-month oncologic outcomes were collected for comparative evaluation. RATS resulted in shorter operative time, reduced blood loss, and increased lymph node and mediastinal station retrieval compared with U-VATS. Postoperative pain, drainage volume, length of hospital stay, and complication rates were comparable between groups. Patients undergoing RATS demonstrated significantly higher global health and functional scores, along with lower symptom scores, during the first 6 months after surgery (p < 0.05). Pulmonary function recovery, 1-year disease-free survival (DFS), and overall survival (OS) did not differ significantly between the two approaches. However, hospitalization costs were higher for the RATS group (p < 0.001). Both RATS and U-VATS are safe and effective minimally invasive approaches for anatomic lobectomy in early-stage NSCLC. RATS offers advantages in operative precision, lymph node dissection, and short-term quality of life without compromising safety or early oncologic outcomes, although it is associated with increased cost.

This study aimed to provide Chinese data on Days Alive and Out of Hospital (DAOH) following video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy. The analyzed data was derived from a prospective cohort study. Consecutive patients who underwent either VATS lobectomy or segmentectomy from April 2021 to July 2022 were included. The primary outcome was DAOH within the first 90 days postoperatively (DAOH90). The secondary outcomes were identifying the predominant complications and reasons for readmission during the DAOH90. Additionally, we utilized multivariate logistic regression to identify factors independently associated with decreased DAOH90. A total of 919 primary lung cancer patients were included. The median DAOH90 was 86 days (IQR, 85–87). The predominant postoperative complications within postoperative 90 days (POD90) were pneumonia (22.5%), pleural pneumothorax (15.8%), incision dehiscence (13.8%) and pleural effusion (12.8%). The primary causes of readmission in POD90 included pleural effusion (10 cases), pneumonia (7 cases), and incision dehiscence (4 cases). Age (P < .001), operative time (P < .001), operative bleeding (P = .023) and multiportal VATS (compared with robot-assisted VATS) were independently associated with decreased DAOH90. In this study, the median DAOH90 following VATS lobectomy or segmentectomy was 86 days. Advanced age, longer surgical duration, more operative bleeding and multiportal VATS may be independent risk factors for “low DAOH90.”

This double-blinded randomized study aimed to investigate the effects of esketamine-based patient-controlled intravenous analgesia (PCIA) on postoperative analgesia and quality of recovery in patients undergoing video-assisted thoracoscopic (VATS) lobectomy. Patients undergoing selective VATS lobectomy were enrolled and randomly assigned (1:1) to receive PICA with 1.5 mg/kg esketamine (group K) or 1.5 mg/kg sufentanil (group S). Pain intensity was evaluated using the short-form of the McGill Pain Questionnaire (SF-MPQ) and the visual analog scale (VAS). The primary endpoint was the SF-MPQ score of patients on postoperative day 1. Between December 2021 and May 2022, 84 eligible patients received the allocated treatment, with 80 patients (40 per group) ultimately included in the analysis. The total SF-MPQ score in group K was lower than that in group S on postoperative day 1 (P < 0.001) and day 2 (P < 0.001). Additionally, the VAS-rest, VAS-movement and patients' depression-related scores in group K were all significantly lower than those in group S on postoperative day 1 (P = 0.012, P = 0.008 and P = 0.009, respectively) and day 2 (all P < 0.001), whereas the postoperative recovery quality was significantly higher in group K than that in group S on postoperative days 1 and 2 (both P < 0.001). A lower incidence of total adverse events (AEs) was observed in group K than in group S (15% vs. 35%, P = 0.039). The use of 1.5 mg/kg esketamine in PCIA for postoperative analgesia in patients undergoing VATS lobectomy showed a promising analgesic effect and improved perioperative depression and postoperative recovery quality, with no severe AEs observed.

Bilateral pulmonary sequestration (BPS) is an exceptionally rare congenital bronchopulmonary and vascular anomaly. Its complex anatomy and aberrant systemic arterial supply make diagnosis and treatment difficult, especially when severe fungal infection is present. A 28-year-old woman presented with a 1-year history of cough and hemoptysis and bilateral lower-lung masses. CT with 3D reconstruction showed bilateral intralobar pulmonary sequestration linked by an anomalous fistulous tract across the posterior mediastinum and supplied by multiple arteries from the descending aorta. Sputum culture and bronchoalveolar lavage next-generation sequencing confirmed Aspergillus infection. Because systemic antifungal therapy was ineffective, surgery was performed. Guided by 3D reconstruction, staged uniportal video-assisted thoracoscopic bilateral lower lobectomy was chosen to maximize safety and preserve function. The more severely infected left lower lobe was resected first, followed by pulmonary rehabilitation. Six months later, the right lower lobectomy and careful division of the communicating tract were completed successfully. Histopathology confirmed bilateral intralobar pulmonary sequestration and Aspergillus hyphae in the bronchial lumen. One year after surgery, lung expansion and cardiopulmonary function were well preserved, with no major postoperative complications and an excellent overall recovery. This case delineates the clinical presentation of an extremely rare bilateral ILS connected via a posterior mediastinal fistulous tract and complicated by aspergilloma. Staged uniportal VATS, augmented by preoperative 3D reconstruction and interval pulmonary rehabilitation, represents an optimal, safe, and effective strategy for managing such intricate congenital malformations while maximizing functional preservation.

ObjectiveLung cancer remains the leading cause of cancer-related mortality worldwide. Although minimally invasive surgery continues to advance, postoperative complications (such as pleural effusion and pulmonary air leaks) remain significant challenges, prolonging the duration of chest tube placement and increasing patient burden. This study aimed to systematically evaluate the safety and clinical efficacy of porcine fibrin sealant (PFS, a biological tissue adhesive), in VATS lobectomy for lung cancer.MethodsWe conducted a single-center, retrospective observational cohort study including 345 lung cancer patients who underwent VATS lobectomy plus systematic lymph node dissection between 2017 and 2023. The patients were divided into a control group (n = 142) and a PFS group (n = 203) receiving intraoperative PFS application. The primary endpoints were total postoperative chest drainage volume and the duration of chest tube placement. Secondary endpoints included the incidence of pulmonary air leaks, severely prolonged drainage (>5 days), and other complications. PSM and OW models were employed to adjust for the baseline.ResultsThe unadjusted and PSM cohorts demonstrated the statistical benefits of PFS across multiple aspects. After rigorous adjustment using OW, the difference in total drainage volume was attenuated (P = 0.089). Nevertheless, in the OW cohort, PFS still significantly shortened the duration of chest tube placement (P = 0.036) and effectively decreased the occurrence of PAL (0.0% vs. 5.0%, P = 0.019) and severely prolonged drainage (0.0% vs. 22.3%, P < 0.001). There were no significant differences in other complications, and no allergic reactions occurred, indicating its good biosafety.ConclusionThe results demonstrate that the intraoperative application of PFS during VATS lobectomy is safe and effective. It can significantly prevent postoperative pulmonary air leaks and reduce delayed chest tube removal.

The optimal volume for pleural lavage during lung cancer surgery remains controversial, despite its recognized importance in thoracic cavity decontamination, tumor cell clearance, and prevention of postoperative complications. This study assessed the impact of varying lavage volumes on perioperative outcomes in non-small cell lung cancer (NSCLC) patients, with the objective of establishing evidence-based procedural guidelines. Participants underwent lobectomy for NSCLC were randomly assigned to receive either 1,000 or 250 mL of pleural lavage before chest closure. The primary outcome was overall fever rates, and secondary outcomes included complication rates, drainage parameters, and length of hospital stay. A total of 415 patients were screened, and 406 were randomized to either the 1,000 mL (n=206) or 250 mL (n=200) groups. Postoperative fever (≥37.3 ℃) occurred in 23.08% of the 1,000 mL group and 17.01% of the 250 mL group (P=0.17). The fever rates at ≥38 ℃ were similar between groups (5.13% vs. 4.12%, P=0.82). A temporal difference in fever progression was observed, with the 1,000 mL group peaking 24 hours earlier on postoperative day 1 (POD1) evening, while the 250 mL group peaked on POD2 evening. Postoperative pneumonias were comparable (1.54% vs. 1.55%, P>0.99) between groups. Surgery duration, drainage volume, and cost were slightly more favorable in the 250 mL group, though not statistically significant. A volume of 250 mL pleural lavage demonstrated comparable efficacy to 1,000 mL in controlling postoperative fever and complications, while showing trends toward reduced resource utilization (shorter surgery duration, lower drainage volume and cost). The trial protocol was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1900021950) before patient enrollment.

PP01.11: Robotic-Assisted versus Video-Assisted Thoracoscopic Lobectomy for Early-Stage Lung Cancer: Preliminary Results of Single Center Prospective Study

Bronchial blockers (BBs) manage airways during thoracoscopic lobectomy and isolate lungs by occluding the bronchus at the surgical site. However, intraoperative malpositioning remains a concern. We compared the performance of a new double-cuff BB (DcBB) with an additional cuff near the end of a single-cuff BB (ScBB) with that of ScBBs during thoracoscopic lobectomy. This single-center, randomized, parallel, controlled clinical study enrolled 80 patients undergoing thoracoscopic lobectomy for lung cancer at Nanpi People's Hospital. The patients were randomized into two groups (n = 40 each); DcBB (DcBB used during one-lung ventilation) and ScBB (ScBB used during one-lung ventilation). The primary outcomes were the incidence and number of BB malpositioning. Secondary outcomes time for BB placement and positioning, surgical duration, hypoxemia, incidence of adverse cardiovascular events, grades of lung collapse, surgeon satisfaction, tracheal wall damage assessed during bronchoscopy, contamination rates of the non-surgical lung lobe on the surgical site determined by bronchoscopy, radiographic incidence of pulmonary infiltration on postoperative day 1, and intraoperative blood gas values. The incidence of malpositioning was significantly lower in the DcBB than the ScBB group (7.5% vs. 30%, P = 0.02). The incidence of malposition was significantly lower in the DcBB cohort (P = 0.002). However, positioning the DcBB required more time (32.28 ± 5.37 vs. 19.90 ± 4.16 sec, P < 0.001). Other secondary outcomes did not differ significantly. In patients undergoing thoracoscopic lobectomy, the DcBB was associated with a lower incidence of malposition than the ScBB. The DcBB did not increase tracheal wall injury or cause significant adverse hemodynamic effects, and therefore may serve as a promising optional device for airway management during thoracoscopic lobectomy, particularly in clinical scenarios requiring high placement stability. the Chinese Clinical Trial Registry ChiCTR2400086472.

To compare the clinical efficacy and safety of video-assisted thoracoscopic surgery (VATS) lobectomy and VATS wedge resection in elderly patients with early-stage non-small cell lung cancer (NSCLC). A retrospective analysis was conducted on the clinical data of 156 elderly patients with early-stage NSCLC who underwent surgical treatment at our hospital between January 2019 and December 2023. According to the surgical procedure, the patients were divided into a lobectomy group (n = 88) and a wedge resection group (n = 68). Perioperative outcomes, inflammatory markers, changes in pulmonary function, tumor marker levels, postoperative complications, quality of life, and survival outcomes were compared between the two groups. There were no statistically significant differences in baseline characteristics between the two groups (P > 0.05). Compared with the lobectomy group, the wedge resection group had less intraoperative blood loss, shorter postoperative drainage duration, lower drainage volume, and shorter hospital stay, and all these differences were statistically significant (P < 0.001), whereas operative time was comparable between the two groups (P > 0.05). Serum C-reactive protein (CRP) and procalcitonin (PCT) levels on postoperative days 1 and 3 were significantly increased in both groups compared with preoperative levels, but the increase was significantly smaller in the wedge resection group. At 3 months after surgery, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and maximal voluntary ventilation (MVV) were all decreased in both groups compared with preoperative values, but the decline was less pronounced in the wedge resection group (P < 0.001). Postoperative tumor marker levels, including carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1), were reduced in both groups compared with pretreatment levels, but no significant differences were found between the groups (P > 0.05). The overall incidence of postoperative complications was lower in the wedge resection group than in the lobectomy group (4.41% vs. 12.50%), although the difference was not statistically significant (P > 0.05). Survival analysis was exploratory only and limited by the small number of events and relatively short follow-up duration; therefore, no definitive conclusions can be drawn (P > 0.05). At 12 months after surgery, quality-of-life scores in physical functioning, role functioning, and emotional functioning were significantly higher in the wedge resection group than in the lobectomy group (P < 0.001). Multivariate logistic regression analysis showed that TNM stage was an independent risk factor for poor prognosis in elderly patients with early-stage NSCLC (OR = 6.087, P = 0.001), whereas age ≤ 70 years was independently associated with a better prognosis (OR = 0.135, P < 0.001). A nomogram prediction model was further established based on these variables, and the area under the receiver operating characteristic curve (AUC) was 0.810, indicating good predictive performance. Both VATS lobectomy and VATS wedge resection are safe and effective surgical options for elderly patients with early-stage NSCLC. Wedge resection shows certain advantages in reducing perioperative trauma, alleviating inflammatory response, preserving pulmonary function, and improving postoperative quality of life, whereas no statistically significant difference was observed between the two procedures in short-term oncological outcomes or survival prognosis. TNM stage and age were independent prognostic factors. The prediction model constructed based on these two variables may have good clinical value for individualized prognostic assessment in elderly patients with early-stage NSCLC.

Background Patients undergoing high-risk surgical procedures frequently experience postoperative pulmonary complications (PPCs) that impact outcomes. Acupuncture has demonstrated potential benefits during surgery. Press needle stimulation is increasingly recognized as an alternative to conventional techniques. We aimed to evaluate the effect of press needle stimulation on PPCs in patients with lung cancer undergoing video-assisted thoracoscopic surgery. Methods Eighty-seven patients undergoing video-assisted thoracoscopic surgery were randomized into press needle (n = 48) or sham needle (n = 39) groups. The press needle group underwent bilateral stimulation of acupoints LU9 (Taiyuan), RN17 (Danzhong), LU6 (Kongzui), and BL13 (Feishu) before anesthesia and during surgery. The sham group received a placebo stimulation. The primary endpoint was the incidence of PPCs within seven days post-surgery. The secondary endpoints included cytokine levels, intraoperative respiratory mechanics, postoperative pain score, analgesic consumption, and related complications. Results Press needle acupoint stimulation was associated with a significantly lower incidence of PPCs than the sham needle group. Perioperative data, tachycardia, cough, postoperative nausea, vomiting, and most inflammatory markers exhibited no significant differences, except for lower hypoxia-inducible factor-1α levels in the press needle group. Hemodynamic and blood gas analyses indicated no significant cardiovascular or respiratory differences between groups. The press needle group exhibited reduced patient-controlled analgesia (PCA) pump utilization and lower total PCA usage, indicating improved pain management. Conclusion This study indicates that press needle stimulation lowers PPC incidence and improves postoperative analgesia in patients with lung cancer undergoing video-assisted thoracoscopic lobectomy.

Rationale:Early lung cancer diagnosis is crucial for prognosis, but elderly patients with comorbidities poorly tolerate invasive procedures. Conventional percutaneous biopsy for major vessel-adjacent high-risk nodules has a mere 60% to 70% success rate and high complications, while artificial pneumothorax boosts it to 85% to 90%. This case verifies the technique’s safety in this population.Patient concerns:A 72-year-old female had a 7-mm left lung ground-glass nodule (2021, no intervention). Follow-up computed tomography (CT) (November 2024) showed the nodule enlarged to 10 × 10 mm with a new 18 × 17 mm irregular consolidation. Empirical anti-infection failed; the lesion was adjacent to the aortic arch and heart, so artificial pneumothorax-assisted CT-guided biopsy was adopted.Diagnoses:Video-assisted thoracoscopic surgery confirmed stage IA1 (tumor, node, metastasis stage T1aN0M0) lung adenocarcinoma (lepidic-predominant + invasive mucinous subtypes), with negative margins and no vascular, nerve, or pleural invasion.Interventions:CT-guided artificial pneumothorax-assisted percutaneous lung biopsy, followed by video-assisted thoracoscopic surgery left upper lobectomy plus lymph node dissection.Outcomes:Vital signs were stable; drainage tube removed on day 4 post-biopsy. One-month follow-up: no hemoptysis, chest pain, or pneumothorax; CT showed no intrapulmonary exudation.Lessons:The technique is safe for lesions adjacent to the heart and major vessels. However, large-sample studies and artificial intelligence–based nodule analysis are needed to further verify its efficacy.