Video-Assisted Thoracoscopic Day Surgery for Patients with Pulmonary Nodules: A Single-Center Clinical Experience of 200 Cases

Figures & data

Figure 1 (A–C) The 18F silicone Foley catheter was inserted into the thoracic cavity and filled with 15 mL sterile water to be fixed on the Parietal pleura, no need for suture to fix.

Figure 2 (A–C) TINB were administered by infiltration of local anesthetic mixture (15 mL for each intercostal space) from the third to the ninth intercostal nerve under the parietal pleura, 2 cm lateral to the sympathetic chain, using an infusion needle.

Table 1 Preoperative, Operative, and Postoperative Characteristics of Patients Included in the Study

Total of Patients	200
Gender, n (%)
Male	45 (22.50%)
Female	155 (77.50%)
Age (years)
Median (range)	43 (18~58)
Comorbidities, n (%)
Hypertension	4 (2.00%)
Surgical history	4 (2.00%)
Type 2 diabetes	2 (1.00%)
Surgical location, n (%)
Right	87 (43.50%)
Left	113 (56.50%)
Surgical approaches, n (%)
Lobectomy	73 (36.50%)
Segmentectomy	118 (59.00%)
Wedge excision	9 (4.50%)
Operative time (minutes)
Mean ± SD	72.47±21.59
Intraoperative blood loss(mL)
Mean ± SD	42.43±1.43
Pathology, n (%)
Adenocarcinoma	158 (79.00%)
Benign	42 (21.00%)
Postoperative complications, n (%)
PAL	9 (4.50%)
Pneumothorax	4 (2.00%)
Bleeding	4 (2.00%)
Pleural effusion	2 (1.00%)
Hoarseness	2 (1.00%)
Chylothorax	1 (0.50%)
Pulmonary infection	1 (0.50%)
Outcome, n (%)
Planned discharge	187(93.50%)
Transfer to in-hospital	13 (6.50%)
Mean LOS (day)
Mean ± SD	1.25±0.95
VAS
Median (range)	3 (1~7)

Abbreviations: SD, standard deviation; PAL, persistent air leakage; LOS, length of stay; VAS, visual analogue score.

Table 2 Comparison of PPCs Among Different Surgical Approaches

	LG (n=73)	SG (n=118)	WEG (n=9)	P value
PAL	4	4	1	0.360
Pneumothorax	2	2	0	0.819
Pleural effusion	1	1	0	0.906
Hoarseness	1	1	0	0.906
Bleeding	1	2	1	0.793
Chylothorax	1	0	0	0.423
Pulmonary infection	0	1	0	0.711
Total	10	12	1	0.742

Abbreviations: PPCs, postoperative complications; PAL, persistent air leakage; LG, lobectomy group; SG, segmentectomy group; WEG, wedge excision group.

Table 3 Treatment-Related Costs and Resource Consumption Among Different Surgical Approaches

	LG(n=73)	SG(n=118)	WEG(n=9)	P value
Length of operation (min)
Mean ± SD	74.99±18.76	70.87±22.61	74.14±30.66	0.915
Blood loss(mL)
Mean ± SD	32.14±8.92	38.62±10.34	33.13±3.74	0.759
LOS (day)
Mean ± SD	1.27±1.06	1.24±0.89	1.29±0.76	0.231
Hospital cost (USD)
Mean ± SD	5639.17±832.22	5264.96±842.50	5414.41±899.59	0.782

Abbreviations: SD, standard deviation; LOS, length of stay; USD, united states dollar; LG, lobectomy group; SG, segmentectomy group; WEG, wedge excision group.

Table 4 Comparison of PPCs Between Different Pathological Diagnoses

	Benign (n=42)	Malignant (n=158)	P value
PAL	3	6	0.353
Pneumothorax	0	4	0.298
Pleural effusion	1	1	0.312
Hoarseness	0	2	0.464
Bleeding	1	3	0.843
Chylothorax	0	1	0.605
Pulmonary infection	0	1	0.605
Total	5	18	0.833

Abbreviations: PPCs, postoperative complications; PAL, persistent air leakage.

Table 5 Information of Failure Cases

	Age	Sex	BMI	Reason	Operation Approach	Surgical Site	Histology	Intraoperative Situation	Treatment	LOS
Patient 1	41	Female	23.18	PAL	Lobectomy	RUL	Adenocarcinoma	Undeveloped fissure	Chest drainage	4
Patient 2	39	Female	17.82	PAL	Lobectomy	RLL	Adenocarcinoma	Undeveloped fissure	Chest drainage	4
Patient 3	31	Female	21.51	PAL	Segmentectomy	LUL S^1+2	Adenocarcinoma	Extensive pleural adhesion	Chest drainage	4
Patient 4	56	Female	24.46	PAL	Segmentectomy	RLL S^6	Adenocarcinoma		Chest drainage	6
Patient 5	42	Female	24.75	PAL	Segmentectomy	RUL S^1+2	Adenocarcinoma		Chest drainage	5
Patient 6	47	Male	23.45	PAL	Segmentectomy	LUL S^1+2	Adenocarcinoma		Chest drainage	4
Patient 7	32	Female	22.68	PAL	Segmentectomy	RUL S^2 & RLL S^6	Adenocarcinoma		Chest drainage	6
Patient 8	28	Female	21.63	PAL	Wedge excision	LUL	Granuloma	Extensive pleural adhesion	Chest drainage	5
Patient 9	33	Male	24.34	PAL	Lobectomy	RUL	Fibrous hyperplasia	Undeveloped fissure	Chest drainage	2
Patient 10	35	Female	25.85	Bleeding	Segmentectomy	LUL S^3	Adenocarcinoma	Pulmonary artery broken	Thoracotomy	5
Patient 11	44	Male	18.52	Bleeding	Segmentectomy	RLL S^6	Adenocarcinoma		Re-operation	5
Patient 12	51	Female	26.84	Bleeding	Lobectomy	LUL	Adenocarcinoma		Hemostatic	3
Patient 13	50	Male	27.53	Bleeding	Segmentectomy	RLL S^7	Adenocarcinoma		Hemostatic	4

Abbreviations: BMI, body mass index; PAL, persistent air leakage; RUL, right upper lobe; RLL, right lower lobe; LUL, left upper lobe; S¹⁺², apico-posterior segment; S², posterior segment; S³, anterior segment; S⁶, dorsal segment; S⁷, anterior basal segment.

Figure 3 Study flow of VATDS.