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Video-assisted thoracoscopic (VATS) lobectomy: left lower lobe

G Rakovich, MD, FRCSC, FACS
Epublication WebSurg.com, Dec 2014;14(12). URL: http://websurg.com/doi/vd01en4390

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  • 2014-12-15
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Standard treatment of early-stage non-small cell lung cancer (NSCLC) involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterior lateral thoracotomy, requiring division of chest wall muscles and rib spreading. This is frequently associated with chronic postoperative pain, which may become incapacitating in 5% of patients. One of the major potential advantages of video-assisted thoracoscopic (VATS) lobectomy is decreasing the incidence of chronic post-thoracotomy pain. Key aspects of the procedure include the following: - proper patient positioning; - access to the pleural cavity and appropriate positioning of operating incisions; - careful dissection of pulmonary arterial branches, using a “fissure-sparing” technique whenever possible to decrease the incidence of prolonged postoperative air leaks; - division of lung parenchyma, blood vessels, and bronchus using endoscopic staplers. The VATS approach can be performed with lower morbidity and an equivalent or better oncologic outcome to traditional open surgery. We present a VATS lobectomy for a carcinoid tumor of the left lower lobe in a 42-year-old patient. The video lays emphasis on the steps of lobe resection; mediastinal lymph node dissection was performed but is not shown. Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens for their continued support.