Video-assisted thoracoscopic lobectomy was introduced in the early 1990s but has not yet gained widespread acceptance. The VATS approach is still controversial although several studies suggest less postoperative morbidity compared with open thoracotomy. Nevertheless, some patients report long-lasting chest wall pain following VATS procedures, and, in theory, such pain may be related to intercostal nerve injury. The present study presents our experience with a commercially available flexible thoracoscope.
The study was designed as a case-control series of prospectively collected data to determine if performing VATS with a flexible thorascope could have benefits for both the patient and the surgeon.
During the last 24 months 128 of 274 consecutive lobectomies (47%) were scheduled as VATS procedures with a new flexible high-definition thoracoscope. Six operations (4.6%) were converted to open surgery but only one case was converted during the last 12 months. There was no hospital mortality. The median duration of the operation was 105 min (range: 50–289 min), and the median postoperative hospital stay was 4 days (range: 2–27 days). At routine follow-up 2 weeks postoperatively all but three patients (2%) were considered pain free, which was significantly less than in 15 consecutive VATS lobectomies with rigid thoracoscopy performed prior to the introduction of flexible VATS (p = 0.02).
Video-assisted thoracoscopic lobectomy by flexible thoracoscopy is feasible and in our opinion easier and safer compared with rigid thoracoscopy. In our experience all parts of the operation are better visualized and many surgical pitfalls may be avoided. Even during early phases of setting up the VATS lobectomy program, the duration of the operation is comparable with open surgery, and postoperative pain is low, possibly because porthole angulation is minimized.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Roviaro G, Rebuffat C, Varoli F et al (1992) Videoendoscopic pulmonary lobectomy for cancer. Surg Laparosc Endosc 2:244–247
Kirby TJ, Rice TW (1993) Thoracoscopic lobectomy. Ann Thorac Surg 56:784–786
Lewis RJ (1993) The role of video-assisted thoracic surgery for carcinoma of the lung: wedge resection to lobectomy by simultaneous individual stapling. Ann Thorac Surg 56:762–768
McKenna R Jr (1995) VATS lobectomy with mediastinal lymph node sampling or dissection. Chest Surg Clin North Am 5:223–232
Walker WS, Carnochan FM, Pugh GC (1993) Thoracoscopic pulmonary lobectomy. Early operative experience and preliminary clinical results. J Thorac Cardiovasc Surg 106:1111–1117
McKenna RJ Jr, Wolf RK, Brenner M et al (1998) Is lobectomy by video-assisted thoracic surgery an adequate cancer operation? Ann Thorac Surg 66:1903–1908
Flores RM, Alam N (2008) Video-assisted thoracic surgery lobectomy (VATS), open thoracotomy, and the robot for lung cancer. Ann Thorac Surg 85:S710–S715
Nicastri DG, Wisnivesky JP, Litle VR et al (2008) Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg 135:642–647
Shigemura N, Yim AP (2007) Variation in the approach to VATS lobectomy: effect on the evaluation of surgical morbidity following VATS lobectomy for the treatment of stage I non-small cell lung cancer. Thorac Surg Clin 17:233–239
Reed MF, Lucia MW, Starnes SL et al (2008) Thoracoscopic lobectomy: introduction of a new technique into a thoracic surgery training program. J Thorac Cardiovasc Surg 136:376–381
Roviaro G, Varoli F, Vergani C et al (2004) Long-term survival after videothoracoscopic lobectomy for stage I lung cancer. Chest 126:725–732
McKenna RJ Jr, Fischel RJ, Wolf R et al (1998) Video-assisted thoracic surgery (VATS) lobectomy for bronchogenic carcinoma. Semin Thorac Cardiovasc Surg 10:321–325
Mahtabifard A, DeArmond DT, Fuller CB et al (2007) Video-assisted thoracoscopic surgery lobectomy for stage I lung cancer. Thorac Surg Clin 17:223–231
Walker WS, Codispoti M, Soon SY et al (2003) Long-term outcomes following VATS lobectomy for non-small cell bronchogenic carcinoma. Eur J Cardiothorac Surg 23:397–402
Kaseda S, Aoki T, Hangai N et al (2000) Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg 70:1644–1646
Ohtsuka T, Nomori H, Horio H et al (2004) Is major pulmonary resection by video-assisted thoracic surgery an adequate procedure in clinical stage I lung cancer? Chest 125:1742–1746
West D, Rashid S, Dunning J (2007) Does video-assisted thoracoscopic lobectomy produce equal cancer clearance compared to open lobectomy for non-small cell carcinoma of the lung? Interact Cardiovasc Thorac Surg 6:110–116
Iwasaki A, Shirakusa T, Shiraishi T et al (2004) Results of video-assisted thoracic surgery for stage I/II non-small cell lung cancer. Eur J Cardiothorac Surg 26:158–164
Shigemura N, Akashi A, Funaki S et al (2006) Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stage IA lung cancer: a multi-institutional study. J Thorac Cardiovasc Surg 132:507–512
Kirby TJ, Mack MJ, Landreneau RJ et al (1995) Lobectomy–video-assisted thoracic surgery versus muscle-sparing thoracotomy. A randomized trial. J Thorac Cardiovasc Surg 109:997–1001
Sugi K, Kaneda Y, Esato K (2000) Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg 24:27–30
Craig SR, Leaver HA, Yap PL et al (2001) Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg 20:455–463
McKenna RJ Jr, Houck W, Fuller CB (2006) Video-assisted thoracic surgery lobectomy: experience with 1, 100 cases. Ann Thorac Surg 81:421–425
Mahtabifard A, Fuller CB, McKenna RJ Jr (2008) Video-assisted thoracic surgery sleeve lobectomy: a case series. Ann Thorac Surg 85:S729–S732
Hazelrigg SR, Cetindag IB, Fullerton J (2002) Acute and chronic pain syndromes after thoracic surgery. Surg Clin North Am 82:849–865
Stammberger U, Steinacher C, Hillinger S et al (2000) Early and long-term complaints following video-assisted thoracoscopic surgery: evaluation in 173 patients. Eur J Cardiothorac Surg 18:7–11
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Licht, P.B., Ladegaard, L. Flexible Thoracoscopy may Facilitate Video-Assisted Thoracoscopic Lobectomy. World J Surg 34, 1470–1474 (2010). https://doi.org/10.1007/s00268-010-0468-6
- Analgesic Medication
- Mediastinal Lymph Node Station
- Thoracoscopic Wedge Resection
- Standard Posterolateral Thoracotomy
- Lobectomy Procedure