AbstractBackgroundPersistent air leak (PAL) is a common complication after video‐assisted thoracoscopic surgery (VATS) lobectomy. We aimed to evaluate whether the intraoperative quantitative measurement of air leaks using a mechanical ventilation test could predict PAL and identify those patients needing additional treatment for the prevention of PAL.MethodsThis was an observational, retrospective, single‐center study that included 82 patients who underwent VATS lobectomy with a mechanical ventilation test for VL. Only 2% of patients who underwent lobectomy surgery had persistent air leaks.ResultsAt the end of lobectomy performed in patients with non‐small cell lung cancer, the lung was reinflated at a 25–30 mmH2O pressure and ventilatory leaks (VL) were calculated and in relation to the entity of the air leaks, we evaluated the most suitable intraoperative treatment to prevent persistent air leaks.ConclusionVL is an independent predictor of PAL after VATS lobectomy; it provides a real‐time intraoperative guidance to identify those patients who can benefit from additional intraoperative preventive interventions to reduce PAL.