Comparison of intraoperative oxygenation and perioperative outcomes between thoracoscopic and open thoracic surgery during one-lung ventilation
Abstract
Objective
To compare intraoperative oxygenation and early perioperative outcomes between patients undergoing thoracoscopic and open thoracic surgery with one-lung ventilation, using peripheral oxygen saturation 30 minutes after initiation of one-lung ventilation as the primary outcome.
Methods
In this single-center retrospective study, 42 adults undergoing elective thoracic surgery with one-lung ventilation in 2025 were classified according to the planned surgical approach as thoracotomy (n = 29) or thoracoscopy (n = 13). Three converted procedures remained in the thoracoscopy group. Secondary outcomes included intraoperative PaO₂/FiO₂ ratio, calculated shunt fraction, hypoxemia, ventilatory settings, one-lung ventilation duration, postoperative gas exchange, duration of postoperative mechanical ventilation, and intensive care unit stay. Secondary analyses were considered exploratory.
Results
Baseline characteristics were similar, whereas major thoracic procedures were more frequent in the thoracotomy group (58.6% vs. 15.4%, p = 0.017). During one-lung ventilation, peripheral oxygen saturation was higher in the thoracoscopy group (98% [IQR 94–100] vs. 90% [IQR 89–95], p = 0.011; Hodges–Lehmann estimate 5 percentage points, bootstrap 95% CI 1–8). One-lung ventilation lasted longer in the thoracotomy group (130 [IQR 115–180] vs. 60 [IQR 50–140] minutes, p = 0.038; Hodges–Lehmann estimate 50 minutes, bootstrap 95% CI 0–80). Other intraoperative and early outcomes were similar.
Conclusions
For the primary outcome, thoracoscopy was associated with higher peripheral oxygen saturation during one-lung ventilation. Among exploratory secondary outcomes, open thoracotomy was associated with longer one-lung ventilation. The imbalance in procedural complexity and attenuation of the saturation difference after exclusion of conversions indicate that these associations should not be interpreted as causal.
© 2026 Gergő Ráduly, Ionuț Branea, Irina Săplăcan, Raluca Ștefania Fodor, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
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