Intrathoracic light-assisted anterior limited thoracotomy in lung cancer surgery

We recently developed an intrathoracic light-assisted anterior limitted tho racotomy (ILAALT) for use in lung cancer surgery. A skin incision 12 cm lon g is made below the breast, then the pectoral major muscle is divided, and the fourth intercostal space is opened with a disconnection of the anterior cartilagenous portion. The posterior skin, including the serratus anterior muscle, is drawn posteriorly using a retractor, To illuminate the posterio r and apex portions of the thoracic cavity, a flexible fiber light is intro duced into the thoracic cavity through the eighth intercostal space at the posterior axillary line. These techniques provided adequate exposure and su fficient illumination in the thoracic ca,;ib, thus making surgery easy for most thoracic applications. Using this approach, we undertook 28 lung resec tions with a mediastinal nodal dissection for lung cancer (24 lobectomies, 2 bilobectomies, and 2 pneumonectomies) without difficulty. The mean intras urgical blood loss was 217 ml, the operative time 262 min, and chest tube d rainage duration 2.3 days, Except for one case, no patients required a bloo d transfusion. All patients underwent continuous epidural anesthesia until postoperative day (POD) 8. The mean time that other analgesic medication wa s required was 0.5 times per patient until POD 13, but none from POD 14 on. We thus conclude ILAALT to be low-invasive thoracotomy and is thus indicat ed for most types of lung cancer surgery, providing a reduction of pain as its main advantage.