A hybrid technique: video-assisted thoracoscopic surgery (VATS) pulmonary resections for community-based surgeons

Abstract

Background

Although video-assisted thoracoscopic surgery (VATS) for pulmonary resection was first described more than 15 years ago, it has yet to gain grass-roots acceptance. The majority of surgeons who routinely perform VATS resections work in academic or government institutions. The perceived complexity of the technique, inadequate instrumentation and resources, and concern regarding the potential compromise of surgical and oncologic principles may present a greater barrier to adoption by community-based surgeons. This article illustrates some of the technical aspects of a hybrid technique that enables a single surgeon to perform VATS pulmonary resection on a routine basis in a community-based practice.

Methods

From January 2005 to March 2008, 492 VATS pulmonary resections were performed by a community-based, solo-practice surgeon using a hybrid VATS technique. The highlight of this technique is utilization of a thoracoscopy port and a utility incision. The advantages of this dual access are ease in instrumentation, visualization, lighting, and retraction. In addition, this technique allows immediate access under direct vision for urgent control of bleeding, which can be difficult using a conventional thoracoscopic approach.

Results

Mean operative time was 52 (median, 48) minutes. Mean length of stay was 7 (median, 4) days. Mean length of ICU stay was 1.7 days, with 85% of patients having no days spent in the ICU. Mean length of chest tube duration was 4 days. Perioperative mortality was 3.5% and overall mortality was 9.8%, with a mean follow-up of 239 days. These results compare favorably with the conventional VATS approach.

Conclusions

This series shows that our hybrid VATS approach to pulmonary resection is safe and feasible at community hospital-based practices.

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References

  1. 1.

    Roviaro G, Rebuffat C, Varoli F, Vergani C, Mariani C, Maciocco M (1992) Videoendoscopic pulmonary lobectomy for cancer. Surg Laparosc Endosc 2:244–247

    CAS  PubMed  Google Scholar 

  2. 2.

    McKenna RJ Jr, Houck W, Fuller CB (2006) Video-assisted thoracic surgery lobectomy: experience with 1, 100 cases. Ann Thorac Surg 81:421–425

    Article  PubMed  Google Scholar 

  3. 3.

    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 23:397–402

    Article  PubMed  Google Scholar 

  4. 4.

    Yim AP, Landreneau RJ, Izzat MB, Fung AL, Wan S (1998) Is video-assisted thoracoscopic lobectomy a unified approach? Ann Thorac Surg 66:1155–1158

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Alam N, Flores RM (2007) Video-assisted thoracic surgery (VATS) lobectomy: the evidence base. JSLS 11:368–374

    PubMed  Google Scholar 

  6. 6.

    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

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    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

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Sugi K, Kaneda Y, Esato K (2000) Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg 24:27–30

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Demmy TL, Curtis JJ (1999) Minimally invasive lobectomy directed toward frail and high-risk patients: a case-control study. Ann Thorac Surg 68:194–200

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    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 128:2696–2701

    Article  PubMed  Google Scholar 

  11. 11.

    Sugi K, Kaneda Y, Esato K (2000) Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg 24:27–30; discussion 30–31

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    McKenna RJ Jr, Wolf RK, Brenner M, Fischel RJ, Wurnig P (1998) Is lobectomy by video-assisted thoracic surgery an adequate cancer operation? Ann Thorac Surg 66:1903–1908

    Article  PubMed  Google Scholar 

  13. 13.

    Lewis RJ, Caccavale RJ (1998) Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy (VATS(n)SSL). Semin Thorac Cardiovasc Surg 10:332–339

    CAS  PubMed  Google Scholar 

  14. 14.

    Kaseda S, Aoki T (2002) Video-assisted thoracic surgical lobectomy in conjunction with lymphadenectomy for lung cancer. Nippon Geka Gakkai Zasshi 103:717–721

    PubMed  Google Scholar 

  15. 15.

    Hoksch B, Ablassmaier B, Walter M, Muller JM (2003) Complication rate after thoracoscopic and conventional lobectomy. Zentralbl Chir 128:106–110

    Article  PubMed  Google Scholar 

  16. 16.

    Roviaro G, Varoli F, Vergani C, Maciocco M, Nucca O, Pagano C (2004) Video-assisted thoracoscopic major pulmonary resections: technical aspects, personal series of 259 patients, and review of the literature. Surg Endosc 18:1551–1558

    CAS  PubMed  Google Scholar 

  17. 17.

    Shaw JP, Dembitzer FR, Wisnivesky JP, Litle VR, Weiser TS, Yun J, Chin C, Swanson SJ (2008) Video-assisted thoracoscopic lobectomy: state of the art and future directions. Ann Thorac Surg 85:S705–S709

    Article  PubMed  Google Scholar 

  18. 18.

    Congregado M, Merchan RJ, Gallardo G, Ayarra J, Loscertales J (2008) Video-assisted thoracic surgery (VATS) lobectomy: 13 years’ experience. Surg Endosc 22:1852–1857

    Article  PubMed  Google Scholar 

  19. 19.

    Hazelrigg SR, Cetindag IB, Fullerton J (2002) Acute and chronic pain syndromes after thoracic surgery. Surg Clin North Am 82:849–865

    Article  PubMed  Google Scholar 

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Correspondence to Kazuaki Takabe.

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Kim, R.H., Takabe, K. & Lockhart, C.G. A hybrid technique: video-assisted thoracoscopic surgery (VATS) pulmonary resections for community-based surgeons. Surg Endosc 24, 700–704 (2010). https://doi.org/10.1007/s00464-009-0615-z

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Keywords

  • Video-assisted thoracoscopic surgery
  • Pulmonary resection
  • Minimally invasive
  • Community-based
  • Lung cancer