Ann Thorac Surg 1998;66:1466-1467
© 1998 The Society of Thoracic Surgeons
Correspondence
Reply
Masayuki Iwasaki, MDa,
Hiroshi Inoue, MDa
a Department of Surgery, School of Medicine, Tokai University, Isahara, Kanagawa 2591193, Japan
To the Editor
We thank Dr Tovar for his letter regarding our article. We would like to make the following comments.
Whenever we have attempted to remove resected lung tissue (lobe of the lung) from the thoracic cavity without using a bag, it has always been necessary to make at least a 5-cm skin incision. There are two reasons for placing the resected lung tissue in a bag: one is to prevent malignant cells from falling into the thoracic cavity, and the other is to make it possible to extract the resected lung tissue smoothly through a smaller skin incision. The length of the skin incisions at the time we developed the two-windows method in 1993 [1, 2] was about 2 cm anteriorly and about 5 cm posteriorly, and at that time we also used bags. In those days we thought at least a 5-cm skin incision was needed to smoothly remove the resected lung tissue from the body thoracoscopically. However, we found that a 2-cm skin incision was long enough to perform pulmonary lobectomy thoracoscopically (Fig 1), and we also discovered that it was possible to remove the resected lung tissue from the body through a 3-cm incision by using a bag made of stronger material instead of the thoracoscopic surgery bags available at the time. Because the bags made for thoracoscopic use are expensive and fragile, when we attempted to remove fairly large volumes of resected lung tissue through small skin incisions, the bags often broke, and we had no choice but to make the skin incision slightly larger to remove them. The bags that we are currently using that meet these conditions are the bags that contain Vital Vue (Sherwood Davis & Geck, Boston, MA). We process these bags in a simple manner before using them. Their use has allowed removal of resected lung tissue from smaller skin incisions and has resulted in the two-windows method assuming its current form.
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Fig 1. A lateral incision (Thoraco-Holder; Fuji Systems Corporation, Tokyo, Japan) and a posterior incision (original opener) were made in the fourth intercostal space centering on the angle of the scapula (two-windows method).
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References
- Iwasaki M., Nishiumi N., Inoue H., et al. Thoracoscopic surgery for lung cancer using the two small skin incisional method. J Cardiovasc Surg 1996;37:79-81.[Medline]
- Iwasaki M., Kaga K., Nishiumi N., et al. Experience with the two-windows method for mediastinal lymph node dissection in lung cancer. Ann Thorac Surg 1998;65:800-802.[Abstract/Free Full Text]
