TY - JOUR
T1 - Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach
AU - Hansen, Henrik Jessen
AU - Petersen, René Horsleben
AU - Christensen, Merete
PY - 2011/4
Y1 - 2011/4
N2 - BACKGROUND: Lobectomy using video-assisted thoracoscopic surgery (VATS) still is a controversial operation despite its many observed benefits. The controversy may be due to difficulties performing the procedure. This study addresses a standardized anterior approach facilitating the operation.METHODS: This report describes 156 VATS lobectomies performed with a uniform anterior three-port technique. The surgeon and the assistant stand on the abdominal side of the patient, and the setup is independent of the lobe to be resected.RESULTS: From 2005 to 2007, 156 VATS lobectomies and 13 conversions (7.7%) were performed with an anterior three-port technique. No mortality occurred among the VATS lobectomies during a 30-day period. The major comorbidity rate was 78%. The comorbidities included former thoracic surgery (9%) or a history of another cancer (22%), indicating potentially difficult surgery and a nonselected population. The majority (92%) of the patients had lung cancer. The major postoperative problem was air leakage, which usually prolongs the tube time and the in-hospital stay, but a "no-touch fissure" technique significantly reduced the median tube time to 4 days and the postoperative hospital stay to 5 days.CONCLUSIONS: This study shows that VATS lobectomies can be performed using a standardized anterior approach with low rates of conversion and morbidity. A "no-touch fissure" technique lowers the postoperative tube time, the in-hospital stay, and the number of patients with prolonged air leakage. A uniform anterior approach facilitates VATS lobectomy and makes this advanced procedure more easily adaptable by many surgeons familiar with an open anterior approach. The findings show that VATS lobectomy can be performed safely for a large proportion of lung cancer patients.
AB - BACKGROUND: Lobectomy using video-assisted thoracoscopic surgery (VATS) still is a controversial operation despite its many observed benefits. The controversy may be due to difficulties performing the procedure. This study addresses a standardized anterior approach facilitating the operation.METHODS: This report describes 156 VATS lobectomies performed with a uniform anterior three-port technique. The surgeon and the assistant stand on the abdominal side of the patient, and the setup is independent of the lobe to be resected.RESULTS: From 2005 to 2007, 156 VATS lobectomies and 13 conversions (7.7%) were performed with an anterior three-port technique. No mortality occurred among the VATS lobectomies during a 30-day period. The major comorbidity rate was 78%. The comorbidities included former thoracic surgery (9%) or a history of another cancer (22%), indicating potentially difficult surgery and a nonselected population. The majority (92%) of the patients had lung cancer. The major postoperative problem was air leakage, which usually prolongs the tube time and the in-hospital stay, but a "no-touch fissure" technique significantly reduced the median tube time to 4 days and the postoperative hospital stay to 5 days.CONCLUSIONS: This study shows that VATS lobectomies can be performed using a standardized anterior approach with low rates of conversion and morbidity. A "no-touch fissure" technique lowers the postoperative tube time, the in-hospital stay, and the number of patients with prolonged air leakage. A uniform anterior approach facilitates VATS lobectomy and makes this advanced procedure more easily adaptable by many surgeons familiar with an open anterior approach. The findings show that VATS lobectomy can be performed safely for a large proportion of lung cancer patients.
KW - Adenocarcinoma/surgery
KW - Blood Loss, Surgical
KW - Comorbidity
KW - Dissection/methods
KW - Electrocoagulation/methods
KW - Humans
KW - Length of Stay/statistics & numerical data
KW - Lung Neoplasms/secondary
KW - Lymph Node Excision/methods
KW - Middle Aged
KW - Pneumonectomy/methods
KW - Postoperative Complications/epidemiology
KW - Reoperation
KW - Retrospective Studies
KW - Surgical Stapling
KW - Thoracic Surgery, Video-Assisted/methods
U2 - 10.1007/s00464-010-1355-9
DO - 10.1007/s00464-010-1355-9
M3 - Journal article
C2 - 20927543
SN - 0930-2794
VL - 25
SP - 1263
EP - 1269
JO - Surgical Endoscopy
JF - Surgical Endoscopy
IS - 4
ER -
