OBJECTIVES: Our aim was to investigate the incidence and risk factors for prolonged air leak (PAL) in patients undergoing minimally invasive single-port pulmonary segmentectomy. METHODS: A retrospective analysis of all patients undergoing uniportal segmentectomy in our department from March 2015 to September 2023 was performed. Univariable, multivariable logistic regression analyses and machine learning were used to investigate risk factors for PAL (>5 days). RESULTS: In total, 575 segmentectomies were performed using uniportal video-assisted thoracoscopic surgery. In total, 333 patients (57.9%) were men, and the mean age was 64.8 years. PAL occurred in 88 patients (15.3%). Length of stay and duration of chest drainage were 8.6 (SD: 4.86) and 10.6 (SD: 8.12) days in the subgroup with PAL, compared to 3.6 (SD: 2.25) and 2.0 (SD: 1.3) days in the subgroup without air leak (P < 0.0001). Multivariable analysis revealed that upper lobe location, lower body mass index (BMI), an additional wedge resection on another segment and hypertension were associated with increased risk of PAL. Machine learning was used to develop models that predicted the occurrence of PAL with an accuracy of 70%. The first model detected the following parameters as significant: resection of segment 2, diabetes, inhalers, and squamous cell carcinoma. The second model recognized diffusing capacity of the lungs for carbon monoxide (DLCO%), pack-years, forced expiratory volume in one second (FEV1%) and surgery time, respectively. CONCLUSIONS: Low BMI, DLCO% or FEV1% values, increased pack-years, inhalers, diabetes, hypertension, histology of primary lung cancer, longer surgery time, an additional wedge resection, segment 2 removal and upper lobe surgery were identified as risk factors for PAL.

OBJECTIVES: Evaluation of smoke capture efficiency of different mobile smoke evacuation devices with respect to volatile organic compounds and their noise emission. METHODS: Electrosurgical incisions were performed on fresh porcine liver in an operating room with vertical laminar flow. The generated surgical smoke was analysed with proton-transfer-reaction mass spectrometry with and without the use of a mobile smoke evacuation system consisting of a smoke evacuator machine, a suction hose and a handpiece. The inlet of the mass spectrometer was positioned 40 cm above the specimen. Various devices were compared: a hard plastic funnel, a flexible foam funnel, an on-tip integrated aspirator of an electrosurgical knife and a standard secretion suction (Yankauer). Also, sound levels were measured at a distance of 40 cm from the handpieces’ inlet. RESULTS: The smoke capture efficiency of the secretion suction was only 53%, while foam funnel, plastic funnel and integrated aspirator were all significantly more effective with a clearance of 95%, 91% and 91%, respectively. The mean sound levels were 68 and 59 A-weighted decibels with the plastic and foam funnel, respectively, 66 A-weighted decibels with the integrated aspirator and 63 A-weighted decibels with the secretion suction. CONCLUSIONS: Carcinogenic, mutagenic and reprotoxic volatile organic compounds in surgical smoke can be efficiently reduced by mobile smoke evacuation system, providing improved protection for medical personnel. Devices specifically designed for smoke evacuation are more efficient than standard suction tools. Noise exposure for the surgeon was lowest with the flexible foam funnel and higher with the other handpieces tested.

Background/Objectives: This study aimed to investigate pneumothorax risk, focusing on the gravitational effect of pleural pressure caused by specific patient positioning. Methods: We retrospectively analyzed 144 percutaneous CT-guided lung biopsies performed between January 2019 and December 2023. Patients were grouped into those with or without pneumothorax. Variations in patient positioning (prone, supine, lateral, lesion in decubitus biopsy-side-down [LD BSD] and the dependent area [L DA M], and access route beginning in the dependent area [AR LD M]) were compared using the chi-square, Fisher’s exact, and Mann–Whitney U tests. Performance metrics were evaluated. Univariate and binomial logistic regression models assessed the influence of these factors and other patient-related and interventional parameters on pneumothorax occurrence. Results: Three positional variants (AR DA M, L DA M, and L LD BSD; p < 0.001), general emphysema (p = 0.009), emphysema in the access route (p = 0.025), greater needle size (18G vs. 20G; p < 0.001), and the use of a side-cut instead of a full-core system (p = 0.002) were significantly linked to lower peri-interventional pneumothorax incidence. Even after adjusting for various factors, AR DA M and general emphysema remained independently associated with a reduced pneumothorax risk (OR 0.168, p < 0.001; OR 2.72, p = 0.034). Assessing the dependent zones showed superior performance regardless of the patient’s position, with the best performance demonstrated for AR DA M (AUC 0.705; sensitivity 60%, specificity 81.8%). Conclusions: Focusing on the dependent zones of each lung and adjusting the access route accordingly can significantly reduce the risk of pneumothorax compared to conventional positioning techniques.

Purpose: Pulmonary sequestration is a rare pulmonary malformation that often necessitates surgical intervention due to potential complications such as recurrent infections or hemoptysis. This case series presents the clinical trajectory of four patients diagnosed with pulmonary sequestration, from initial diagnosis through postoperative care, with a specific focus on the limited arterial supply in two of the cases. Materials and Methods: We conducted a retrospective descriptive analysis of four patients diagnosed with pulmonary sequestration who underwent surgical treatment at our institution between January 2013 and November 2022. The affected lung segments were excised via either thoracoscopy or thoracotomy. We evaluated perioperative and postoperative complications, hospital stay duration, histological findings, and the vascular supply of the affected areas. Results: Thoracoscopic surgery was initially preferred for all patients, though one required conversion to an open procedure due to technical challenges. Perioperative complications included increased pain and atelectasis. Two patients developed pleural empyema postoperatively, necessitating additional surgical intervention. The overall outcomes were favorable, with appropriate management addressing the complications effectively. Conclusions: Pulmonary sequestration, despite its rarity, often requires surgical treatment. Both thoracoscopic and open surgical methods are effective, though thoracoscopic surgery is generally preferred when feasible. The findings underscore the importance of meticulous preoperative planning and vigilant postoperative care to manage and mitigate potential complications.

Background and Objectives: Lobectomy has traditionally been the gold standard for surgical treatment of early-stage non-small cell lung cancer (NSCLC). However, recent randomized trials suggest anatomical segmentectomy may offer comparable outcomes for selected patients with small, peripheral tumors. The role of segmentectomy in stage IA3 tumors remains less apparent in the context of video-assisted thoracoscopic surgery. Methods: This retrospective study analyzed 232 patients with pathological stage IA NSCLC who underwent uniportal anatomical segmentectomy (n = 160) or lobectomy (n = 72). Clinicopathological characteristics, recurrence rates, and overall survival (OS) were compared, with subgroup analysis for IA1–IA3 tumors. Results: The 5-year OS was 76.9% for segmentectomy and 87.5% for lobectomy (p = 0.105). Recurrence occurred in 15.8% of segmentectomy patients and 11.3% of lobectomy patients. In IA3 tumors, recurrence rates were higher after segmentectomy (23.5% vs. 18.2%), though not statistically significant. Lymphatic invasion was an independent predictor of mortality. No significant differences were found in tumor size, histologic subtype, or nodal involvement between groups. Conclusions: Uniportal anatomical segmentectomy may be a feasible alternative to lobectomy for stage IA NSCLC, especially for tumors ≤ 2 cm. For IA3 tumors, caution is advised given a trend toward worse outcomes. Careful patient selection and adherence to oncologic principles are essential.