Abstract
Background
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.
Methods
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.
Results
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.
Conclusion
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.
Similar content being viewed by others
References
M Iwasaki N Nishiumi F Maitani (1996) ArticleTitleThoracoscopic surgery for lung cancer using the two small skin incisional method: two-windows method J Thorac Cardiovasc Surg 37 79–81 Occurrence Handle1:STN:280:BymC1cbhsFc%3D
HC Jacobaeus (1910) ArticleTitleUder die Moglichkeit der Zystokope bei Untersuching seroser Hohlungen auzuwenden Munch Med Wochenschr 10 2090–2192
S Kaseda T Aoki M Kitano (1997) ArticleTitlePreliminary experience using Harmonic Scalpel for lung resection under thoracoscopic guidance Jpn Endosc Surg 3 254–258
S Kitano Y Iso M Moriyama (1994) ArticleTitleLaparoscopy-assisted Billroth I gastrectomy Surg Laparosc Endosc 2 146–148
T Kondo M Sagawa T Tanita M Sato S Ono Y Matsumura S Fujimura (1998) ArticleTitleIs complete systematic nodal dissection by thoracoscopic surgery possible? A prospective trial of video-assisted lobectomy for cancer of right lung J Thorac Cardiovasc Surg 116 651–652 Occurrence Handle1:STN:280:DyaK1cvjsl2rtQ%3D%3D Occurrence Handle9766597
RJ Landreneau MJ Mack SR Hazelrigg (1992) ArticleTitleVideo-assisted thoracic surgery: basic technical concepts and intercostals approach strategies Ann Thorac Surg 54 800–807 Occurrence Handle1:STN:280:ByyD3sjotVw%3D Occurrence Handle1417251
MJ Mack GR Scruggs KM Kelly H Shennib RJ Landreneau (1997) ArticleTitleVideo-assisted thoracic surgery: has technology found its place? Ann Thorac Surg 64 211–215 Occurrence Handle10.1016/S0003-4975(97)00247-6 Occurrence Handle1:STN:280:ByiA2sbls1A%3D Occurrence Handle9236363
T Morikawa H Katoh E Takeuchi (1998) ArticleTitleTechnical feasibility of video-assisted lobectomy with radical lymphadenectomy Surg Laparosc Endosc 8 466–473 Occurrence Handle10.1097/00019509-199812000-00014 Occurrence Handle1:STN:280:DyaK1M%2FnvFyhsw%3D%3D Occurrence Handle9864117
N Shigemura A Akashi T Nakagiri (2002) ArticleTitleNew operative method for a giant bulla: sutureless and stapleless thoracoscopic surgery using the LigaSure system Eur J Thorac Surg 22 646–648 Occurrence Handle10.1016/S1010-7940(02)00412-8
I Uyama A Sugioka J Fujita Y Komori H Matsui A Hasumi (2000) ArticleTitleCompletely laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomy J Am Coll Surg 191 114–119 Occurrence Handle10.1016/S1072-7515(00)00283-0 Occurrence Handle1:STN:280:DC%2BD3czlsVGmtQ%3D%3D Occurrence Handle10898192
AP Yim RJ Landreneau MB Izzat AL Fung S Wan (1998) ArticleTitleIs video-assisted thoracoscopic lobectomy a unified approach? Ann Thorac 66 1155–1158 Occurrence Handle10.1016/S0003-4975(98)00622-5 Occurrence Handle1:STN:280:DyaK1M%2FhsFCitQ%3D%3D
AP Yim HP Liu (1997) ArticleTitleThoracoscopic major lung resection: indications, technique, and early results: experience from two centers in Asia Surg Laparosc Endosc 7 241–244 Occurrence Handle10.1097/00019509-199706000-00013 Occurrence Handle1:STN:280:ByiA3sjlsVM%3D Occurrence Handle9194287
AP Yim S Wan TW Lee AA Arifi (2000) ArticleTitleVATS lobectomy reduces cytokine responses compared with conventional surgery Ann Thorac Surg 70 243–247 Occurrence Handle10.1016/S0003-4975(00)01258-3 Occurrence Handle1:STN:280:DC%2BD3cvgvVKjsw%3D%3D Occurrence Handle10921716
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shigemura, N., Akashi, A., Nakagiri, T. et al. Complete versus assisted thoracoscopic approach: a prospective randomized trial comparing a variety of video-assisted thoracoscopic lobectomy techniques. Surg Endosc 18, 1492–1497 (2004). https://doi.org/10.1007/s00464-003-8252-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-003-8252-4