Comparison of intraoperative oxygenation and perioperative outcomes between thoracoscopic and open thoracic surgery during one-lung ventilation

Abstract

Objective: To compare intraoperative and postoperative oxygenation, ventilatory parameters, and early perioperative outcomes between patients undergoing thoracoscopic and open thoracic surgery with one-lung ventilation.

Methods: This single-center retrospective study included 42 adults undergoing elective thoracic surgery with one-lung ventilation in 2025. Patients were classified by the initially planned approach as thoracotomy (n = 29) or thoracoscopy (n = 13); three conversions to thoracotomy remained in the thoracoscopy group. Baseline characteristics, procedural complexity, intraoperative and postoperative oxygenation, ventilatory settings, and early perioperative outcomes were analyzed.

Results: Baseline age, sex, body mass index, ASA physical status, and preoperative peripheral oxygen saturation did not differ significantly between groups, whereas major thoracic procedures were more frequent in the thoracotomy group (58.6% vs. 15.4%, p = 0.017). During one-lung ventilation, peripheral oxygen saturation was higher in the thoracoscopy group (98% [IQR 94–100] vs. 90% [IQR 89–95], p = 0.011; Hodges–Lehmann estimate 5 percentage points, bootstrap 95% CI 1–8). The duration of one-lung ventilation was longer in the thoracotomy group (130 [IQR 115–180] vs. 60 [IQR 50–140] minutes, p = 0.038; Hodges–Lehmann estimate 50 minutes, bootstrap 95% CI 0–80). Intraoperative PaO₂/FiO₂ ratio, shunt fraction, postoperative oxygenation, ventilatory settings, and other early outcomes were similar.

Conclusions: Open thoracotomy was associated with longer one-lung ventilation, whereas thoracoscopy was associated with higher peripheral oxygen saturation during one-lung ventilation. The imbalance in procedural complexity and the attenuation of the saturation difference after exclusion of conversions indicate that these exploratory associations should not be interpreted as causal.