Application value and clinical effect analysis of suspension technique in difficult thoracoscopic lobectomy: A retrospective study

To explore the application value of suspension technique in difficult thoracoscopic lobectomy, evaluate its impact on perioperative indicators, surgical quality, complication rates, and postoperative recovery, and provide evidence-based medical evidence for clinical practice. A single-center retrospective cohort study was conducted, including 60 patients who underwent difficult thoracoscopic lobectomy from June 2023 to May 2025. Patients were divided into observation group (suspension technique group, n=30) and control group (conventional technique group, n=30) based on whether suspension technique was used intraoperatively. Propensity score matching (PSM) was used to control confounding factors with a 1:1 matching ratio and caliper value of 0.02. Matching variables included surgeon experience, surgical year, and pleural adhesion severity in addition to baseline covariates. Perioperative indicators (operative time, intraoperative blood loss, conversion to thoracotomy rate, postoperative hospital stay, etc.), surgical quality indicators (number and stations of lymph node dissection, margin status, etc.), complications, and postoperative recovery indicators (pain scores, pulmonary function recovery, quality of life, etc.) were compared between the two groups. Sex-stratified subgroup analyses were performed to assess potential differences in surgical outcomes between male and female patients. After PSM matching, baseline characteristics were well-balanced between the two groups (all covariates SMD<0.1). Compared with the control group, the observation group had significantly shorter operative time (156.3±28.4 minutes vs 185.7±35.2 minutes, P=0.001), significantly reduced intraoperative blood loss [120(80,180)ml vs 200(150,280)ml, P<0.001], and significantly lower conversion to thoracotomy rate (3.3% vs 23.3%, P=0.052). The observation group had more lymph nodes dissected (18.6±4.2 vs 15.1±3.8, P=0.001) and more lymph node stations dissected (4.8±0.9 vs 4.2±0.8, P=0.006). The total postoperative complication rate in the observation group was significantly lower than the control group (13.3% vs 40.0%, P=0.039). VAS pain scores at all postoperative time points were significantly lower in the observation group than the control group (P<0.001). The FEV1 recovery rate at 3 months postoperatively was 89.5% in the observation group, significantly higher than 78.6% in the control group (P<0.05). Quality of life assessment showed that the observation group had significantly better scores in all symptom dimensions compared to the control group (P<0.013). Sex-stratified analyses showed consistent benefits across male and female patients with no significant sex × intervention interactions (all P>0.7). No cases of recurrent laryngeal nerve injury were identified in either group. Suspension technique has significant clinical application value in difficult thoracoscopic lobectomy, effectively shortening operative time, reducing intraoperative bleeding, decreasing conversion to thoracotomy rate, improving lymph node dissection quality, reducing postoperative complications, promoting postoperative recovery, and improving quality of life. This technique provides a safe and effective technical solution for difficult thoracoscopic surgery and deserves clinical promotion.