Journal List > J Korean Med Assoc > v.55(12) > 1042520

J Korean Med Assoc. 2012 Dec;55(12):1193-1198. Korean.
Published online December 18, 2012.  https://doi.org/10.5124/jkma.2012.55.12.1193
Copyright © 2012 Korean Medical Association
Video-assisted thoracoscopic lobectomy for lung cancer
Hyun Koo Kim, MD
Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

Corresponding author: Hyun Koo Kim, Email: kimhyunkoo@korea.ac.kr
Received October 16, 2012; Accepted October 30, 2012.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Video-assisted thoracoscopic surgery (VATS) provides a new approach for treating early-stage lung cancer. VATS lobectomy has significant perioperative advantages such having as a lower rate of morbidity and being less immunosuppressive than open lobectomy, and it also provides a shorter recovery time, less postoperative pain, and faster resumption of a normal lifestyle. However, a clear definition of VATS lobectomy is lacking in the current literature. The generally accepted method of VATS lobectomy is from three to four incisions in number of port, 4.0 to 8.0 cm in utility length, and without rib spreading. However, there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer. Concerns regarding safety, the extent of mediastinal lymph node dissection, and long-term survival have made some surgeons apprehensive of its validity for lung cancer. Nevertheless, recent data have shown that VATS lobectomy appears to have equivalent oncological results compared with open lobectomy for patients with early stage non-small cell lung cancer. With growing experience with VATS and development of thoracoscopic instrument, VATS can be beneficial to patients with early stage of lung cancer.

Keywords: Video-assisted thoracoscopic surgery; Lobectomy; Lung neoplasms

Figures


Figure 1
Utility incision and ports placement for video-assisted thoracoscopic surgery right lower lobecotmy.
Click for larger image


Figure 2
(A) Right inferior pulmonary vein dissection. (B) Division using endostapler.
Click for larger image


Figure 3
(A) Dissection of pulmonary artery to lower lobe. (B) Division using endostapler.
Click for larger image


Figure 4
(A) Dissection of right lower lobe bronchus. (B) Division using endostapler.
Click for larger image


Figure 5
(A) Dissection of subcarinal lymph node. (B) Dissection of right paratracheal lymph node. SVC, superior vena cava.
Click for larger image

References
1. Hoksch B, Birken-Bertsch H, Muller JM. Thoracoscopy before Jacobaeus. Ann Thorac Surg 2002;74:1288–1290.
2. Jacobaeus HC. The cauterization of adhesions in artificial pneumothorax treatment of pulmonary tuberculosis under thoracoscopic control. Proc R Soc Med 1923;16(Electro Ther Sect):45–62.
3. Boutin C, Astoul P, Seitz B. The role of thoracoscopy in the evaluation and management of pleural effusions. Lung 1990;168 Suppl:1113–1121.
4. Mack MJ, Aronoff RJ, Acuff TE, Douthit MB, Bowman RT, Ryan WH. Present role of thoracoscopy in the diagnosis and treatment of diseases of the chest. Ann Thorac Surg 1992;54:403–408.
5. Landreneau RJ, Mack MJ, Hazelrigg SR, Dowling RD, Acuff TE, Magee MJ, Ferson PF. Video-assisted thoracic surgery: basic technical concepts and intercostal approach strategies. Ann Thorac Surg 1992;54:800–807.
6. McKenna RJ Jr. Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. J Thorac Cardiovasc Surg 1994;107:879–881.
7. Boffa DJ, Allen MS, Grab JD, Gaissert HA, Harpole DH, Wright CD. Data from The Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg 2008;135:247–254.
8. Kim KH. Thoracoscopic treatment of spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg 1991;24:261–264.
9. Yoon YH, Lee DY, Kim HH, Bae GM. Lobectomy with video-assisted thoracoscopy. Korean J Thorac Cardiovasc Surg 1993;26:236–240.
10. Kim K, Kim HK, Park JS, Chang SW, Choi YS, Kim J, Shim YM. Video-assisted thoracic surgery lobectomy: single institutional experience with 704 cases. Ann Thorac Surg 2010;89:S2118–S2122.
11. Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW, Stiles BM, Port JL, D'Amico TA. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg 2010;139:366–378.
12. Lee HS, Lee JW, Kim KI, Cho SW, Park SJ, Kim HS, Shin YC, Shin HS. Video-assisted thoracic surgery lobectomy: experience with 36 cases. Korean J Thorac Cardiovasc Surg 2009;42:732–737.
13. Swanson SJ, Herndon JE 2nd, D'Amico TA, Demmy TL, McKenna RJ Jr, Green MR, Sugarbaker DJ. Video-assisted thoracic surgery lobectomy: report of CALGB 39802--a prospective, multi-institution feasibility study. J Clin Oncol 2007;25:4993–4997.
14. Zhu M, Fu XN, Chen X. Lobectomy by video-assisted thora coscopic surgery (VATS) for early stage of non-small cell lung cancer. Front Med 2011;5:53–60.
15. Whitson BA, D'Cunha J, Andrade RS, Kelly RF, Groth SS, Wu B, Miller JS, Kratzke RA, Maddaus MA. Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity. Ann Thorac Surg 2008;86:1735–1744.
16. Hirai T, Matsumoto H, Yamashita K, Urakami A, Iki K, Yamamura M, Tsunoda T. Surgical oncotaxis: excessive surgical stress and postoperative complications contribute to enhancing tumor metastasis, resulting in a poor prognosis for cancer patients. Ann Thorac Cardiovasc Surg 2005;11:4–6.
17. Walker WS. Video-assisted thoracic surgery (VATS) lobectomy: the Edinburgh experience. Semin Thorac Cardiovasc Surg 1998;10:291–299.
18. Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 2009;27:2553–2562.
19. Nakata M, Saeki H, Yokoyama N, Kurita A, Takiyama W, Takashima S. Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg 2000;70:938–941.
20. Li WW, Lee RL, Lee TW, Ng CS, Sihoe AD, Wan IY, Arifi AA, Yim AP. The impact of thoracic surgical access on early shoulder function: video-assisted thoracic surgery versus posterolateral thoracotomy. Eur J Cardiothorac Surg 2003;23:390–396.
21. Andrade RS, Maddaus MA. Thoracoscopic lobectomy for stage I non-small cell lung cancer. Semin Thorac Cardiovasc Surg 2010;22:14–21.
22. Watanabe A, Koyanagi T, Ohsawa H, Mawatari T, Nakashima S, Takahashi N, Sato H, Abe T. Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study. Surgery 2005;138:510–517.
23. Sagawa M, Sato M, Sakurada A, Matsumura Y, Endo C, Handa M, Kondo T. A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg 2002;73:900–904.
24. Denlinger CE, Fernandez F, Meyers BF, Pratt W, Zoole JB, Patterson GA, Krupnick AS, Kreisel D, Crabtree T. Lymph node evaluation in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy. Ann Thorac Surg 2010;89:1730–1735.
25. Yamashita Y, Harada H, Misumi K. Video-assisted thoracic surgery lobectomy for lung cancer: the point at issue. Gen Thorac Cardiovasc Surg 2011;59:164–168.
26. Yamamoto K, Ohsumi A, Kojima F, Imanishi N, Matsuoka K, Ueda M, Miyamoto Y. Long-term survival after video-assisted thoracic surgery lobectomy for primary lung cancer. Ann Thorac Surg 2010;89:353–359.
27. Nicastri DG, Wisnivesky JP, Litle VR, Yun J, Chin C, Dembitzer FR, Swanson SJ. Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg 2008;135:642–647.
28. Kim HR, Cho JS, Jang HJ, Lee SC, Choi ES, Jheon S, Sung SW. Video-assisted thoracic surgery lobectomy for non-small cell lung cancer: experience of 133 cases. Korean J Thorac Cardiovasc Surg 2009;42:615–623.