VATS lobectomy

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VATS lobectomy
Specialtysurgical oncology

Video-assisted thoracoscopic surgery (VATS) lobectomy is an approach to lung cancer surgery.

Thoracotomy

Dissection of the right superior pulmonary vein with VATS
Dissection of the anterior trunk of the right pulmonary artery with VATS
Preparing to divide the anterior trunk of the right pulmonary artery with the endoscopic stapler
Placing the resected lobe into a water-tight bag for removal from the chest

Anatomic lung resection, i.e. pulmonary

morbidity is considerably less with lobectomy.[1]

Traditionally, pulmonary

bronchial secretions, which in turn leads to an increased risk of persistent atelectasis (collapsed areas of lung) or pneumonia. Finally, to allow time for the divided muscles and bone fractures to heal, patients must refrain from strenuous activity or lifting greater than 5 lbs for 6 weeks after surgery.[2]

History

Video-assisted thoracoscopic surgery, or VATS, came into widespread use in the 1990s and early on in its development practitioners began to perform lobectomy via VATS incisions.[3] The advantage of VATS over thoracotomy is that major chest wall muscles are not divided and ribs are not spread. This leads to reductions in the intensity and duration of post-operative pain and allows patients to return to full activity more quickly.

For lung cancer

VATS lobectomy is the same as lobectomy performed via thoracotomy in that the

costovertebral joint pain are not used. This results in a hospital length of stay after VATS lobectomy generally reported to range from 3–5 days,[4]
or roughly half that for lobectomy via thoracotomy.

Candidates

Not all patients are candidates for VATS lobectomy. The classic indication for a VATS approach to lobectomy is early stage

arteries and airways to portions of the lung that are not being removed are preserved intact. In addition, patients who have had pre-operative chemotherapy or radiation for lung cancer or previous chest surgeries may not be candidates for VATS due to scarring around the major blood vessels that makes dissection via VATS difficult. But recent evidence suggests that thoracoscopic lobectomy is a feasible approach for selected patients undergoing resection after induction therapy, and is associated with shorter hospital stay and chest tube duration.[5] Cases in which a lung tumor invades the chest wall and an en bloc resection of ribs must be performed to achieve negative resection margins generally are felt to abrogate the value of VATS. Also pneumonectomy by VATS is a safe and feasible treatment for both benign and malignant lung diseases that induces acceptable damage and has lower morbidity.[6]

Published benefits

Because of the lesser chest wall trauma of VATS compared to

medical economics, VATS lobectomy is less expensive than lobectomy performed via thoracotomy because hospital length of stay and number of days in the intensive care unit are significantly reduced.[10]

See also

References

  1. PMID 12527560
    .
  2. ^ "What to Expect After Your Thoracic Surgery | Memorial Sloan Kettering Cancer Center". www.mskcc.org. Retrieved 2023-01-23.
  3. PMID 26286240
    .
  4. PMID 17626400
    .
  5. PMID 24040521
    .
  6. PMID 29445597
    .
  7. PMID 18154816
    .
  8. PMID 18329487
    .
  9. PMID 17118669
    .
  10. PMID 19136272
    .

External links
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