Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach

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 and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

IS - 4

ER -