Use of free subcutaneous fat pad for reduction of intraoperative air leak in thoracoscopic pulmonary resection cases with lung cancer

Intraoperative alveolar air leaks occur in patients with non-small-cell lung cancer (NSCLC) following a pulmonary resection using thoracoscopic surgery. We showed the efficacy of covering damaged lung tissue with a subcutaneous fat pad for preventing postoperative air leak. Thoracoscopic surgery was performed for NSCLC patients with three incisions along with a 3-4 cm anterior utility incision. When an air leak originated from deep within the pulmonary parenchyma or was large, a subcutaneous fat pad similar to 2 x 2 cm in size was harvested from the utility incision and placed on the damaged lung tissue with fibrin glue and 2-3 mattress sutures. Subcutaneous fat pads were used for 50 patients with NSCLC during thoracoscopic surgery procedures. There were no intraoperative complications in any of the patients. A prolonged air leak (> 7 days) was noted in 3 (6%) of the 50 patients. Air leak was diminished at 1.5 +/- 2.6 postoperative days and the chest tubes removed at 3.2 +/- 2.8 postoperative days. Reinforcement of damaged lung tissues by use of subcutaneous free fat pads is a safe and intriguing procedure in NSCLC patients who underwent a pulmonary resection in thoracoscopic surgery.