Video-assisted thoracic surgery (VATS): right lower lobectomy with complete node clearance using an anterior approach
Epublication WebSurg.com, Jun 2012;12(06). URL: http://websurg.com/doi/vd01en3707
This video presents the management of a suspicious peripheral pulmonary tumor located in the right lower lobe (RLL), classified cT3N0M0 after preoperative staging (positive PET-scan with positive pathology). This case has been presented in a thoracic oncology multidisciplinary meeting, which validated a first-line surgical treatment by lobectomy and radical mediastinal lymph node resection. The video demonstrates the videothoracoscopic anterior approach, initially described by McKenna and modified by Hansen. This anterior approach seems easier to reproduce and generally simpler than a videothoracoscopic posterior approach for many reasons: no dissection of the fissure, which is an unpredictable technique depending on the patient, use of a 5cm pleurotomy allowing for an easy access for curved instruments, and a very quick conversion, should it be needed; this last safety measure is fundamental. Videothoracoscopic surgery is poorly developed in France although it is becoming a standard procedure in some major reference centers in thoracic surgery. This procedure offers many advantages: early rehabilitation linked to lesser postoperative pain, a rapid return to regular daily activities, an earlier onset for any potential adjuvant therapy. It is important to be familiar with the anterior approach because it presents very different anatomical features as compared with the conventional posterior approach by thoracotomy. The emergence of reference centers should make training for this complex surgery possible, and it will probably become a therapeutic standard for cancer treatment, along with other specialities. This video shows many tips to deal with fissure and pulmonary artery.