Troubleshooting in thoracoscopic anatomical lung resection for lung cancer
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REVIEW ARTICLE
Troubleshooting in thoracoscopic anatomical lung resection for lung cancer Atsushi Watanabe1 Received: 28 June 2020 / Accepted: 28 July 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Video-assisted thoracoscopic surgery (VATS) anatomical lung resection (ALR) has been gaining popularity in the treatment of lung cancer in line with remarkable advances in both equipment and technique. The development and refinement of its technique have allowed thoracic surgeons to perform a wide variety of challenging and complex procedures in a minimally invasive fashion. Careful and meticulous preparation may shift in the future with the increasing sophistication and capabilities of VATS ALR. Moreover, constant awareness and a structured plan of the procedure are imperative to reducing or preventing complications. Intraoperative major complications during VATS ALR are infrequent, but can have catastrophic consequences. The decision to continue with VATS should take into consideration the surgeon’s skill level and ease with the approach and the relative potential benefit against the risk to the patient. We conducted this study to investigate the possible problems during VATS ALR and identify how to solve them based on the previous literature and our institutional data sampling. Keywords Troubleshooting · VATS · Anatomical lung resection · Primary lung cancer
Introduction Video-assisted thoracoscopic surgery (VATS) lobectomy is a safe and widely accepted treatment for early stage non-small cell lung cancer (NSCLC) [1, 2]. However, VATS lobectomy is associated with a significantly higher rate of intraoperative complications than lobectomy by thoracotomy (odds ratio, 1.6; 95% confidence interval, 1.0–2.4; p = 0.04) [3]. Intraoperative complications can occur at any time: during the early, middle, and later parts of the learning curve [3]. Several studies have focused on troubleshooting and outlined a predetermined stepwise plan to introduce VATS lobectomy into their thoracic training programs [3–6]. Although these studies try to facilitate successful VATS lobectomy, they do not provide specific situations to be aware of and none describes measures to address these situations. Thus, we review the mechanism, contributing factors, treatment, and prevention strategies for intraoperative issues during
* Atsushi Watanabe [email protected] 1
Department of Thoracic Surgery, Sapporo Medical University School of Medicine and Hospital, South 1, West 16, Chuo‑ku, Sapporo 060‑8543, Japan
VATS anatomical lung resection (ALR), being lobectomy and segmentectomy.
Present status of VATS ALR for primary lung cancer (PLC) Definition of VATS ALR The Cancer and Leukemia Group B defined VATS lobectomy as “no use of rib-spreading and a maximum length of 8 cm for the utility incision” [7]. On the other hand, VATS lobectomy can be defined as “lobectomy performed entirely under monitor-vision without rib spreading”. It can be distinguished from mini-thoracotomy with video assistance, in which surgery is performed under dire
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