THORACOSCOPIC PULMONARY LOBECTOMY - EARLY OPERATIVE EXPERIENCE AND PRELIMINARY CLINICAL-RESULTS

Thoracoscopic video-assisted lobectomy procedures were performed in 11 patients (7 men, 4 women; age range 40 to 74 years, mean 66 years). T en patients had peripheral pulmonary opacities: eight of these were br onchogenic carcinomas, one was an atypical carcinoid lesion, and one w as a pulmonary infarct. All of these cases had preoperative evaluation by computed tomographic scanning to exclude mediastinal lymphadenopat hy. The remaining patient had preoperatively diagnosed lobar bronchiec tasis. Surgical access was gained via three stab (I cm) incisions and one short (7 cm) submammary incision, which was made without rib separ ation and was used for specimen delivery. Lobes resected were the left upper (n = 4), left lower (n = 2), right upper (n = 2), and right low er (n = 3). All patients survived. Overall man operative time was 3.3 hours and blood loss 263 ml. For the latter five cases, however, these figures were reduced to 2.3 hours and 100 ml, respectively, indicatin g improvement with experience. In no cases was ventilatory assistance required. Mean high-dependency unit time was 41 hours. In each case, i t was possible to perform a standard dissectional lobectomy with lobar lymph node clearance equal to that obtained at open thoracotomy. Comp arison with a series of 33 open lobectomy procedures demonstrated redu ced postoperative pain, morphine consumption, and high-dependency unit stay. This preliminary experience supports the development of video-a ssisted thoracoscopic pulmonary lobectomy for patients with small peri pheral opacities or known benign disease.