Negative-pressure assistance for intraoperative cone-beam computed tomography localization in lung tumor resection: comparative study.

PURPOSE: To evaluate the effectiveness of wound negative-pressure-assisted (NPA) localization in facilitating pulmonary expansion during intraoperative cone-beam computed tomography (CBCT) localization for thoracoscopic resection of small pulmonary nodules.

METHODS

A retrospective comparative study included 55 consecutive patients who underwent wedge resection for small lung tumors using uniportal video-assisted thoracoscopic surgery (VATS) with CBCT localization between June 2022 and December 2024. Patients were grouped by localization technique: Group 1 received NPA and Group 2 did not. Primary outcomes were CBCT localization workflow time and CBCT-defined incomplete lung expansion/residual pleural air (CTILA) occurrence. Univariate comparisons used Welch's t-test for continuous variables and chi-square tests for categorical variables. Multivariable logistic regression assessed factors associated with CTILA, and multivariable linear regression analyzed CBCT localization workflow time.

RESULTS

Baseline demographic and clinical characteristics were similar between groups. CBCT localization workflow time was significantly shorter in Group 1 than in Group 2 (17.31 ± 7.13 vs. 25.69 ± 9.57 min; mean difference - 8.38 min; 95% CI - 13.00 to - 3.76; p = 0.0007; Hedges' g = - 0.987). CTILA occurred less frequently in Group 1 (3/29, 10.3%) than in Group 2 (13/26, 50.0%) (risk difference - 39.7%, 95% CI - 61.8% to - 17.5%; Fisher's exact p = 0.0023; odds ratio 8.67). In a multivariable model adjusted for airway management type, smoking exposure, and nodule depth, the non-NPA group remained associated with a higher likelihood of CBCT-defined incomplete lung expansion/residual pleural air (adjusted OR 7.56, 95% CI 1.03-55.61; p = 0.047).

CONCLUSION

NPA localization was associated with shorter CBCT localization workflow time and a lower rate of CTILA during intraoperative CBCT localization for thoracoscopic resection of small pulmonary nodules.