Low-cost video-assisted thoracic surgery lobectomy versus regular VATS lobectomy: a propensity-matched retrospective cohort study

The study aims to compare the safety and cost-effectiveness of low-cost video-assisted thoracoscopic surgery (VATS) lobectomy, utilizing the twining high-tension knot method, with regular stapler-based VATS lobectomy. This retrospective cohort study included 102 patients who underwent VATS lobectomy at a single center between January 2013 and April 2020. Patients were divided into a regular group (n = 57) and a low-cost group (n = 45). Propensity score matching (1:1) balanced baseline characteristics between the groups (45 patients each). Clinical and cost outcomes were analyzed. The operative time (256.24 ± 87.45 min vs. 252.67 ± 73.46 min, p = 0.834), intraoperative blood loss (102.89 ± 96.38 mL vs.138.44 ± 257.07 mL, p = 0.39), and postoperative drainage tube indwelling time (3.04 ± 1.62 days vs. 4.02 ± 4.8 days, p = 0.19) were comparable between the low-cost and regular groups. The length of hospital stay was significantly lower in low-cost VATS (5.91 ± 2.51) compared to regular VATS (8.47 ± 7.39) (P = 0.03). The low-cost group demonstrated significantly reduced intraoperative consumable expenses (11,830.09 ± 7,565.13 CNY vs. 25,965.42 ± 7,441.93 CNY, P < 0.001) and total hospitalization costs (34,001.55 ± 12,649.06 CNY vs. 53,166.76 ± 10,966.48 CNY, P < 0.001). Low-cost VATS lobectomy, using the twining high-tension knot method, is as safe and effective as conventional stapler-based VATS lobectomy while significantly reducing costs. This innovative technique offers a practical, accessible alternative for minimally invasive thoracic surgery, particularly in resource-limited settings. ChiCTR2100047430 in Chinese Clinical Trial Registry.