Original article
General thoracic
Video-Assisted Thoracic Surgery Lobectomy: Experience With 1,100 Cases

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.
https://doi.org/10.1016/j.athoracsur.2005.07.078Get rights and content

Background

Although many video-assisted thoracic surgery (VATS) lobectomies have been performed over the 12 years since the first VATS lobectomy, controversies about the procedure remain regarding the safety and associated morbidity and mortality of that procedure. This series is reviewed to assess these issues.

Methods

Between 1992 and 2004, we performed 1,100 VATS lobectomies in 595 women (54.1%) and 505 men (45.9%), with a mean age of 71.2 years. Diagnoses were as follows: benign disease (53), pulmonary metastases (27), lymphoma (5), and lung cancer (1,015). Of the primary lung cancers, 641 (63.1%) were adenocarcinoma. With visualization on a monitor, anatomic hilar dissection and lymph node sampling or dissection were performed, primarily through a 5-cm incision without spreading the ribs.

Results

There were 9 deaths (0.8%), and none was intraoperative or due to bleeding; 932 patients had no postoperative complications (84.7%). Blood transfusion was required in 45 of 1,100 patients (4.1%). Length of stay was median 3 days (mean, 4.78). One hundred eighty patients (20%) were discharged on postoperative day 1 or 2. Conversion to a thoracotomy occurred in 28 patients (2.5%). Recurrence developed in the incisions in 5 patients (0.57%). In 2003, 89% of 224 lobectomies were performed with VATS.

Conclusions

VATS lobectomy with anatomic dissection can be performed with low morbidity and mortality rates. The risk of intraoperative bleeding or recurrence in an incision seems minimal.

Section snippets

Procedure

Under single-lung anesthesia, the VATS procedures were anatomic dissections with individual ligation of the vessels and bronchi. A 5-mm trocar for the 5-mm, 30-degree thoracoscope was placed through the eighth intercostal space in the midaxillary line. A 2-cm incision was made in the sixth intercostal space in the midclavicular line. A ring forceps through that incision displaced the lung posteriorly to expose the superior pulmonary vein. A utility incision was made directly lateral from the

Results

From February 1992 through December 2004, 1,100 patients underwent VATS with the intention to perform a minimally invasive anatomic pulmonary resection. They were 595 women (54.1%) and 505 men (45.9%). Mean age was 71.2 years (range, 16 to 94); 160 patients were aged 80 years or more.

The resections performed are seen in Table 1. The pathologic diagnoses for the 1,100 resections include the following: primary lung cancer (1,015 patients), benign diseases (53 patients, as seen in Table 2),

Comment

Published series of VATS lobectomy shows that the procedure is being performed around the world [2, 7, 8, 9, 10, 11, 12, 13, 14, 15]. However, less than 10% of lobectomies are currently performed with VATS, because most thoracic surgeons are still not comfortable with the technique. In the largest published experience with VATS lobectomy, we have shown that the procedure can be performed safely and with some apparent advantages over a thoracotomy. The length of stay is short and the rate of

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