IS VIDEO-ASSISTED THORACOSCOPIC LOBECTOMY A UNIFIED APPROACH

Background. Few surgeons worldwide currently perform video-assisted th oracoscopic (VAT) lobectomy. We conducted a questionnaire survey of th is selected group of surgeons to gain insight into their current pract ice. Methods. A survey with 25 questions on VAT lobectomy including op erative approaches, techniques, its role in their practice, and limita tions were mailed to 45 thoracic surgeons worldwide who are believed t o perform this operation. Results. Thirty-three completed questionnair es were analyzed. Among those surgeons practicing VAT lobectomy, the v ast majority work in an academic or government institution and have at least 5 years of practice experience. Two thirds reported that at lea st 40% of all their thoracic procedures are currently performed using VAT techniques. However, considerable variations exist regarding prefe rence for VAT lobectomy tone third uses VAT techniques in less than 10 % of all lobectomies performed, whereas another third uses it in more than 40% of lobectomies), their approaches to mediastinal and hilar ly mph nodes, and their operative techniques. The latter range from a pur ely endoscopic technique to one that is more appropriately termed mini thoracotomy with video-assistance when the surgeons operate primarily by looking through the utility thoracotomy. There were no significant differences in the practices of surgeons working in different continen ts, except that Asian surgeons were more likely to use suture ligation as opposed to a staple-cutter on pulmonary vessels. Conclusions. Vide o-assisted thoracoscopic lobectomy is not a unified approach. Consider able variations exist among the small group of surgeons performing thi s procedure, in their approach to surgical oncology as well as the ope rative technique. Distinctions in these different operative approaches must be made before one can make a meaningful comparison of results. Different terms should probably be introduced to further clarify the e xact techniques used. (Ann Thorac Surg 1998;66:1155-8) (C) 1998 by The Society of Thoracic Surgeons.