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Can Neurovascular Bundle-Sparing Thoracotomy(NVBST) rival Video Assisted Thoracoscopic Surgery (VATS) in terms of pain scores?
Sanjeet Singh Avtaar Singh, Ahmad Ali, Peter Lang, Rohith Govindraj, Alan Kirk.
Golden Jubilee National Hospital, Glasgow, United Kingdom.

OBJECTIVE: VATS has become the gold standard for lung cancer resection and constitutes a key component of enhanced recovery programmes. However, certain patient characteristics ensure that an open approach may sometimes be essential. Numerous publications have championed VATS to be superior primarily due to better post-operative pain scores. We postulated that post-thoracotomy pain can be reduced by protecting the neurovascular bundle. We sought to determine whether there is a difference in patient-reported pain scores and hospital length of stay (LOS) between those undergoing lobectomy via VATS compared to NVBST.
METHODS: We retrospectively analysed an e-database of prospectively entered data of all lobectomies for primary lung cancer performed by 1 surgeon over 1 year. For VATS, standard 3-port posterior approach was used. For NVBST, 8cm serratus-sparing posterolateral incision was used; closure was effected using intracostal sutures (Size 2 Vicryl) running through four holes drilled into the lower rib. In all patients, paravertebral catheters and a single chest drain were sited. Pain scores on postoperative days (POD) 0, 1, 2 and 3 and LOS were compared.
RESULTS: From September 2014 to September 2015, there were 93 lobectomies (39 NVBST, 54 VATS).


There was no significant difference between the age, gender and side of surgery. Post-operatively, pain scores were similar in both groups although there was a shorter length of stay in patients who underwent VATS Lobectomies.
There was no statistically significant difference between pain scores: but LOS was longer for NVBST. (8 days vs 6.5 days, p=0.004)
CONCLUSIONS: Our study shows that there is no difference in pain scores following lobectomy via VATS vs. NVBST. However, LOS is shorter for VATS. The establishment of VATS as standard technique for lung resection has catalysed the parallel evolution of improved thoracotomy techniques. Continued development of both techniques as part of enhanced recovery programmes will ensure better outcomes for all patients undergoing lung cancer resection.


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