Partial pressure of oxygen control versus modified inflation-deflation method in identifying intersegmental plane during anatomical sublobectomy: a prospective, randomized, controlled trial.

Background: With increasing early-stage non-small cell lung cancer (NSCLC) diagnoses, sublobar resections including segmentectomy and wedge resection have become commonly used in clinical settings. The success of lung segment surgery hinges on the accurate identification of intersegmental planes (ISPs), which is typically achieved by the modified inflation-deflation method; however, this technique is associated with a prolonged duration for identifying ISP. The "partial pressure of oxygen control method" represents an optimization of the inflation-deflation technique, designed to facilitate rapid identification of ISP during surgical procedures. The present study was designed to assess the safety and effectiveness of the partial pressure of oxygen (PaO₂) control method for ISP identification in thoracoscopic anatomical sublobectomy, in comparison to the modified inflation-deflation method.

Methods: A total of 60 patients scheduled for thoracoscopic anatomical sublobectomy were randomly allocated into two groups: the intervention group (using the PaO₂ control method; n=30) and the control group (using the modified inflation-deflation method; n=30). The time to ISP appearance (T_ISP) was compared between these two groups. Arterial blood gas (ABG) levels were recorded at the following time points: prior to entry to operating room, during one-lung ventilation (OLV), upon completion of lung inflation, 3 minutes post-lung inflation, and 6 minutes post-lung inflation. Statistical analyses were conducted to evaluate the differences in operative time, intraoperative blood loss, incidence of postoperative complications, and average postoperative hospital stay.

Results: The T_ISP was significantly shorter in the intervention group than in the control group (307.0±108.3 vs. 496.7±154.0 seconds; P<0.001). Furthermore, the PaO₂ in the intervention group was significantly lower compared to the control group at 3 minutes following 100% oxygen administration (156.6±76.5 vs. 114.1±47.5 mmHg; P=0.01).

Conclusions: The PaO₂ control method facilitates more rapid acquisition of ISP compared to the modified inflation-deflation method, and it is deemed a safe and effective technique in thoracoscopic anatomical sublobectomy.

Trial registration: ClinicalTrials.gov NCT06644066.