Fissureless Non-arterial Dissection Videothoracoscopic Lobectomy for Lower Lobes

Abstract

Background

Two primary techniques, namely, the conventional transfissural and the fissureless approaches, have been defined for videothoracoscopic lobectomy. We hypothesized that a videothoracoscopic fissureless, non-arterial dissection (NAD) technique—using new generation staplers—for lower lobe resections may reduce operative time and lower the intra- and postoperative complication rates.

Methods

We had 69 consecutive patients assigned to a fissureless NAD or a conventional lobectomy for lower lobes. In the fissureless NAD technique, the pulmonary artery, together with the adjacent lung parenchyma along the fissure line, was divided as the last anatomical structure using staplers with tri-height cartridges. We analyzed the feasibility and safety of the fissureless NAD technique.

Results

A total of 29 (42%) patients underwent NAD lobectomy. The mean operative time was significantly shorter in the NAD group (p = 0.003). No patient had intraoperative complication, and three (10.3%) patients (p = 0.212) had postoperative complication in the NAD group. The mean time of chest tube removal (p = 0.031) and the length of hospital stay (p = 0.008) were significantly shorter in the NAD group.

Conclusion

The fissureless NAD videothoracoscopic lobectomy is a safe and feasible technique for lower lobectomies. This technique significantly reduces the operative time with potential benefit of earlier patient discharge.

Keywords

thoracoscopy/VATS - lung cancer treatment (surgery medical) - surgery/incisions

Note

The paper was presented at the 38th EACTS Annual Meeting, Lisbon, Portugal, October 9–12, 2024.

Ethical Approval Statement

This study was approved by the Istanbul Medical Faculty Ethics Committee of Istanbul University (2023/872), and was conducted in accordance with the principles of the Declaration of Helsinki. A written consent was obtained from all patients for the anonymous use of in-hospital data.

Authors' Contribution

M.K. contributed in conceptualization, project administration, data collection and validation, interpretation of data and drafting of the manuscript; S.D. contributed to statistical analysis, interpretation of data and drafting of the manuscript; I. K. contributed to data collection and validation and drafting of the manuscript; A.S. contributed to statistical analysis and interpretation of data, drafting of the manuscript; S.C. contributed to data collection and validation, drafting of the manuscript; B.O. contributed in conceptualization and drafting of the manuscript.

Publication History

Received: 22 July 2025

Accepted: 19 August 2025

Article published online:
03 September 2025

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