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The Annals of Thoracic Surgery, Vol 56, 784-786, Copyright © 1993 by The Society of Thoracic Surgeons
TJ Kirby and TW Rice
The various applications of video-assisted thoracic surgery (VATS) have
rapidly expanded in the past 2 years to include may straightforward and
technically unsophisticated procedures. We report our experience in 23
patients in which a VATS lobectomy was attempted. Preoperative staging,
which included a computed tomographic scan of the head, chest, and abdomen
as well as a bone scan, revealed that these patients with primary non-small
cell lung carcinomas were in clinical stage I. All patients had adequate
pulmonary reserve to tolerate a lobectomy. Further staging was accomplished
by invasive means in all patients, and consisted of mediastinoscopy and,
when indicated, mediastinotomy. Three patients were subsequently found to
have N2 disease and were excluded from the study. In 15 of the remaining 20
patients, a successful VATS lobectomy was accomplished. There were no major
intraoperative complications and all patients recovered uneventfully. Their
mean hospital stay was 5.5 +/- 1.9 days. We conclude that VATS lobectomy is
technically possible in this good-risk group of patients with early
clinical stage I lung cancer. However, as with all VATS procedures, the
advantages of this approach over more conventional surgical techniques need
to be addressed in randomized trials. Our experience also indicates that
considerable improvements are necessary, both in terms of the imaging and
the instrumentation, to allow major procedures such as pulmonary lobectomy
to be safely and expeditiously performed using a VATS approach.
ARTICLES
Thoracoscopic lobectomy
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195.
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