Does Fissureless Videothoracoscopic Lobectomy Help for Postoperative Air Leak?

ABSTRACT

BACKGROUND: Postoperative air leak is a common problem in patients undergoing pulmonary resections. A conventional fissure dissection technique during videothoracoscopic lobectomy, particularly in patients with fused fissures is very likely to result in parenchymal damage and prolonged air leak (PAL). In contrast, fissureless video-assisted thoracoscopic surgery (VATS) lobectomy may have advantages regarding PAL and hospital stay. METHODS: We conducted a retrospective study consisting of 103 consecutive patients who underwent a VATS lobectomy either with a conventional or fissureless technique and statistically analyzed the results particularly with respect to PAL, chest tube duration (CTD), and length of hospital stay (LOS). RESULTS: We had 21 (20.4%) cases with PAL. Gender (p = 0.009), histological size of tumor (p = 0.003), and surgical technique (p = 0.009) showed statistically significant differences for PAL in contingency tables. Significant predictors for PAL in univariate analysis were male sex (p = 0.017), histological size of tumor more than 24 mm (p = 0.005), and conventional technique (p = 0.017). Similarly, multivariate analysis revealed male sex (p = 0.036), histological size of tumor more than 24 mm (p = 0.043), and conventional technique (p = 0.029) as significant predictors for PAL. In addition, both the medians of CTD (p = 0.015) and LOS (p = 0.005) were comparably lesser as 3 days, in patients who underwent fissureless videothoracoscopic lobectomy. CONCLUSION: The fissureless technique helps for PAL in patients undergoing videothoracoscopic lobectomy.