The goal of this clinical trial is to learn whether a brief suction of the airway going to the surgical lung (bronchus) can help the lung collapse faster and more completely during uniportal video-assisted thoracoscopic surgery (UVATS). This type of surgery is performed through a small incision in the chest, and good lung collapse helps the surgeon see and work safely. The main questions it aims to answer are
1. Does brief bronchial suction improve the quality of lung collapse 1 minute after chest cavity is opened? 2. Does brief bronchial suction help reach satisfactory lung collapse faster?
Researchers will compare patients who receive brief bronchial suction and those who do not. This is to see if suction improves and fastens lung collapse, reduce the need for additional steps if lung is not adequately collapsed, affect inflammation, oxygenation, postoperative pulmonary complications, operative time, and the duration of one-lung ventilation. Participants will
1. Undergo UVATS under general anesthesia 2. Have a double-lumen breathing tube placed as part of the standard anesthetic care 3. Be randomly assigned to either receive bronchial suction for one minute or receive no bronchial suction 4. Have the surgical team assess the quality of lung collapse at different time points 5. Have information collected from the routine anesthesia and surgical records such as oxygen levels during surgery, length of surgery and lung-related complications within 7 days after surgery
Age ≥ 18 years old
BMI ≤ 35 kg/m2
American Society of Anesthesiologists (ASA) physical status I to III
Scheduled for elective single-port video-assisted thoracoscopic surgery (VATS) at Siriraj Hospital
Previous thoracic surgery
Known or suspected severe pleural adhesions based on preoperative imaging or clinical history
Tracheobronchial anatomical abnormalities
Pulmonary bullae identified on chest radiography or computed tomography, or a history of recurrent pneumothorax
Parallel
bronchial suction
Other interventionParticipants will receive bronchial suction at -30 cmH₂O through the bronchoscopy port of the operative lumen of the double-lumen endotracheal tube on two occasions: (1) during a 60-second apnea period immediately before initiation of one-lung ventilation and (2) during a 60-second apnea period immediately after pleural opening. Following the first suction period, the bronchoscopy port of the operative lumen will be closed. The bronchoscopy port of the operative lumen will be opened to ambient air following the second suction period after pleural entry.
Sham Control
Other interventionParticipants will undergo the same 60-second apnea periods as the bronchial suction group immediately before initiation of one-lung ventilation and immediately after pleural opening. The suction device will be activated for 60 seconds to produce sham suction noise but will not be connected to the patient.
Quality of lung collapse at 1 minute after pleural opening
Surgical team to assess quality of lung collapse at 1 minute after pleural opening by using lung collapse score (LCS). The higher the LCS, the better the lung collapse.
Quality of lung collapse at pleural opening, 5 minutes and 10 minutes after pleural opening
Quality of lung collapse assessed by the surgical team using the Lung Collapse Score (LCS) immediately after pleural opening, and at 5 minutes and 10 minutes after pleural opening.
Time to satisfactory lung collapse
Time from pleural opening to the first Lung Collapse Score (LCS) of 8 or greater
Requirement for rescue maneuvers for inadequate lung collapse
Need for additional intraoperative maneuvers to improve lung collapse due to inadequate surgical exposure
Incidence of intraoperative hypoxemia
Occurrence of intraoperative hypoxemia during one-lung ventilation, defined as SpO2 \< 90%
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