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 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. 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.

Citation： SHAO Guangqiang, PANG Dazhi, ZHANG Jitian, YAN Jinjin, LIU Zhihai, LIU Rutaiyang, LI Zhenda. 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, 2025, 32(9): 1249-1254. doi: 10.7507/1007-4848.202501022 Copy

1.	楊麗, 錢桂生. 肺結節臨床精準診斷的新理念. 中華肺部疾病雜志(電子版), 2022, 15(1): 1-5.Yang L, Qian GS. New concepts in clinical precision diagnosis of pulmonary nodules. Chin J Lung Dis (Electron Ed), 2022, 15(1): 1-5.
2.	中華醫學會呼吸病學分會, 中國肺癌防治聯盟專家組. 肺結節診治中國專家共識 (2024年版). 中華結核和呼吸雜志, 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, 李亞文, 李翔宇, 等. 肺結節惡變危險因素的系統評價與meta分析. 河南醫學研究, 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, 王建衛. 肺磨玻璃結節干預策略. 中華腫瘤防治雜志, 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.	羅于杰, 朱冰. 胸腔鏡下肺楔形切除術在早期肺癌的應用. 現代醫藥衛生, 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.	張彭衍. 胸腔鏡下肺楔形切除和肺段切除對于治療早期外周肺腺癌的療效比較. 大連醫科大學, 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. Chin J Lung Cancer, 2024, 27(3): 170-178.
11.	黃明君, 梁鵬, 王煜, 等. 基于加速康復外科理念的日間四級手術圍手術期管理的華西經驗. 華西醫學, 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.	史校銘, 焦子宸, 張子睿, 等. 集中管理日間手術模式下胸腔鏡手術與普通住院手術模式治療肺結節的療效及安全性比較. 川北醫學院學報, 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.	蔣麗莎, 詹麗莉, 沈誠, 等. 日間手術模式下胸腔鏡手術治療肺結節的安全性分析. 華西醫學, 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.	劉小娟, 朱吉, 李春光, 等. 免氣管插管麻醉技術在肺磨玻璃結節楔形切除術中的應用效果研究. 海軍醫學雜志, 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, 林紹立, 蔡東妙, 等. 單孔胸腔鏡下保留自主呼吸喉罩麻醉在肺結節楔形切除術中的應用. 中外醫療, 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, 曹琿. 單孔無管化技術在早期惡性肺結節微創手術中的應用價值. 臨床肺科雜志, 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.	李樹本, 劉君, 陳漢章, 等. 自主呼吸麻醉單孔非置管胸腔鏡技術診治肺小結節的24小時解決方案. 中華外科雜志, 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.	陳光耀. CT引導下肺結節術前穿刺定位及穿刺活檢并發癥及風險因素探討. 影像研究與醫學應用, 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, 丁鋒, 陳開林, 等. 肺外周結節HOOKWIRE 穿刺定位后脫落原因分析及應用體會. 臨床外科雜志, 2024, 32(1): 58-61.Gu L, Ding F, Chen KL, et al. Analysis of cause and application of detachment after hookwire puncture positioning of peripheral lung nodules . J Clin Surg, 2024, 32(1): 58-61.
23.	仇度旺. 肺結節穿刺活檢中血凝酶針道封堵預防并發癥的價值研究. 山東大學, 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, 李長青, 等. 肺組織切除前Hook-wire定位穿刺并發癥的危險因素分析. 局解手術學雜志, 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. 楊麗, 錢桂生. 肺結節臨床精準診斷的新理念. 中華肺部疾病雜志(電子版), 2022, 15(1): 1-5.Yang L, Qian GS. New concepts in clinical precision diagnosis of pulmonary nodules. Chin J Lung Dis (Electron Ed), 2022, 15(1): 1-5.
2. 中華醫學會呼吸病學分會, 中國肺癌防治聯盟專家組. 肺結節診治中國專家共識 (2024年版). 中華結核和呼吸雜志, 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, 李亞文, 李翔宇, 等. 肺結節惡變危險因素的系統評價與meta分析. 河南醫學研究, 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, 王建衛. 肺磨玻璃結節干預策略. 中華腫瘤防治雜志, 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. 羅于杰, 朱冰. 胸腔鏡下肺楔形切除術在早期肺癌的應用. 現代醫藥衛生, 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. 張彭衍. 胸腔鏡下肺楔形切除和肺段切除對于治療早期外周肺腺癌的療效比較. 大連醫科大學, 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. Chin J Lung Cancer, 2024, 27(3): 170-178.
11. 黃明君, 梁鵬, 王煜, 等. 基于加速康復外科理念的日間四級手術圍手術期管理的華西經驗. 華西醫學, 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. 史校銘, 焦子宸, 張子睿, 等. 集中管理日間手術模式下胸腔鏡手術與普通住院手術模式治療肺結節的療效及安全性比較. 川北醫學院學報, 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. 蔣麗莎, 詹麗莉, 沈誠, 等. 日間手術模式下胸腔鏡手術治療肺結節的安全性分析. 華西醫學, 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. 劉小娟, 朱吉, 李春光, 等. 免氣管插管麻醉技術在肺磨玻璃結節楔形切除術中的應用效果研究. 海軍醫學雜志, 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, 林紹立, 蔡東妙, 等. 單孔胸腔鏡下保留自主呼吸喉罩麻醉在肺結節楔形切除術中的應用. 中外醫療, 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, 曹琿. 單孔無管化技術在早期惡性肺結節微創手術中的應用價值. 臨床肺科雜志, 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. 李樹本, 劉君, 陳漢章, 等. 自主呼吸麻醉單孔非置管胸腔鏡技術診治肺小結節的24小時解決方案. 中華外科雜志, 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. 陳光耀. CT引導下肺結節術前穿刺定位及穿刺活檢并發癥及風險因素探討. 影像研究與醫學應用, 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, 丁鋒, 陳開林, 等. 肺外周結節HOOKWIRE 穿刺定位后脫落原因分析及應用體會. 臨床外科雜志, 2024, 32(1): 58-61.Gu L, Ding F, Chen KL, et al. Analysis of cause and application of detachment after hookwire puncture positioning of peripheral lung nodules . J Clin Surg, 2024, 32(1): 58-61.
23. 仇度旺. 肺結節穿刺活檢中血凝酶針道封堵預防并發癥的價值研究. 山東大學, 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, 李長青, 等. 肺組織切除前Hook-wire定位穿刺并發癥的危險因素分析. 局解手術學雜志, 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

Efficacy 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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