Fissure‐last video‐assisted thoracoscopic lobectomy for ‘non‐upper’ lobes

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Air leak represents the most common complication in thoracic surgery, with a prevalence up to 58%.1 Prolonged air leak (PAL) is defined as an air leak that lasts longer than 5 or 7 days and according to that difference in definition among the authors, it has a reported prevalence of 8–26%.2 As a consequence, chest tube duration and length of hospital stay (LOS) is extended, and it adds to morbidity and overall costs of treatment.1
In order to either prevent or shorten air leak duration after anatomical lung resections, the surgical technique may be a modifiable factor. It has been shown that ‘fissureless fissure‐last’ anatomical lung resection technique in ‘open’ surgery, with hilar bronchovascular structures being divided first and the fissural parenchyma being divided at the last step of the procedure, may attribute to the reduction of air leak.6 Yet in video‐assisted thoracoscopic surgery (VATS), the data related to this technique are very limited.7 Data on safety and feasibility of fissureless fissure‐last resection of ‘non‐upper’ lobes are almost lacking, while the data for the upper lobes only, particularly right upper lobes, are good documented.9
The objective of this study was to evaluate the safety and feasibility of fissureless fissure‐last VATS resection of ‘non‐upper’ lobes and the impact of this technique on the immediate outcome especially relating to air leak.
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