Surgical techniques to avoid parenchymal injury during lung resection (fissureless lobectomy).

Thoracoscopic lobectomy has become an accepted, safe, and oncologically sound procedure compared with open lobectomy. Several studies have reported that it reduces the length of stay, postoperative pain, and postoperative complications, including air leaks. Although there are specific technical considerations that must be taken into account, it is increasingly becoming the preferred method of anatomic lobectomy. Surgeons should be encouraged to embrace the minimally invasive strategy, which may be learned in courses using novel simulation techniques. Future directions suggest that this technique will be expanded to address even the most challenging thoracic procedures.

Thoracoscopic lobectomy for the management of non-small cell lung cancer.

Surgical resection is the primary treatment for early-stage non-small cell lung cancer (NSCLC). While open thoracotomy is the most frequently performed approach for lobectomy, minimally invasive surgical resection is a safe and viable alternative. Thoracoscopic lobectomy, also termed video-assisted thoracoscopic surgery lobectomy, is defined as the anatomic resection of an entire lobe of the lung-including mediastinal lymph node dissection-using a thoracoscope and an access incision without using a mechanical retractor and spreading of the ribs. As the procedure has evolved and been studied, thoracoscopic lobectomy has been demonstrated to be a safe and oncologically effective strategy in the surgical management of patients with stage I or II NSCLC, as well as selected patients with stage III NSCLC after induction therapy. Advantages of this approach include less postoperative pain, shorter chest tube duration and subsequent length of stay, fewer overall complications, better compliance with adjuvant chemotherapy, faster return to full activity, and greater preservation of pulmonary function.

Anatomic thoracoscopic segmentectomy for early-stage lung cancer.

Over the past 20 years, there have been significant advancements in thoracoscopic surgical techniques as well as in lung cancer screening protocols, which have identified greater numbers of smaller lung tumors (<2 cm) that are more frequently operable and curable. These advancements have led to new interest in the thoracoscopic (VATS) approach to segmentectomy. This article will discuss the outcomes and technical considerations associated with VATS segmentectomy.

Thoracoscopic sympathectomy in the management of vasomotor disturbances and complex regional pain syndrome of the hand.

Complex regional pain syndrome, vasospastic disorders, and hyperhidrosis are chronic and debilitating upper extremity problems. Twenty-nine consecutive patients treated with thoracoscopic sympathectomy are presented. Diagnoses included complex regional pain syndrome, hyperhidrosis, Buerger's disease, Raynaud's disease, and peripheral vascular disease. All patients with hyperhidrosis had complete symptom resolution. Patients with Buerger's and Raynaud's disease had excellent/good results. Six patients with complex regional pain syndrome had excellent or good relief; the remaining six patients had varying degrees of recurrence. A statistically significant association was noted between duration of complex regional pain syndrome prior to sympathectomy and outcome. Thoracoscopic sympathectomy is an effective treatment for hyperhidrosis and vasospastic disorders. Although the results for complex regional pain syndrome are not uniformly excellent, this technique offers promise in the treatment of this difficult problem.

Thoracoscopic left upper lobectomy in patients with internal mammary artery coronary bypass grafts.

BACKGROUND: This study examined outcomes of a technique for performing thoracoscopic left upper lobectomy (LUL) in patients with a previous left internal mammary artery (LIMA) coronary artery bypass graft, where a small wedge of lung parenchyma adjacent to the graft is left to avoid injury. METHODS: All patients undergoing thoracoscopic LUL from 1999 to 2010 at a single institution were reviewed. Perioperative morbidity, cancer recurrence, and long-term survival were compared between patients who had (LIMA group) or did not have (control group) a previous LIMA graft. RESULTS: During the study period, 290 patients underwent thoracoscopic LUL; 14 (5%) had previous LIMA grafts. There was no perioperative mortality in the LIMA group versus 4 (1%) in the control group (p = 0.65). One patient (7%) in the LIMA group required conversion to thoracotomy, which was similar to the control group (n = 16, 6%; p = 0.83). Overall perioperative morbidity was also not different between the groups (LIMA 36% [5 of 14] versus control 29% [81 of 276], p = 0.61). No patient in the LIMA group had perioperative cardiac ischemia. For patients with lung cancer, 5-year survival (LIMA 50% vs control 63%, p = 0.23) and cancer recurrence rates (LIMA 27% (3 of 11) versus control 15% (36 of 242), p = 0.27) were not different between the groups. Only 1 LIMA recurrence was local, and it was not related to the parenchyma left on the LIMA graft. CONCLUSIONS: Thoracoscopic LUL can be performed safely in patients with LIMA bypass grafts. Leaving lung parenchyma on the graft may prevent injury and does not compromise oncologic outcomes in appropriately selected patients.