LOBE-SPECIFIC INTERCOSTAL INCISIONAL STRATEGY IN VIDEO-ASSISTED LOBECTOMY

When performing video-assisted lobectomy for lung diseases, the incisi onal strategy for the minithoracotomy and two trocar ports is crucial for successful completion of the procedure. Our strategy is primarily determined according to three principles: The hilar bronchovascular st ructures should be easily accessible; the minithoracotomy should be re adily convertible to a standard open thoracotomy; and the wounds shoul d create only Limited damage. To enable a quick conversion, the minith oracotomy incision must be placed on the scheduled posterolateral thor acotomy line regardless of its location. The entire procedure is best managed when the minithoracotomy is placed anteriorly on the inframamm ary line in the fourth intercostal space for upper and middle lobectom ies and posteriorly over the auscultation triangle in the fifth interc ostal space for lower lobectomies. Two trocars are used for thoracosco py and retraction. The sequence of each operative step should be deter mined by the lobe to be resected. This lobe-specific incisional and op erative strategy based on anatomical considerations not only facilitat es the safe dissection of the hilum but also enables a rapid conversio n to a standard posterolateral thoracotomy.