Efficacy of day surgery for pulmonary nodules in a full-process minimally invasive model based on non-invasive localization technology: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHAO Guangqiang ,  PANG Dazhi , ZHANG Jitian , YAN Jinjin , LIU Zhihai , LIU Rutaiyang , LI Zhenda

Department of Thoracic Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518000, Guangdong, P. R. China;

Corresponding author：

PANG Dazhi, Email: pangdz@hku-szh.org

Keywords：

Pulmonary nodule; day surgery; wedge resection; non-invasive localization; tubeless surgery

DOI：

10.7507/1007-4848.202501022

Video：

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Objective To investigate the feasibility and effectiveness of a comprehensive minimally invasive approach for pulmonary nodule day surgery, utilizing non-invasive localization techniques. Methods A retrospective analysis was conducted on the clinical data of patients diagnosed with peripheral pulmonary nodules and undergoing video-assisted thoracoscopic wedge resection at the Department of Thoracic Surgery, the University of Hong Kong-Shenzhen Hospital, from January 2020 to May 2024. Patients were divided into a conventional surgery group and a day surgery group based on different treatment approaches. The perioperative data between the two patient groups were compared. Results A total of 40 patients were included, comprising 19 males and 21 females, with an average age of (47.4±12.5) years. The day surgery group consisted of 20 patients, and the conventional surgery group consisted of 20 patients. There were no statistically significant differences in baseline demographic characteristics between the two groups (P>0.05). All patients successfully completed the surgery without any deaths or serious complications. The two groups showed statistically significant differences (P<0.05) in key indicators such as pulmonary nodule localization time, incidence of localization-related complications, operative time, blood loss, duration of postoperative chest tube placement, total length of hospital stay, and patient satisfaction on the day of discharge. Conclusion Pulmonary nodule day surgery based on a comprehensive minimally invasive approach with non-invasive localization techniques can maximize the reduction of hospital stay and operative time, reduce surgery-related complications, and improve patient satisfaction and recovery speed while ensuring safety and effectiveness. The implementation of this model not only meets the needs of patients but also optimizes the allocation of medical resources, demonstrating significant clinical application value and broad potential for promotion.

1.	杨丽, 钱桂生. 肺结节临床精准诊断的新理念. 中华肺部疾病杂志(电子版), 2022, 15(1): 1-5.Yang L, Qian GS. New concepts in clinical precision diagnosis of pulmonary nodules. Chin J Pulm Dis (Electron Version), 2022, 15(1): 1-5.
2.	中华医学会呼吸病学分会, 中国肺癌防治联盟专家组. 肺结节诊治中国专家共识 (2024年版). 中华结核和呼吸杂志, 2024, 47(8): 716-729.Chinese Thoracic Society, China Alliance for Lung Cancer Prevention and Treatment Expert Group. Chinese expert consensus on diagnosis and treatment of pulmonary nodules (2024 edition). Chin J Tuberc Respir Dis, 2024, 47(8): 716-729.
3.	潘峒林, 李亚文, 李翔宇, 等. 肺结节恶变危险因素的系统评价与meta分析. 河南医学研究, 2021, 30(23): 4244-4248.Pan DL, Li YW, Li XY, et al. Systematic review and meta-analysis of risk factors for malignant transformation of pulmonary nodules. Henan Med Res, 2021, 30(23): 4244-4248.
4.	崔舒蕾, 王建卫. 肺磨玻璃结节干预策略. 中华肿瘤防治杂志, 2024, 31(4): 233-240.Cui SL, Wang JW. Intervention strategies for ground-glass nodules. Chin J Cancer Prev Treat, 2024, 31(4): 233-240.
5.	罗于杰, 朱冰. 胸腔镜下肺楔形切除术在早期肺癌的应用. 现代医药卫生, 2021, 37(4): 602-606.Luo YJ, Zhu B. Application of thoracoscopic wedge resection in early-stage lung cancer. Mod Med Health, 2021, 37(4): 602-606.
6.	张彭衍. 胸腔镜下肺楔形切除和肺段切除对于治疗早期外周肺腺癌的疗效比较. 大连医科大学, 2022.Zhang PY. Comparison of efficacy between thoracoscopic wedge resection and segmentectomy in the treatment of early-stage peripheral lung adenocarcinoma. Dalian Medical University, 2022.
7.	Shi Y, Wu S, Ma S, et al. Comparison between wedge resection and lobectomy/segmentectomy for early-stage non-small cell lung cancer: A Bayesian meta-analysis and systematic review. Ann Surg Oncol, 2022, 29(3): 1868-1879.
8.	Xiu J, Wang S, Wang X, et al. Effectiveness and safety of segmentectomy vs. wedge resection for the treatment of patients with operable non-small cell lung cancer: A meta-analysis and systematic review. Oncol Lett, 2024, 28(1): 336.
9.	Al-Thani S, Nasar A, Villena-Vargas J, et al. Wedge resection, segmentectomy, and lobectomy: Oncologic outcomes based on extent of surgical resection for ≤2 cm stage ⅠA non-small cell lung cancer. J Thorac Dis, 2024, 16(3): 1875-1884.
10.	Tang Z, Ge W, Zhou D, et al. Impact of the size and depth of pulmonary nodules on the surgical approach for lung resection in the treatment of early-stage lung cancer ≤2 cm. Zhongguo Fei Ai Za Zhi, 2024, 27(3): 170-178.
11.	黄明君, 梁鹏, 王煜, 等. 基于加速康复外科理念的日间四级手术围手术期管理的华西经验. 华西医学, 2024, 39(2): 295-299.Huang MJ, Liang P, Wang Y, et al. West China experience in perioperative management of day-care level Ⅳ surgery based on enhanced recovery after surgery (ERAS). West China Med J, 2024, 39(2): 295-299.
12.	史校铭, 焦子宸, 张子睿, 等. 集中管理日间手术模式下胸腔镜手术与普通住院手术模式治疗肺结节的疗效及安全性比较. 川北医学院学报, 2023, 38(6): 806-809.Shi XM, Jiao ZC, Zhang ZR, et al. Comparison of efficacy and safety between centralized day-care and conventional inpatient thoracoscopic surgery for pulmonary nodules. J North Sichuan Med Coll, 2023, 38(6): 806-809.
13.	蒋丽莎, 詹丽莉, 沈诚, 等. 日间手术模式下胸腔镜手术治疗肺结节的安全性分析. 华西医学, 2020, 35(2): 152-155.Jiang LS, Zhan LL, Shen C, et al. Safety analysis of thoracoscopic surgery for pulmonary nodules under day-care mode. West China Med J, 2020, 35(2): 152-155.
14.	刘小娟, 朱吉, 李春光, 等. 免气管插管麻醉技术在肺磨玻璃结节楔形切除术中的应用效果研究. 海军医学杂志, 2021, 42(6): 722-726.Liu XJ, Zhu J, Li CG, et al. Application of non-intubated anesthesia in wedge resection of ground-glass nodules. J Navy Med, 2021, 42(6): 722-726.
15.	洪甲庚, 林绍立, 蔡东妙, 等. 单孔胸腔镜下保留自主呼吸喉罩麻醉在肺结节楔形切除术中的应用. 中外医疗, 2024, 43(11): 24-27.Hong JG, Lin SL, Cai DM, et al. Application of laryngeal mask anesthesia with spontaneous breathing in uniportal thoracoscopic wedge resection for pulmonary nodules. Chin Foreign Med J, 2024, 43(11): 24-27.
16.	Szabo Z, Fabo C, Oszlanyi A, et al. Anesthetic ®evolution from the conventional concept to the minimally invasive techniques in thoracic surgery-narrative review. J Thorac Dis, 2022, 14(8): 3045-3060.
17.	Kim HJ, Kim M, Park B, et al. Feasibility of ventilator-assisted tubeless anesthesia for video-assisted thoracoscopic surgery. Medicine (Baltimore), 2023, 102(28): e34220.
18.	奚雷, 方申存, 曹珲. 单孔无管化技术在早期恶性肺结节微创手术中的应用价值. 临床肺科杂志, 2023, 28(12): 1846-1851.Xi L, Fang SC, Cao H. Value of tubeless uniportal technique in minimally invasive surgery for early malignant pulmonary nodules. J Clin Pulm Med, 2023, 28(12): 1846-1851.
19.	Liu CY, Hsu PK, Leong KI, et al. Is tubeless uniportal video-assisted thoracic surgery for pulmonary wedge resection a safe procedure? Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i70-i76.
20.	李树本, 刘君, 陈汉章, 等. 自主呼吸麻醉单孔非置管胸腔镜技术诊治肺小结节的24小时解决方案. 中华外科杂志, 2015, 53(10): 778-780.Li SB, Liu J, Chen HZ, et al. A 24-hour solution for diagnosis and treatment of small pulmonary nodules using tubeless uniportal thoracoscopy under spontaneous breathing anesthesia. Chin J Surg, 2015, 53(10): 778-780.
21.	陈光耀. CT引导下肺结节术前穿刺定位及穿刺活检并发症及风险因素探讨. 影像研究与医学应用, 2023, 7(3): 194-196.Chen GY. Complications and risk factors of CT-guided preoperative needle localization and biopsy for pulmonary nodules. Imaging Res Med Appl, 2023, 7(3): 194-196.
22.	古琳, 丁锋, 陈开林, 等. 肺外周结节HOOKWIRE 穿刺定位后脱落原因分析及应用体会. 临床外科杂志, 2024, 32(1): 58-61.Gu L, Ding F, Chen KL, et al. Analysis of hookwire dislodgement after localization of peripheral pulmonary nodules and clinical experience. J Clin Surg 2024, 32(1): 58-61.
23.	仇度旺. 肺结节穿刺活检中血凝酶针道封堵预防并发症的价值研究. 山东大学, 2023.Qiu DW. Value of hemocoagulase needle tract sealing in preventing complications of lung nodule biopsy. Shandong University, 2023.
24.	耿耿, 芮玉峰, 李长青, 等. 肺组织切除前Hook-wire定位穿刺并发症的危险因素分析. 局解手术学杂志, 2022, 31(10): 890-894.Geng G, Rui YF, Li CQ, et al. Risk factors for complications of hook-wire localization before lung resection. J Reg Anat Oper Surg, 2022, 31(10): 890-894.
25.	Pang D, Shao G, Zhang J, et al. 3D localization based on anatomical LANDmarks in the treatment of pulmonary nodules. J Thorac Dis, 2022, 14(9): 3133-3144.
26.	Park CH, Han K, Hur J, et al. Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules: A systematic review and meta-analysis. Chest, 2017, 151(2): 316-328.

1. 杨丽, 钱桂生. 肺结节临床精准诊断的新理念. 中华肺部疾病杂志(电子版), 2022, 15(1): 1-5.Yang L, Qian GS. New concepts in clinical precision diagnosis of pulmonary nodules. Chin J Pulm Dis (Electron Version), 2022, 15(1): 1-5.
2. 中华医学会呼吸病学分会, 中国肺癌防治联盟专家组. 肺结节诊治中国专家共识 (2024年版). 中华结核和呼吸杂志, 2024, 47(8): 716-729.Chinese Thoracic Society, China Alliance for Lung Cancer Prevention and Treatment Expert Group. Chinese expert consensus on diagnosis and treatment of pulmonary nodules (2024 edition). Chin J Tuberc Respir Dis, 2024, 47(8): 716-729.
3. 潘峒林, 李亚文, 李翔宇, 等. 肺结节恶变危险因素的系统评价与meta分析. 河南医学研究, 2021, 30(23): 4244-4248.Pan DL, Li YW, Li XY, et al. Systematic review and meta-analysis of risk factors for malignant transformation of pulmonary nodules. Henan Med Res, 2021, 30(23): 4244-4248.
4. 崔舒蕾, 王建卫. 肺磨玻璃结节干预策略. 中华肿瘤防治杂志, 2024, 31(4): 233-240.Cui SL, Wang JW. Intervention strategies for ground-glass nodules. Chin J Cancer Prev Treat, 2024, 31(4): 233-240.
5. 罗于杰, 朱冰. 胸腔镜下肺楔形切除术在早期肺癌的应用. 现代医药卫生, 2021, 37(4): 602-606.Luo YJ, Zhu B. Application of thoracoscopic wedge resection in early-stage lung cancer. Mod Med Health, 2021, 37(4): 602-606.
6. 张彭衍. 胸腔镜下肺楔形切除和肺段切除对于治疗早期外周肺腺癌的疗效比较. 大连医科大学, 2022.Zhang PY. Comparison of efficacy between thoracoscopic wedge resection and segmentectomy in the treatment of early-stage peripheral lung adenocarcinoma. Dalian Medical University, 2022.
7. Shi Y, Wu S, Ma S, et al. Comparison between wedge resection and lobectomy/segmentectomy for early-stage non-small cell lung cancer: A Bayesian meta-analysis and systematic review. Ann Surg Oncol, 2022, 29(3): 1868-1879.
8. Xiu J, Wang S, Wang X, et al. Effectiveness and safety of segmentectomy vs. wedge resection for the treatment of patients with operable non-small cell lung cancer: A meta-analysis and systematic review. Oncol Lett, 2024, 28(1): 336.
9. Al-Thani S, Nasar A, Villena-Vargas J, et al. Wedge resection, segmentectomy, and lobectomy: Oncologic outcomes based on extent of surgical resection for ≤2 cm stage ⅠA non-small cell lung cancer. J Thorac Dis, 2024, 16(3): 1875-1884.
10. Tang Z, Ge W, Zhou D, et al. Impact of the size and depth of pulmonary nodules on the surgical approach for lung resection in the treatment of early-stage lung cancer ≤2 cm. Zhongguo Fei Ai Za Zhi, 2024, 27(3): 170-178.
11. 黄明君, 梁鹏, 王煜, 等. 基于加速康复外科理念的日间四级手术围手术期管理的华西经验. 华西医学, 2024, 39(2): 295-299.Huang MJ, Liang P, Wang Y, et al. West China experience in perioperative management of day-care level Ⅳ surgery based on enhanced recovery after surgery (ERAS). West China Med J, 2024, 39(2): 295-299.
12. 史校铭, 焦子宸, 张子睿, 等. 集中管理日间手术模式下胸腔镜手术与普通住院手术模式治疗肺结节的疗效及安全性比较. 川北医学院学报, 2023, 38(6): 806-809.Shi XM, Jiao ZC, Zhang ZR, et al. Comparison of efficacy and safety between centralized day-care and conventional inpatient thoracoscopic surgery for pulmonary nodules. J North Sichuan Med Coll, 2023, 38(6): 806-809.
13. 蒋丽莎, 詹丽莉, 沈诚, 等. 日间手术模式下胸腔镜手术治疗肺结节的安全性分析. 华西医学, 2020, 35(2): 152-155.Jiang LS, Zhan LL, Shen C, et al. Safety analysis of thoracoscopic surgery for pulmonary nodules under day-care mode. West China Med J, 2020, 35(2): 152-155.
14. 刘小娟, 朱吉, 李春光, 等. 免气管插管麻醉技术在肺磨玻璃结节楔形切除术中的应用效果研究. 海军医学杂志, 2021, 42(6): 722-726.Liu XJ, Zhu J, Li CG, et al. Application of non-intubated anesthesia in wedge resection of ground-glass nodules. J Navy Med, 2021, 42(6): 722-726.
15. 洪甲庚, 林绍立, 蔡东妙, 等. 单孔胸腔镜下保留自主呼吸喉罩麻醉在肺结节楔形切除术中的应用. 中外医疗, 2024, 43(11): 24-27.Hong JG, Lin SL, Cai DM, et al. Application of laryngeal mask anesthesia with spontaneous breathing in uniportal thoracoscopic wedge resection for pulmonary nodules. Chin Foreign Med J, 2024, 43(11): 24-27.
16. Szabo Z, Fabo C, Oszlanyi A, et al. Anesthetic ®evolution from the conventional concept to the minimally invasive techniques in thoracic surgery-narrative review. J Thorac Dis, 2022, 14(8): 3045-3060.
17. Kim HJ, Kim M, Park B, et al. Feasibility of ventilator-assisted tubeless anesthesia for video-assisted thoracoscopic surgery. Medicine (Baltimore), 2023, 102(28): e34220.
18. 奚雷, 方申存, 曹珲. 单孔无管化技术在早期恶性肺结节微创手术中的应用价值. 临床肺科杂志, 2023, 28(12): 1846-1851.Xi L, Fang SC, Cao H. Value of tubeless uniportal technique in minimally invasive surgery for early malignant pulmonary nodules. J Clin Pulm Med, 2023, 28(12): 1846-1851.
19. Liu CY, Hsu PK, Leong KI, et al. Is tubeless uniportal video-assisted thoracic surgery for pulmonary wedge resection a safe procedure? Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i70-i76.
20. 李树本, 刘君, 陈汉章, 等. 自主呼吸麻醉单孔非置管胸腔镜技术诊治肺小结节的24小时解决方案. 中华外科杂志, 2015, 53(10): 778-780.Li SB, Liu J, Chen HZ, et al. A 24-hour solution for diagnosis and treatment of small pulmonary nodules using tubeless uniportal thoracoscopy under spontaneous breathing anesthesia. Chin J Surg, 2015, 53(10): 778-780.
21. 陈光耀. CT引导下肺结节术前穿刺定位及穿刺活检并发症及风险因素探讨. 影像研究与医学应用, 2023, 7(3): 194-196.Chen GY. Complications and risk factors of CT-guided preoperative needle localization and biopsy for pulmonary nodules. Imaging Res Med Appl, 2023, 7(3): 194-196.
22. 古琳, 丁锋, 陈开林, 等. 肺外周结节HOOKWIRE 穿刺定位后脱落原因分析及应用体会. 临床外科杂志, 2024, 32(1): 58-61.Gu L, Ding F, Chen KL, et al. Analysis of hookwire dislodgement after localization of peripheral pulmonary nodules and clinical experience. J Clin Surg 2024, 32(1): 58-61.
23. 仇度旺. 肺结节穿刺活检中血凝酶针道封堵预防并发症的价值研究. 山东大学, 2023.Qiu DW. Value of hemocoagulase needle tract sealing in preventing complications of lung nodule biopsy. Shandong University, 2023.
24. 耿耿, 芮玉峰, 李长青, 等. 肺组织切除前Hook-wire定位穿刺并发症的危险因素分析. 局解手术学杂志, 2022, 31(10): 890-894.Geng G, Rui YF, Li CQ, et al. Risk factors for complications of hook-wire localization before lung resection. J Reg Anat Oper Surg, 2022, 31(10): 890-894.
25. Pang D, Shao G, Zhang J, et al. 3D localization based on anatomical LANDmarks in the treatment of pulmonary nodules. J Thorac Dis, 2022, 14(9): 3133-3144.
26. Park CH, Han K, Hur J, et al. Comparative effectiveness and safety of preoperative lung localization for pulmonary nodules: A systematic review and meta-analysis. Chest, 2017, 151(2): 316-328.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesEfficacy of day surgery for pulmonary nodules in a full-process minimally invasive model based on non-invasive localization technology: A retrospective cohort study

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