Technique for delivering large tumors in video-assisted thoracoscopic lobectomy. (March 2014)

• Record Type: Journal Article
• Authors: Sihoe, Alan DL; Chawla, Surbhi; Paul, Sohini; Nair, Arun; Lee, Jesse; Yin, Kanhua
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 22:Number 3(2014)
• Page Start: 319
• Page End: 328
• Publication Date: 2014-03
• Subjects: Lung neoplasms -- pneumonectomy -- ribs -- thoracic surgery -- video-assisted; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492313503641
• Languages: English
• ISSNs: 0218-4923

Abstract

Background: The optimal technique for delivering large tumors during video-assisted thoracoscopic lobectomy remains uncertain. Methods: In 258 patients receiving video-assisted thoracoscopic lobectomy for lung cancer, techniques for delivering the resected lobe included complete video-assisted thoracoscopic lobectomy without rib spreading ( n = 206, 80%), resection of a short rib segment ( n = 9, 3%), brief rib spreading ( n = 12, 5%), and conversion to a minithoracotomy ( n = 21, 8%). In 10 (4%) patients, a novel anterior rib cutting technique was used: one rib at the utility port was cut near its anterior end to widen the intercostal space without forcible rib spreading for lobe delivery. Results: There was no mortality or major morbidity using the anterior rib cutting technique, and it delivered tumors of a larger mean diameter than complete video-assisted thoracoscopic lobectomy (5.4 ± 3.4 vs. 2.3 ± 1.4 cm, p = 0.017) whilst yielding a similar mean operation time and blood loss to the other non-complete video-assisted thoracoscopic lobectomy techniques. The anterior rib cutting technique gave similar postoperative patient pain scores and analgesic use to complete video-assisted thoracoscopic lobectomy, and shorter mean hospital stay than the other non-complete video-assisted thoracoscopic lobectomy techniques (5.6 ± 2.8 vs. 10.0 ± 7.1 days, p = 0.003). Conclusions: In video-assisted thoracoscopic lobectomy, the anterior rib cutting technique is a safe and feasible procedure for delivering large tumors, causing no more pain than complete video-assisted thoracoscopic lobectomy, and allowing faster recovery than other non-complete video-assisted thoracoscopic lobectomy techniques.