Closed Versus Open Vent Port Techniques and the Disconnection Technique for Optimizing Lung Collapse With Bronchial Blockers in Video‐Assisted Thoracoscopic Surgery: A Randomized Controlled Trial
Juan Yao, Ya‐Jing Chen, Fang‐Ming Shen, Jue Xie, Jiao‐Jiao Yang, Lu‐Xin Huang, Xiao‐Xiang Tan, Ying Yang, Jie SunABSTRACT
Introduction
For patients undergoing video‐assisted thoracoscopic surgery (VATS) for lung cancer or other pulmonary lesions, effective one‐lung ventilation (OLV) is essential to provide surgical exposure. Bronchial blockers (BBs) are increasingly used for OLV, but the optimal management of their vent port to accelerate lung collapse remains unclear.
Methods
In this prospective, randomized, controlled trial, 75 patients were allocated to three groups ( n = 25 each): Group 1—BB with vent port closed; Group 2 (control)—BB with vent port open; Group 3—BB with the disconnection technique. Primary outcome was the time to complete lung collapse, which was scored according to the video clips obtained during the operation. Secondary outcomes included intraoperative hypoxemia, blood gas analysis, blocker malposition, perioperative complications, and surgeon satisfaction.
Results
A total of 72 patients were included in the modified intention‐to‐treat analysis, with 24 patients in each group. Median time to complete lung collapse was 15 min (95% CI: 10–15) in Groups 1 and 3 but was not reached in Group 2 (15/24, 62.5% had not achieved complete collapse by 30 min). In an exploratory 30‐min restricted mean survival time (RMST), complete collapse occurred on average 14.17 min earlier in Group 1 (95% CI: 11.10–17.23) and 12.50 min earlier in Group 3 (95% CI: 9.62–15.38) than in Group 2, with no difference between Groups 1 and 3 (1.67 min, 95% CI: −1.85 to 5.19); time‐averaged hazard ratios were consistent (Group 1 vs. 2, 9.80 [4.22–22.73]; Group 3 vs. 2, 7.63 [3.36–17.31]; Group 1 vs. 3, 1.20 [0.67–2.16]). No significant differences were detected in hypoxemia, blocker malposition, or complications across groups; however, the trial was not powered for safety outcomes.
Conclusion
In patients aged 18–65 years with ASA I–II and normal pulmonary function undergoing thoracic surgery, the closure of the BB vent port results in a more rapid lung collapse compared to maintaining the vent port open. However, there was no statistically significant difference observed between the vent port closure technique and the disconnection technique regarding the time required for complete lung collapse.
Trial Registration
ChiCTR identifier: ChiCTR2000039896