Video-assisted thoracoscopic (VATS) lobectomy: middle lobe
Epublication WebSurg.com, Apr 2014;14(04). URL: http://websurg.com/doi/vd01en4235
Standard treatment of early-stage non-small cell lung cancer involves anatomic pulmonary lobectomy and mediastinal lymph node dissection. Traditionally, this procedure has been carried out via a posterolateral 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: - proper patient positioning; - access to the pleural cavity and appropriate positioning of operating incisions (Although we favor a fully thoracoscopic technique for all our cases, some centers may use a 4 to 5cm “working incision” near the axilla); - 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 carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for an adenocarcinoma of the middle lobe in a 67-year-old patient (the video emphasizes the steps of lobe resection - mediastinal lymph node dissection was effected but is not shown). Acknowledgment: we would like to thank Nathalie Leroux RN and Suzanne Desbiens RN for their unfaltering dedication and continued support.