Thoracoscopic Lobectomy

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.