MUSCLE-SPARING MINITHORACOTOMY WITH INTERCOSTAL NERVE CRYOANALGESIA -AN IMPROVED METHOD FOR MAJOR LUNG RESECTIONS

To decrease incisional pain, morbidity, and length of hospital stay (L OS) and, hopefully, to reduce costs, most surgical specialties have tu rned to minimally invasive procedures to access the body cavities duri ng commonly performed operations. Video-assisted thoracic surgery (VAT S) has emerged as the standard approach for a number of diagnostic and therapeutic procedures in thoracic surgery. Major lung resections (lo bectomy, bilobectomy, and pneumonectomy), however, can be performed th rough an incision similar in size to the utility or access thoracotomy used in VATS to remove the specimen. The purpose of this study was to compare an oblique muscle-sparing minithoracotomy with intercostal ne rve cryoanalgesia with the standard posterolateral thoracotomy incisio n and VATS to perform major lung resections. Forty consecutive patient s with bronchogenic carcinoma, operated on by a single surgeon, were c hronologically divided into two groups, each with equivalent age, sex distribution, physiologic parameters, tumor size, and clinical stage. In addition, data were collected from a MEDLINE search of all publishe d studies in which major lung resections were performed via VATS. The first group (group A, n = 20) underwent posterolateral thoracotomy to access the chest cavity, whereas the patients in the second group (gro up B, n = 20) underwent oblique minithoracotomy with intercostal nerve cryoanalgesia. Group B compared favorably with group A in LOS (P = 0. 002), narcotic requirements (P = 0.001), morbidity (P = 0.042), and co st (P = 0.058). Group B also compared favorably with VATS major lung r esection published data regarding LOS and morbidity.