Abstract
Background
Although more than 10 years have passed since the first video-assisted thoracoscopic lobectomies, these procedures have not gained widespread acceptance. We discuss the technical aspects and major problems associated with these operations, focusing on their present status and future perspectives. The results of our clinical series are presented and the relevant literature is reviewed.
Methods
From October 1991 to June 2003, 344 patients were submitted to surgery for an intended video major pulmonary resection.
Results
Of the 344 patients, seven (2.0%) were deemed inoperable at video exploration; 78 (23.1%) required conversion, either for technical reasons (n=3), anatomical problems (n=49), oncological conditions (n=20), or intraoperative complications (n=6). We carried out 253 video-assisted lobectomies and six pneumonectomies (209 for primary lung tumor, 43 for benign disease, and seven for metastases). There were no intraoperative deaths. Two patients died postoperatively. Complications occurred in 20 patients (7.7%). Global survival at 3 and 5 years was 83.24% (±6.9) and 68.87% (±9.7) respectively. Patients with T1 N0 cancer had a better survival rate at 3 and 5 years (87.13±8.3% and 75.12±12.2%) than those with T2 N0 cancer (78.49±11.2% and 61.2±15%).
Conclusions
Based on our experience and a review of the literature, we conclude that video-assisted thoracoscopic lobectomies offer less postoperative pain, a more rapid recovery, and better cosmetic results than their conventional counterpart. The results at 3- and 5-year follow-up for cancer are attractive. However, because no randomized study has yet proved these benefits definitively, further studies are still needed.
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References
Brown WT (1998) Video-assisted thoracic surgery: the Miami experience. Semin Thorac Cardiovasc Surg 10: 305–312.
Giudicelli R, Thomas P, Lonjon T, Ragni J, Bulgare JC, Ottomani R, Fuentes P (1994) Major pulmonary resection by video-assisted minithoracotomy: initial experience in 35 patients. Eur J Cardiothorac Surg 8: 254–258.
Kaseda S, Aoki T, Hangai N (1998) Video-assisted thoracic surgery (VATS) lobectomy: the Japanese experience. Semin Thorac Cardiovasc Surg 10: 300–304.
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: 1644–1646.
Kirby TJ, Mack MJ, Landreneau RJ, Rice TW (1993) Initial experience with video-assisted thoracoscopic lobectomy. Ann Thorac Surg 56: 1248–1253
Kirby TJ, Mack MJ, Landreneau RJ, Rice TW (1995) Lobectomy—video-assisted thoracic surgery versus muscle-sparing thoracotomy: a randomized trial. J Thorac Cardiovasc Surg 109: 997–1001.
Lewis RJ (1993) The role of video-assisted thoracic surgery for cancer of the lung: wedge resections to lobectomy by simultaneous stapling. Ann Thorac Surg 56: 762–768.
Lewis RJ, Caccavale RJ, Bocage JP, Widman MD (1999) Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy. Chest 116: 1119–1124.
Loscertales J, Jmienez-Merchan R, Arenas-Linares C, Giron-Arjona JC, Congregado-Loscertales M (1997) The use of video-assisted thoracic surgery in lung cancer: evaluation of resectability in 296 patients and 71 pulmonary exeresis with radical lymphadenectomy. Eur J Cardiothorac Surg 12: 892–897.
Mack MJ, Scruggs GR, Kelly KM, Shennib H, Landreneau RJ (1997) Video-assisted thoracic surgery: has technology found its place? Ann Thorac Surg 64: 211–215.
McKenna RJ Jr (1994) Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. J Thorac Cardiovasc Surg 107: 879–881.
McKenna RJ (2000) Commentary 17A to the article by Roviaro et al. Anatomic lung resections. In: Yim APC, Hazelrigg SR, Izzat MB, Landreneau RJ, Mack MJ, Naunheim KS, Ferguson TB. (eds) Minimal access cardiothoracic surgery. WB Saunders, Philadelphia, pp 114–115.
McKenna RJ Jr, Fischel RJ, Wolff R, Wurning P (1998) Video-assisted thoracoscopic surgery (VATS) lobectomy for bronchogenic carcinoma. Semin Thorac Cardiovasc Surg 10: 321–325.
Nakata M, Saeki H, Yokoyama N, Kurita A, Takiyama W, Takashima S (2000) Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg 70: 938–941.
Naruke T (2000) Thoracoscopic lobectomy with mediastinal lymph node dissection or sampling. In: Yim APC, Hazelrigg SR, Izzat MB, Landreneau RJ, Mack MJ, Naunheim KS, Ferguson TB. (eds) Minimal access cardiomoracic surgery. WB Saunders, Philadelphia, pp 116–126.
Roviaro GC, Rebuffat C, Varoli F, Vergani C, Maciocco M, Scalambra SM, Corti D (1993) Major videothoracoscopic pulmonary resections. Endosc Surg 1: 288–293.
Roviaro GC, Varoli F, Rebuffat C, Vergani C, D'Hoore A, Scalambra SM, Maciocco M, et al. (1993) Major pulmonary resections: pneumonectomies and lobectomies. Ann Thorac Surg 56: 779–783.
Roviaro GC, Varoli F, Rebuffat C, Sonnino C, Vergani C, Maciocco M, Pastori M (1996) Videothoracoscopic operative staging for lung cancer. Int Surg 81: 252–254.
Roviaro GC, Varoli F, Vergani C, Maciocco M (1998) Video-assisted thoracoscopic surgery (VATS) major pulmonary resections: the Italian experience. Semin Thorac Cardiovasc Surg 10: 313–320.
Roviaro GC, Varoli F, Vergani C, Maciocco M (1999) Techniques of pneumonectomy: video-assisted thoracic surgery pneumonectomy. Chest Surg Clin North Am 9: 419–436.
Walker WS (1998) Video-assisted thoracic surgery (VATS) lobectomy: the Edimburgh experience. Semin Thorac Cardiovasc Surg 10: 291–299.
Yim APC, Ko K, Chau W, Ma C, Ho JKS, Kyaw K (1996) Video-assisted thoracoscopic anatomic lung resection: the initial Hong Kong experience. Chest 109: 13–17.
Yim APC, Izza MB, Liu H, Ma C (1998) Thoracoscopic major lung resections: an Asian perspective. Semin Thorac Cardiovasc Surg 10: 326–331.
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Online publication: 13 October 2004
This review article contains a video, which is available to subscribers toSurgical Endoscopy at http://www.springerlink.comCorrespondence to: G. Roviaro
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Roviaro, G., Varoli, F., Vergani, C. et al. Video-assisted thoracoscopic major pulmonary resections. Surg Endosc 18, 1551–1558 (2004). https://doi.org/10.1007/BF02637119
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DOI: https://doi.org/10.1007/BF02637119