Video-assisted thoracoscopy with two-lung ventilation and CO2 insufflation in primary spontaneous pneumothorax: propensity score matching comparison.

BACKGROUND

Primary spontaneous pneumothorax (PSP) is commonly treated with video-assisted thoracoscopic surgery (VATS), which traditionally requires one-lung ventilation (OLV) with double-lumen endotracheal intubation to optimize the surgical field. However, OLV may be associated with complications such as airway trauma and postoperative sore throat. In contrast, two-lung ventilation (TLV) with CO2 insufflation has been proposed as an alternative that may reduce airway-related complications while maintaining adequate visualization. This study assessed the feasibility of VATS with TLV and CO2 insufflation for PSP compared to the conventional OLV approach.

METHODS

We retrospectively analyzed 181 patients with PSP treated at our center between July 2020 and December 2023; of these, 134 underwent thoracoscopic bullectomy. Fifty-six patients received VATS with TLV and CO2 insufflation. Seventy-eight patients underwent OLV via double-lumen endotracheal intubation. Patient data were categorized into groups based on the minimization of bias between those receiving TLV and those receiving OLV, following analysis matched by propensity scores. A comparative analysis across these groups was also conducted, focusing on demographic data and intraoperative and postoperative outcomes.

RESULTS

The TLV group demonstrated several advantages, including shorter anesthesia induction time (13.45±5.25 min, P=0.01), shorter total anesthesia time (63.18±14.45 min, P=0.003), fewer days of chest tube drainage (1.41±1.22 days, P=0.04), shorter postoperative hospital stay (2.36±0.88 days, P=0.01), lower wedge resection specimen weight (3.21±2.5 g, P=0.03), fewer instances of postoperative ipsilateral and contralateral recurrence, and lower likelihood of short-term recurrence. No significant differences were found in surgical time (P=0.17), anesthesia recovery time (P=0.48), use of endostaplers (P=0.35), number of wedge resections (P=0.21), and pleurodesis (P=0.73).

CONCLUSIONS

In appropriately selected patients, TLV appears to be a viable option that does not increase recurrence risk compared to OLV while offering the benefit of a shorter anesthesia duration. Therefore, this method may be suitable for patients with PSP.