Safety in complex VATS lobectomy: how to secure your procedure
Epublication WebSurg.com, Feb 2015;15(02). URL: http://websurg.com/doi/vd01en4436
Objective As surgical teams performing video-assisted thoracoscopic (VATS) lobectomy procedures improve in technicality, surgeons have to face more complex cases which could not be handled without an open thoracotomy before. Consequently, unexpected events occur and safety measures must be implemented in order to prevent whatever could be prevented. Clinical videos have become a very powerful tool that allow surgeons from the world over to share their experience on the matter. Methods In this video, routine safety procedures used in our center are illustrated. The case presented is that of a 52-year-old woman with a clinical stage IIIA (T3N1M0) mass at the left upper lobe. CT-scan showed a close relationship between the tumor and the first upper lobar branch. In many centers, this would often contraindicate a minimally invasive approach. Results A preoperative assessment is crucial in order to anticipate the anatomy of the area. CT-scan reconstruction is of great importance whenever the surgeon requires it. The procedure is begun with an extended safety checklist including the availability of conversion instruments and a second suction line as major ‘’go/no go’’ factors. The anterior approach of the hilum allows for a control of both arterial and venous structures using vessel loops. Conclusions Our technique allows to routinely perform safe and reproducible complex cases of VATS lobectomy.