Introduction

Abstract

Although video-assisted thoracoscopic major pulmonary resections are not widely used yet, the interest in these techniques has grown after the publication of a large number of studies reporting good results. Increasing evidence suggests that thoracoscopic lobectomies can be performed with reduced morbidity and equivalent oncologic outcomes compared to open lobectomies. A multivariate analysis of 21 series of video-assisted lobectomies for early-stage non-small-cell lung carcinoma has demonstrated that they competed with open lobectomies not only in terms of morbidity but also in terms of survival. One of the main concern for surgeons wishing to embark on these new approaches is that the term “video-assisted lobectomy” covers a broad spectrum of techniques that may be very different according to the use or nonuse of a utility incision and/or of a rib spreader. Differences are also related to other factors: the type of instrumentation, i.e., conventional versus endoscopic, and the type of imaging, i.e., natural vision through the incision or video display or a combination of both. After having used a video-assisted technique we have switched to a full endoscopic technique, termed « complete VATS or “closed technique” in some recent papers. As for some major abdominal surgical procedures (hepatectomies, nephrectomies, colectomies), the operation is carried out using only endoscopic instruments and video display. In this technique, there is no utility incision and the specimen is retrieved through one of the port sites that is enlarged after completion of the resection.