Intraoperative ventilatory leak: Real‐time guidance for management of air leak in lung cancer patients undergoing VATS lobectomy

Background Persistent air leak (PAL) is a common complication after video‐assisted thoracoscopic surgery (VATS) lobectomy. We aimed to evaluate whether the intraoperative quantitative measurement of air leaks using a mechanical ventilation test could predict PAL and identify those patients needing additional treatment for the prevention of PAL. Methods This was an observational, retrospective, single‐center study that included 82 patients who underwent VATS lobectomy with a mechanical ventilation test for VL. Only 2% of patients who underwent lobectomy surgery had persistent air leaks. Results At the end of lobectomy performed in patients with non‐small cell lung cancer, the lung was reinflated at a 25–30 mmH2O pressure and ventilatory leaks (VL) were calculated and in relation to the entity of the air leaks, we evaluated the most suitable intraoperative treatment to prevent persistent air leaks. Conclusion VL is an independent predictor of PAL after VATS lobectomy; it provides a real‐time intraoperative guidance to identify those patients who can benefit from additional intraoperative preventive interventions to reduce PAL. Evaluation of intraoperative air leaks through the calculation of ventilatory leaks (VL) by mechanical ventilator during VATS lobectomy and identification of patients who may benefit from additional surgical treatments to prevent prolonged air leaks (PAL). VL is an independent predictor of PAL after VATS lobectomy; it provides an intraoperative guidance to identify those patients who can benefit from additional intraoperative preventive interventions to reduce PAL.