Ultrasound for Intra-Operative Detection of Peri-Centimetric Pulmonary Nodules in Uniportal Video-Assisted Thoracic Surgery (VATS): A Comparison with Conventional Techniques in Multiportal VATS

Background: Video-assisted thoracic surgery (VATS) has become the gold-standard approach for lung resections. Given the impossibility of digital palpation, we witnessed the progressive development of peri-centimetric and deeply located pulmonary nodule alternative detection techniques. Intra-operative lung ultrasound is an increasingly effective diagnostic method, although only a few small studies have evaluated its accuracy. This study analyzed the effectiveness and sensitivity of uniportal VATS with intra-operative lung ultrasound (ILU), in comparison to multiportal VATS, for visualizing solitary and deep-sited pulmonary nodules. Methods: Patient data from October 2021 to October 2023, from a single center, were retrospectively gathered and analyzed. In total, 31 patients who received ILU-aided uniportal VATS (Group A) were matched for localization time, operative time, sensitivity, and post-operative complications, with 33 undergoing nodule detection with conventional techniques, such as manual or instrumental palpation, in multiportal VATS (Group B). Surgeries were carried out by the same team and ILU was performed by a certified operator. Results: Group A presented a significantly shorter time for nodule detection [median (IQR): 9 (8-10) vs. 14 (12.5-15) min; p < 0.001] and operative time [median (IQR): 33 (29-38) vs. 43 (39-47) min; p < 0.001]. All nodules were correctly localized and resected in Group A (sensitivity 100%), while three were missed in Group B (sensitivity 90.9%). Two patients in Group B presented with a prolonged air leak that was conservatively managed, compared to none in Group A, resulting in a post-operative morbidity rate of 6.1% vs. 0% (p = 0.16). Conclusions: ILU-aided uniportal VATS was faster and more effective than conventional techniques in multiportal VATS for nodule detection.