Surgical Endoscopy

, Volume 25, Issue 4, pp 1263–1269 | Cite as

Video-assisted thoracoscopic surgery (VATS) lobectomy using a standardized anterior approach

  • Henrik Jessen HansenEmail author
  • René Horsleben Petersen
  • Merete Christensen



Lobectomy using video-assisted thoracoscopic surgery (VATS) still is a controversial operation despite its many observed benefits. The controversy may be due to difficulties performing the procedure. This study addresses a standardized anterior approach facilitating the operation.


This report describes 156 VATS lobectomies performed with a uniform anterior three-port technique. The surgeon and the assistant stand on the abdominal side of the patient, and the setup is independent of the lobe to be resected.


From 2005 to 2007, 156 VATS lobectomies and 13 conversions (7.7%) were performed with an anterior three-port technique. No mortality occurred among the VATS lobectomies during a 30-day period. The major comorbidity rate was 78%. The comorbidities included former thoracic surgery (9%) or a history of another cancer (22%), indicating potentially difficult surgery and a nonselected population. The majority (92%) of the patients had lung cancer. The major postoperative problem was air leakage, which usually prolongs the tube time and the in-hospital stay, but a “no-touch fissure” technique significantly reduced the median tube time to 4 days and the postoperative hospital stay to 5 days.


This study shows that VATS lobectomies can be performed using a standardized anterior approach with low rates of conversion and morbidity. A “no-touch fissure” technique lowers the postoperative tube time, the in-hospital stay, and the number of patients with prolonged air leakage. A uniform anterior approach facilitates VATS lobectomy and makes this advanced procedure more easily adaptable by many surgeons familiar with an open anterior approach. The findings show that VATS lobectomy can be performed safely for a large proportion of lung cancer patients.


Lobectomy Lung cancer Thoracoscopic VATS 


  1. 1.
    Sedrakyan A, van der Meulen J, Lewsey J, Treasure T (2004) Video-assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials. BMJ 329:1008–1010PubMedCrossRefGoogle Scholar
  2. 2.
    Alberts MW (2007) Diagnosis and management of lung cancer executive summary. ACCP evidence-based clinical practice guidelines (2nd ed). Chest 132:1S–S19PubMedCrossRefGoogle Scholar
  3. 3.
    Downey RJ, Cheng D, Kernstine K, Stanbridge R, Shennib H, Wolf R, Ohtsuka T, Schmid R, Waller D, Fernando H, Yim A, Martin J (2007) Video-Assisted thoracic surgery for lung cancer resection. A Consensus statement of the international society of minimally invasive cardiothoracic surgery (ISMICS) 2007. Innovations 2:293–302Google Scholar
  4. 4.
    Cheng D, Downey RJ, Kernstine K, Stanbridge R, Shennib H, Wolf R, Ohtsuka T, Schmid R, Waller D, Fernando H, Yim A, Martin J (2007) Video-assisted thoracic surgery in lung cancer resection: a meta-analysis and systematic review of controlled trials. Innovations 2:261–292Google Scholar
  5. 5.
    Whitson BA, Groth SS, Duval SS, Swanson SJ, Maddaus MA (2008) Surgery for early-stage non–small-cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg 86:2008–2018PubMedCrossRefGoogle Scholar
  6. 6.
    Yan TD, Black D, Bannon PG, McCaughan (2009) Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small cell lung cancer. J Clin Oncol 27:2553–2562PubMedCrossRefGoogle Scholar
  7. 7.
    Lewis RJ, Caccavale RJ (1998) Video-assisted thoracic surgical non–rib-spreading simultaneously stapled lobectomy (VATS(n)SSL). Semin Thorac Cardiovasc Surg 10:332–339PubMedGoogle Scholar
  8. 8.
    Okada M, Sakamoto T, Yuki T, Mimura T, Miyoshi K, Tsubota N (2005) Hybrid surgical approach of video-assisted minithoracotomy for lung cancer: significance of direct visualization on quality of surgery. Chest 128:2696–2701PubMedCrossRefGoogle Scholar
  9. 9.
    McKenna RJ, Houck W, Fuller CB (2006) Video-assisted thoracic surgery lobectomy: experience with 1, 100 cases. Ann Thorac Surg 81:421–426PubMedCrossRefGoogle Scholar
  10. 10.
    Onaitis MW, Petersen RP, Balderson SS, Toloza E, Burfeind WR, Harpole DH Jr, D’Amico TA (2006) Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg 244:420–425PubMedGoogle Scholar
  11. 11.
    Walker WS, Codispoti M, Soon SY, Stamenkovic S, Carnochan F, Pugh G (2003) Long-term outcomes following VATS lobectomy for non–small-cell bronchogenic carcinoma. Eur J Cardiothorac Surg 23:397–402PubMedCrossRefGoogle Scholar
  12. 12.
    Gossot D (2008) Technical tricks to facilitate totally endoscopic major pulmonary resections. Ann Thorac Surg 86:323–326PubMedCrossRefGoogle Scholar
  13. 13.
    Mountain CF, Dresler CM (1997) Regional lymph node classification for lung cancer staging. Chest 111:1718–1723PubMedCrossRefGoogle Scholar
  14. 14.
    Kaseda S, Aoki T, Hangai N, Shimizu K (2000) Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg 70:1644–1646PubMedCrossRefGoogle Scholar
  15. 15.
    Balduyck B, Hendriks J, Lauwers P, Van Schil P (2007) Quality-of-life evolution after lung cancer surgery: a prospective study in 100 patients. Lung Cancer 56:423–431PubMedCrossRefGoogle Scholar
  16. 16.
    Shigemura N, Akashi A, Funaki S, Nakagiri T, Inoue M, Sawabata N, Shiono H, Minami M, Takeuchi Y, Okumura M, Sawa Y (2006) Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stage IA lung cancer: a multi-institutional study. J Thorac Cardiovasc Surg 132:507–512PubMedCrossRefGoogle Scholar
  17. 17.
    Yim AP, Wan S, Lee TW, Ahmed A, Arifi AA (2000) VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg 70:243–247PubMedCrossRefGoogle Scholar
  18. 18.
    Petersen RP, Pham D, Burfeind WR, Hanish SI, Toloza EM, Harpole DH Jr, D’Amico TA (2007) Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg 83:1245–1249PubMedCrossRefGoogle Scholar
  19. 19.
    Watanabe A, Koyanagi T, Obama T, Ohsawa H, Mawatari T, Noriyuki Takahashi N, Ichimiya Y, Abe T (2005) Assessment of node dissection for clinical stage I primary lung cancer by VATS. Eur J Cardiothorac Surg 27:745–752PubMedCrossRefGoogle Scholar
  20. 20.
    Casali G, Walker WS (2009) Video-assisted thoracic surgery lobectomy: can we afford it? Eur J Cardiothorac Surg 35:423–428PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Henrik Jessen Hansen
    • 1
    Email author
  • René Horsleben Petersen
    • 1
  • Merete Christensen
    • 1
  1. 1.Department of Cardiothoracic Surgery 2.15.2, The Heart Center, RigshospitaletThe National University HospitalCopenhagenDenmark

Personalised recommendations