THORACOSCOPIC SURGERY FOR LUNG-CANCER USING THE 2 SMALL SKIN INCISIONAL METHOD - 2 WINDOWS METHOD

Pulmonary lobectomy and mediastinal lymph node dissection was performe d in 25 patients with Stage I lung cancer under thoracoscopic guidance using the two-windows method. A posterior skin incision (3 cm) and a lateral skin incision (2 cm) were made in the 4th intercostal space ce ntering on the inferior angle of the scapula. The site closest to the operating surgeon was used for direct vision, white the distant site w as used for insertion of the thoracoscope. The mean operative time was 2 hours and 15 minutes, and the mean blood loss was 82.6 mi. The mean number of dissected mediastinal lymph nodes was 32. The length of hos pitalization ranged from 5 to 17 days. Recovery was uneventful, and an algesics were not required by postoperative day 6. The two-windows met hod overcomes the three-dimensional inaccuracy due to the one-directio nal observation of the operative field employed during conventional th oracoscopy. In addition, since we developed this method for mediastina l lymph node dissection, the tracheal bifurcation can be confirmed und er direct vision, increasing the accuracy of the procedure. The advant ages of the two-window thoracoscopic method of pulmonary lobectomy are cosmesis, preservation of respiratory function, and reduced postopera tive pain In addition, there is reduced intraoperative bleeding and sh ortened operative time, while achieving mediastinal dissection similar to that of standard thoracotomy. The two-windows method of thoracosco pic pulmonary lobectomy is equal or superior to standard thoracotomy i n every respect. This method should become the standard surgical techn ique for Stage I lung cancer.