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OBJECTIVE: Video assisted thoracic surgery (VATS) lobectomy although introduced more than twenty years ago it has not gained yet worldwide acceptance. We aimed to present our learning curve with 20 patients regarding the development of a hybrid technique which is in-between open thoracotomy and complete VATS lobectomy.
METHODS: Between July 2012 and July 2014, we retrospectively reviewed 20 patients who underwent lobectomy for lung cancer via a hybrid procedure, which utilizes dual access to the hemithorax, through two thoracoscopy ports (interchangeable for the camera and the Endo-stapler), and a posterior 10-12 cm serratus muscle sparing mini-thoracotomy with minor rib spreading; therefore, it offers direct visualization, and by allowing the insertion of surgeon’s hand, palpation or repair of any inadvertent major pulmonary vessel injury, resection of larger than 3 cm tumors, and radical lymph node dissection.
RESULTS: The study identified 17 men and 3 women, with a median age of 63.5 years (range 51-75 years). Median operative time was 115 minutes (range 90-140 minutes). Uncomplicated patients were discharged on the 5th postoperative day. Complications included atelectasis and chylothorax, were observed in 2 patients (10%), and managed conservatively with success. There was no 30 days mortality. Except for 3 patients (one with anxiety disorder, and 2 with depression), the needs of pain medications of remaining 17 patients were significantly less in comparison to patients undergoing lobectomy via typical open thoracotomy. Excluding 9 patients with postoperative stage Ia, and 2 with Ib, the remaining 7 patients with IIa, one with IIb, and one with IIIa commenced adjuvant chemotherapy within 3 weeks following surgery. All patients were doing well at one and 6 months postoperatively, during follow up.
CONCLUSIONS: Video-assisted mini-thoracotomy lobectomy for lung cancer was proved a safe, oncological, expedient, easy to learn and teach, minimally invasive procedure for major pulmonary resection, that can be applied not only to patients with early stage lung cancer; owing to the integrated advantages of both open thoracotomy and complete VATS operations, it is evolving into our preferred surgical approach.