Progel Platinum for Air Leak Reduction After VATS Lobectomy for NSCLC

A Multicenter, Randomized, Parallel-Group Trial Evaluating Progel Platinum Added to Mechanical Stapling Versus Mechanical Stapling Alone in Patients Undergoing VATS Upper or Lower Lobectomy for Non-Small Cell Lung Cancer

This multicenter randomized trial evaluates whether routine use of Progel Platinum surgical sealant on stapled fissure lines during VATS upper or lower lobectomy for NSCLC reduces pleural drainage duration compared with standard stapling alone. Secondary objectives include postoperative length of stay, incidence and duration of postoperative air leaks, residual pleural space, safety outcomes, and hospitalization costs.

Lobectomy is the standard surgical treatment for many patients with early-stage NSCLC, but postoperative air leak remains a frequent complication associated with prolonged chest tube duration, longer hospitalization, and increased healthcare costs. Preliminary non-randomized evidence suggests that Progel Platinum may improve intraoperative sealing of fissure lines and reduce postoperative air leaks. E-SEAL is a prospective, randomized, controlled, multicenter study in 8 thoracic surgery centers. Eligible adult patients undergoing minimally invasive VATS upper or lower lobectomy for NSCLC are randomized 1:1 to stapling alone or stapling plus Progel Platinum. The primary endpoint is pleural drainage duration in hours. Secondary endpoints include postoperative length of stay, hospitalization costs, postoperative air leak incidence and volume, residual pleural space, complications, re-interventions, and follow-up outcomes up to 60 days after surgery/discharge.

Inclusion Criteria:

• Age ≥18 years
• Written informed consent
• Planned VATS upper or lower lobectomy for NSCLC
• Minimally invasive thoracoscopic approach
• Middle lobectomy excluded

Exclusion Criteria:

• Induction radiochemotherapy or chemo-immunotherapy
• Severe COPD: GOLD 3 or higher
• Sleeve resection or extended resection involving other lobes/chest wall/pericardium, etc.
• Albumin intolerance/allergy
• Renal insufficiency
• Redo surgery
• Use of sealants/adhesives other than the study approach
• Expected extensive pleural adhesions