Video-assisted thoracoscopy with two-lung ventilation and CO2 insufflation in primary spontaneous pneumothorax: Propensity score matching comparison

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Key finding

• Our study demonstrates that compared to the conventional approach using one-lung ventilation (OLV) with double-lumen endotracheal intubation, video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP) utilizing two-lung ventilation (TLV) and CO₂ insufflation does not increase the risk of recurrence, while offering the advantage of a shorter anesthesia duration.

What is known and what is new?

• VATS with TLV and CO₂ insufflation has been introduced as an alternative approach in thoracic surgery. Traditionally, OLV with double-lumen endotracheal intubation has been the standard method for surgical management of PSP. Despite advancements in thoracic surgery, OLV still faces several challenges, including airway trauma and postoperative discomfort. However, there is limited evidence directly comparing the clinical outcomes of TLV with CO₂ insufflation versus conventional OLV.

• Given the absence of robust evidence on the relative benefits and risks of these techniques, further comparative analysis is warranted to guide clinical decision-making. We performed a propensity score matching analysis to minimize baseline differences and achieve a more accurate comparison between the two surgical methods. The results demonstrate that TLV with CO₂ insufflation is a feasible alternative that may preserve more normal lung parenchyma while maintaining comparable surgical outcomes.

What is the implication, and what should change now?

• Compared to the OLV approach, the TLV technique with CO₂ insufflation does not increase the risk of recurrence and also offers the benefit of reducing anesthesia time.

Publication: Cui YJ, Piao WX, Jung YC, Cho HJ, Kang MW. Video-assisted thoracoscopy with two-lung ventilation and CO₂ insufflation in primary spontaneous pneumothorax: propensity score matching comparison. J Thorac Dis 2025;17(3):1217-1227. doi: 10.21037/jtd-24-1749