Technique for delivering large tumors in video-assisted thoracoscopic lobectomy

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.