Preservation vs. Dissection of Inferior Pulmonary Ligament for Thoracoscopic Upper Lobectomy: A Prospective Randomized Controlled Trial

Abstract

Abstract OBJECTIVES The proper procedure for inferior pulmonary ligament (IPL) during upper lobectomy remains a topic of debate. To investigate this issue, we conducted an open, multicenter prospective randomized controlled trial comparing the clinical effects of preserving IPL versus dissecting IPL during thoracoscopic upper lobectomy. METHODS Patients undergoing thoracoscopic left/right upper lobectomy were assigned to either the dissection group (Group D) or the preserved group (Group P). Our primary purpose lay in measuring and contrasting the change of postoperative residual bronchial angle change, postoperative lung volume change, and other intraoperative and postoperative outcomes between the two groups. RESULTS Our findings revealed that in thoracoscopic left upper lobectomy, Group P was able to reduce the degree of postoperative residual bronchial angle change at 3 and 6 months after surgery, as compared to Group D, with a significant difference (P < 0.05). IPL preservation during thoracoscopic left upper lobectomy can therefore reduce the movement of the left residual bronchus. CONCLUSIONS Our study suggests that it makes no sense to dissect IPL since its dissection is of no benefit. These findings have important implications for the clinical management of patients undergoing upper lobectomy.