Video-assisted thoracoscopic (VATS) lobectomy: left upper lobe
Epublication WebSurg.com, Sep 2012;12(09). URL: http://websurg.com/doi/vd01en3755
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 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: 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 carried out with similar morbidity and similar oncologic outcome to traditional open surgery. We present VATS lobectomy for an adenocarcinoma of the left upper lobe in a 66-year-old patient (the video emphasizes the steps of lobe resection – complete 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 continued support.