The Feasibility of a Two-incision Approach for Video-Assisted Thoracoscopic Lobectomy

Hyun Koo Kim, Ho Kyung Sung, Hyun Joo Lee, Jiae Min, Young Ho Choi. College of Medicine, Korea University Guro Hospital



Purpose: We performed video-assisted thoracoscopic (VATS) lobectomy with two incisions for treatment of benign lung disease or primary lung cancer and evaluated the feasibility of this procedure.

Methods: Fifty-two patients (male 35, female 17; mean age 58.9±12.46 years) of 60 (86.7%) who underwent major pulmonary resection (lobectomy, bilobectomy, or pnemonectomy) have been performed a consecutive two-incision approach for VATS lobectomy from July 2010 to July 2011. The thoracoscopy port, approximately 1 cm long, is located at the 7th or 8th intercostal space in the mid-axillary line, and the working port, approximately 3~5 cm long, at the 5th intercostal space in the operator site.

The preoperative diagnosis was benign lung disease in 7 patients (13.7%) (3 pulmonary sequestration, 2 pulmonary tuberculosis, 1 emphysema, and 1 bronchogenic cyst) and primary lung cancer in 45 patients (86.3%). Clinical stage of lung cancer was T1 or T2 N0M0 in 38 patients (84.4%), T3N0M0 in 2 (5.0%), and N1 or N2 in 5 (11.4%). Two patients of N1or N2 disease underwent preoperative adjuvant chemotherapy. Of these, 9 patients (20.0%) needed the third port during surgery because of severe pleural adhesion (6 cases) or incomplete fissure (3 cases). Conversion to thoracotomy was performed in 4 patients (8.9%) due to anthracofibrotic lymph nodes (2 cases), major vessel bleeding (1 case), or securing bronchial resection margin (1 case). Mean duration of operation in the 39 cases completed by two-port VATS lobectomy was 145.1±23.15 min (range, 94~225). In 32 cases completed by two-port VATS lobectomy for primary lung cancer, the total number of dissected lymph nodes per patient was 19.2±5.34 (range, 6~32). The chest tube was removed on postoperative day 5.4 ± 2.8 (range, 3~18), and there was no occurrence of major perioperative morbidity and mortality.

Conclusions: Two-incision VATS lobectomy is applicable in selected cases; however, when needed, conversion to standard VATS or thoracotomy should be performed without hesitation.

Session Number: SS21 – Videos: Solid Organ & Foregut
Program Number: V046

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