Tubeless Strategy for Enhanced Recovery After Sublobar Resection

This is a prospective, open-label, randomized controlled trial with a 1:1 allocation ratio. Adult patients (aged 18-75) scheduled for uniportal VATS sublobar resection for peripheral lung nodules (≤2 cm, ≤2 cm from the pleura) will be assessed for eligibility. Key exclusion criteria include severe pleural adhesions, inability to achieve selective lung ventilation, and severe cardiopulmonary dysfunction.

The primary outcome is a composite endpoint measuring the rate of high-quality fast-track recovery at 24 hours postoperatively, defined as simultaneously meeting all three criteria: 1) meeting standardized discharge criteria, 2) a QoR-15 (Quality of Recovery-15) score ≥130, and 3) absence of Clavien-Dindo grade ≥II respiratory adverse events until the first follow-up.

Secondary outcomes include individual components of the primary endpoint, pneumothorax rate, postoperative pain scores, time to first ambulation, length of hospital stay, hospitalization costs, and patient satisfaction. A sample size of 138 participants (69 per group) was calculated to provide sufficient statistical power. Data analysis will follow the intention-to-treat principle.

Inclusion criteria

• Age between 18 and 75 years.
• Scheduled for uniportal or multiportal video-assisted thoracoscopic surgery (VATS) for sublobar resection (wedge or segmentectomy).
• Presence of peripheral lung nodules ≤ 2 cm in diameter and ≤ 2 cm from the pleura, confirmed by CT scan.
• Ability to understand and provide written informed consent.
• American Society of Anesthesiologists (ASA) physical status I-III.

Exclusion criteria

• Severe pleural adhesions or fibrosis that would preclude non-intubated anesthesia or tubeless approach.
• Severe cardiopulmonary dysfunction: FEV1 < 50% predicted, DLCO < 60% predicted, heart failure (NYHA class III-IV), or unstable angina.
• Pregnancy or lactation (confirmed by urine test if applicable).
• Inability to tolerate one-lung ventilation due to anatomical or physiological reasons.
• History of ipsilateral thoracic surgery.
• Active pulmonary infection, uncontrolled diabetes, or other comorbidities that increase surgical risk.
• Participation in another interventional trial within 30 days.