Abstract
BACKGROUND: With the widespread adoption of enhanced recovery after surgery (ERAS) protocols and ongoing advancements in surgical techniques, video-assisted thoracoscopic surgery (VATS) has become a standard procedure in thoracic surgery due to its minimally invasive nature and accelerated postoperative recovery. The introduction of vascular staplers has revolutionized the intraoperative management of pulmonary vessels, offering surgeons a reliable and efficient method of vascular ligation. However, the optimal technique for pulmonary vessel handling during VATS remains a topic of debate. This retrospective study aims to compare the clinical safety and efficacy of using a vascular stapler alone versus a combination of silk suture ligation and vascular stapling, with a particular focus on postoperative outcomes. METHODS: A total of 211 patients who underwent uniportal VATS lobectomy at The First Affiliated Hospital of Soochow University between January and December 2024 were included. One cohort received vessel management using staplers alone, while the other underwent combined silk suture ligation and stapler use for pulmonary artery and vein handling. Perioperative outcomes were evaluated, including chest tube duration, postoperative hospital stay, drainage volume and postoperative complications. RESULTS: There were no significant differences between the two groups in terms of operative time (P=0.70), intraoperative blood loss (P=0.73), postoperative drainage time (P=0.49), or postoperative hospitalization (P=0.08). However, the incidence of postoperative air leakage was significantly lower in the combined group (13%) compared to the stapler alone group (24%) (P=0.03). Additionally, the combined group exhibited reduced postoperative drainage volume (P=0.01). CONCLUSIONS: The combination of silk suture ligation with vascular stapling enhances pulmonary vessel management by combining mechanical closure and physical ligation. This approach significantly reduces postoperative air leaks and drainage volume, potentially improving surgical stability and vascular stump integrity. These findings support the combined technique as a safer and more effective option for vascular control in VATS lobectomy.