Complete versus assisted thoracoscopic approach: a prospective randomized trial comparing a variety of video-assisted thoracoscopic lobectomy techniques

  • N. Shigemura
  • A. Akashi
  • T. Nakagiri
  • M. Ohta
  • H. Matsuda
Original article



Video-assisted thoracoscopic surgery (VATS) lobectomy does not represent a unified approach, but rather a spectrum of operative techniques ranging from a complete endoscopic thoracotomy to a minithoracotomy. A prospective randomized trial was conducted to compare the differences in these techniques and their results to determine the best of VATS lobectomy for lung cancer.


This study randomized 39 consecutive patients with clinical stage I lung cancer to undergo either a complete (C-VATS, n = 20) or an assisted (A-VATS, n = 19) VATS approach for pulmonary lobectomy.


The operating time was longer (p = 0.002) and blood loss was less (p = 0.004) with C-VATS than with A-VATS. Although there was no significant difference in analgesic use or duration of thoracic drainage between the groups, a shorter hospitalization was observed after C-VATS. Serum peak levels of postoperative inflammatory markers (white blood cell count, C-reactive protein, creatine phosphokinase) were lower with C-VATS and an earlier return to normalization than with A-VATS.


Various differences exist among the VATS lobectomy techniques, and complete VATS lobectomy as a purely endoscopic surgery may be technically feasible and a satisfactory alternative to the conventional procedure for stage I lung cancer.


VATS lobectomy Lung cancer Thoracoscopy Prospective randomized trial Stapler 


  1. 1.
    Iwasaki, M, Nishiumi, N, Maitani, F 1996Thoracoscopic surgery for lung cancer using the two small skin incisional method: two-windows methodJ Thorac Cardiovasc Surg377981Google Scholar
  2. 2.
    Jacobaeus, HC 1910Uder die Moglichkeit der Zystokope bei Untersuching seroser Hohlungen auzuwendenMunch Med Wochenschr1020902192Google Scholar
  3. 3.
    Kaseda, S, Aoki, T, Kitano, M 1997Preliminary experience using Harmonic Scalpel for lung resection under thoracoscopic guidanceJpn Endosc Surg3254258Google Scholar
  4. 4.
    Kitano, S, Iso, Y, Moriyama, M 1994Laparoscopy-assisted Billroth I gastrectomySurg Laparosc Endosc2146148Google Scholar
  5. 5.
    Kondo, T, Sagawa, M, Tanita, T, Sato, M, Ono, S, Matsumura, Y, Fujimura, S 1998Is complete systematic nodal dissection by thoracoscopic surgery possible? A prospective trial of video-assisted lobectomy for cancer of right lungJ Thorac Cardiovasc Surg116651652PubMedGoogle Scholar
  6. 6.
    Landreneau, RJ, Mack, MJ, Hazelrigg, SR 1992Video-assisted thoracic surgery: basic technical concepts and intercostals approach strategiesAnn Thorac Surg54800807PubMedGoogle Scholar
  7. 7.
    Mack, MJ, Scruggs, GR, Kelly, KM, Shennib, H, Landreneau, RJ 1997Video-assisted thoracic surgery: has technology found its place?Ann Thorac Surg64211215CrossRefPubMedGoogle Scholar
  8. 8.
    Morikawa, T, Katoh, H, Takeuchi, E 1998Technical feasibility of video-assisted lobectomy with radical lymphadenectomySurg Laparosc Endosc8466473CrossRefPubMedGoogle Scholar
  9. 9.
    Shigemura, N, Akashi, A, Nakagiri, T 2002New operative method for a giant bulla: sutureless and stapleless thoracoscopic surgery using the LigaSure systemEur J Thorac Surg22646648CrossRefGoogle Scholar
  10. 10.
    Uyama, I, Sugioka, A, Fujita, J, Komori, Y, Matsui, H, Hasumi, A 2000Completely laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomyJ Am Coll Surg191114119CrossRefPubMedGoogle Scholar
  11. 11.
    Yim, AP, Landreneau, RJ, Izzat, MB, Fung, AL, Wan, S 1998Is video-assisted thoracoscopic lobectomy a unified approach?Ann Thorac6611551158CrossRefGoogle Scholar
  12. 12.
    Yim, AP, Liu, HP 1997Thoracoscopic major lung resection: indications, technique, and early results: experience from two centers in AsiaSurg Laparosc Endosc7241244CrossRefPubMedGoogle Scholar
  13. 13.
    Yim, AP, Wan, S, Lee, TW, Arifi, AA 2000VATS lobectomy reduces cytokine responses compared with conventional surgeryAnn Thorac Surg70243247CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • N. Shigemura
    • 1
  • A. Akashi
    • 1
  • T. Nakagiri
    • 1
  • M. Ohta
    • 2
  • H. Matsuda
    • 2
  1. 1.Division of the General Thoracic SurgeryTakarazuka Municipal HospitalHyogoJapan
  2. 2.Department of SurgeryOsaka University Graduate School of MedicineSuitaJapan

Personalised recommendations