A dense fissure is not a contra-indication for uniportal thoracoscopic lobectomy

Background: A dense fissure is a main cause of a postoperative prolonged air leak (PAL). Such a fissure, if exposed, sometimes incidentally injures the pulmonary artery. We investigated whether uniportal thoracoscopic lobectomy which is considered technically more difficult than the conventional multiportal approach was appropriate for patients with dense fissures.

Methods: From February 2019 to January 2022, 140 patients with primary lung cancer underwent uniportal thoracoscopic lobectomy with ≥ ND2a-1 lymphadenectomy. Patients were divided into those with dense (n=22) and separated (n=118) fissures. All dense fissures were treated using a fissureless technique without exposure of the pulmonary artery. We compared the characteristics and perioperative results of the two groups. We used multivariate analysis to identify factors predictive of PAL.

Results: Although dense fissures were significantly associated with right upper lobectomies, the other patient characteristics and perioperative results were similar between the two groups. No significant pulmonary artery injuries occurred in the fissureless group. In subgroup analyses of right upper lobectomy patients, we found no other significant between-group differences in patient characteristics or perioperative results. In multivariate analyses, right upper lobectomy [odds ratio (OR): 0.047, 95% confidence interval (CI): 0.0044-0.49, P=0.011] or smoking index (OR: 1.03, 95% CI: 1-1.07, P=0.048) was the factor predictive of PAL.

Conclusions: A dense fissure is not a contraindication for uniportal thoracoscopic lobectomy using the fissureless technique, which is thus safe.