Air leaks management using polymeric hydrogel matrix after thoracoscopic lung segmentectomy: a single-center prospective randomized trial with a cost-effective analysis

Introduction: Alveolar air leaks are common complications after thoracoscopic lung resections, increasing morbidity, hospital stay, and costs. Polymeric hydrogel matrix (PHM) has shown effectiveness in reducing air leaks and chest tube duration after lobectomy. This study aims to assess PHM’s impact on air leaks, chest drain duration, hospital stay, and its cost-effectiveness following thoracoscopic segmentectomies. Materials and Methods: Patients with moderate intraoperative alveolar air leaks during thoracoscopic lung segmentectomy were randomized to receive either PHM (PHM Group) or standard care (SC Group). A cost-effectiveness analysis compared surgical materials between PHM and SC procedures. Results: Out of 109 screened patients, 60 were randomized into the two groups. No differences were found in baseline characteristics, surgical procedures, or complications. However, the PHM group had significantly shorter durations for air leaks (p = 0.01), chest drain stay (p = 0.01), and hospital stay (p = 0.01). The PHM group had higher procedure expenses (p = 0.02), but a single day of early discharge offset this cost. Conclusion: This prospective trial shows that PHM application in thoracoscopic lung segmentectomies with moderate intraoperative air leaks significantly reduces postoperative air leaks, chest tube duration, and hospital stay. Additionally, the cost-effectiveness analysis supports PHM’s potential to expand surgical capacity. Trial registration: Clinical Trials, www.clinicaltrials.gov, NCT06544200.