Background: Total tubeless (TT) single-port thoracoscopic wedge resection is a novel minimally invasive surgical technique for treating peripheral pulmonary nodules. This study aims to evaluate its safety, efficacy, and patient satisfaction in comparison with partial tubeless (PT) surgery.
Methods: This retrospective study analyzed data from 89 patients with peripheral pulmonary nodules, who underwent tubeless single-port thoracoscopic wedge resection at the Department of Thoracic Surgery I, Fujian Medical University Union Hospital between July 2023 and September 2024. Patients were divided into two groups based on the presence or absence of a chest puncture drainage tube: the TT group and the PT group.
Results: The TT group consisted of 49 patients with a mean age of 44.16±11.03 years, while the PT group comprised 40 patients with a mean age of 51.33±13.66 years. After 1:1 propensity score matching (PSM), 68 patients were analyzed. No significant difference in intraoperative blood loss was observed (10.00±2.13 vs. 11.47±4.85 mL, P>0.05), but the TT group had shorter operative time (65.65±16.38 vs. 79.65±24.78 minutes, P<0.05). The TT group exhibited a higher degree of pneumothorax on day 1 (15.00%±9.53% vs. 10.15%±10.26%, P<0.05), but no significant differences in body temperature, inflammatory markers, or pleural effusion were found (P>0.05). Cough and pain incidence on days 1, 7, and 30 were similar between the groups (P>0.05), with high patient satisfaction (P>0.05).
Conclusions: TT single-port thoracoscopic wedge resection is a safe and effective approach for treating peripheral pulmonary nodules.
Keywords: Tubeless; uniportal; video-assisted thoracoscopic surgery (VATS); wedge resection; peripheral pulmonary nodules
Highlight box
Key findings
• This study demonstrates that total tubeless (TT) single-port thoracoscopic wedge resection is a safe and effective minimally invasive surgical technique for treating peripheral pulmonary nodules.
• Compared with the partial tubeless (PT) group, the TT group had a significantly shorter operative time, with no significant difference in intraoperative blood loss.
• Although the degree of pneumothorax on day 1 was higher in the TT group (15.00%±9.53% vs. 10.15%±10.26%, P<0.05), it did not require any clinical intervention. Additionally, there were no significant differences between the groups in terms of postoperative cough, pain incidence, or patient satisfaction, further validating the safety, feasibility, and high satisfaction of the TT approach.
What is known and what is new?
• Video-assisted thoracoscopic surgery is widely used in thoracic surgery, and various techniques have been proposed to reduce the invasiveness of the procedure. PT thoracoscopic surgery has been shown to have good clinical outcomes.
• This study introduces TT single-port thoracoscopic wedge resection and compares it with PT surgery. The results indicate that the TT method not only shortens the operative time but also has minimal overall impact on the patient, ensuring safety and efficacy. Although the degree of pneumothorax was higher, it did not require clinical intervention.
What is the implication, and what should change now?
• The results support the use of TT single-port thoracoscopic wedge resection as a safe and effective alternative for treating peripheral pulmonary nodules.
• Further research should focus on evaluating the long-term effects of this method in larger sample sizes and across different patient populations to confirm its broader clinical applicability.
Cite this article as: Lin C, Yang Z, Chen H, Chen S, Tong R, Yin Z, Li K, Chen K, Xu C, Zheng B, Chen C, Zheng W, Xu G. Efficacy and outcomes of total tubeless single-port thoracoscopic wedge resection for peripheral pulmonary nodules. J Thorac Dis 2025;17(10):8123-8133. doi: 10.21037/jtd-2025-361
