FULLY THORACOSCOPIC PULMONARY LOBECTOMY AND SPECIMEN EXTRACTION THROUGH RIB SEGMENT RESECTION - PRELIMINARY-REPORT

Background: A technique of fully thoracoscopic pulmonary lobectomy wit h rib-segment resection for specimen extraction is described, and prel iminary results in 18 patients are presented. Methods: Surgery is perf ormed through four 15-mm ports. For all lobes except one, the surgeon operates in front of the patient, where the rib spaces are widest and rib-space trauma is less, When lobar dissection is complete, specimen extraction is performed after resection of a rib segment proportional to tumor size. Muscle section is kept to a minimum. There is no rib re traction. Results: There were no deaths, three conversions to open sur gery, and three major complications. Average postoperative stay was 5. 4 days for patients without complications and 9.6 days for patients wi th complications, In total six patients presented with some degree of air leaks, and two had post-thoracotomy pain (>2 month's duration). Th e literature is reviewed to analyze current techniques and to define p arameters of a truly minimally invasive pulmonary lobectomy. Conclusio ns: This technique is safe and promising; however, thoracoscopic lobec tomy still needs refining. Before valid randomized studies comparing t horacoscopic lobectomy and muscle-sparing thoracotomy or posterolatera l thoracotomy can be credible, technical issues related to the product ion of a truly minimally invasive procedure should be resolved.