Technique for Complete Video-Assisted Thoracic Lobectomy (c-VATS Lobectomy)
c-VATS lobectomy (complete video-assisted thoracic surgery) was introduced in the early 1990s. While in the late 1990s and early 2000s, the question was if c-VATS lobectomy is comparable to open lobectomy, the accent has moved to studies which proof that
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Technique for Complete VideoAssisted Thoracic Lobectomy (c-VATS Lobectomy) Jan Siebenga
Contents
7.1
7.1
Introduction ...............................................
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7.2 7.2.1 7.2.2 7.2.3 7.2.4 7.2.5 7.2.6
General Considerations ............................ Trocars ........................................................ Positioning .................................................. Exposure and Lung Retraction ................... Lymphadenectomy ...................................... Vascular Control ......................................... Thoracic Drainage.......................................
78 78 78 79 80 80 80
7.3 7.3.1 7.3.2 7.3.3 7.3.4 7.3.5
Technique ................................................... Right Upper Lobe ....................................... Right Middle Lobe ...................................... Right Lower Lobe ....................................... Left Upper Lobe.......................................... Left Lower Lobe .........................................
80 80 81 86 88 90
References ................................................................
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J. Siebenga, M.D. Division of Thoracic Surgery, Department of General Surgery, Atrium Medical Centre, Henri Dunantstraat 5, 6401 CX Heerlen, The Netherlands e-mail: [email protected]
Introduction
There is mounting evidence that c-VATS lobectomy is an oncologic adequate procedure and thereby an advantage for our patients [16]. While in the late 1990s and early 2000s, the question was if c-VATS lobectomy is comparable to open lobectomy, the accent has moved to studies which proof that c-VATS lobectomy is better than open lobectomy. Areas in which c-VATS lobectomy performs better are reduced postoperative pain [8], shorter hospital stay [12, 16], better recovery [6], better pulmonary function [8], lower overall complication rate [9, 16], shorter chest tube drainage [5, 12, 16], and better compliance to adjuvant chemotherapy [10]. One of the causes for the relatively slow introduction of c-VATS lobectomy is the technically difficult procedure with a relatively long learning curve [2, 7]. Furthermore, it is difficult to perform an RCT because of the limited compliance with the approach (for VATS surgeons, a thoracotomy is a more morbid operation) and patients request a less invasive approach. In this chapter, the technical aspects of the c-VATS lobectomy are described. There are different definitions for the VATS lobectomy [13]. For this chapter, the definition of report CALGB 39802 will be used: “we prefer to standardize the definition of a VATS lobectomy to encompass a true anatomic lobectomy with individual ligation of lobar vessels and bronchus as well as hilar
R.G.C. Inderbitzi et al. (eds.), Minimally Invasive Thoracic and Cardiac Surgery, DOI 10.1007/978-3-642-11861-6_7, © Springer-Verlag Berlin Heidelberg 2012
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J. Siebenga
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lymph node dissection or sampling using the video screen for guidance, two or three ports, and no retractor use or rib spreading” [14].
7.2
General Considerations
The te
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