THORACOSCOPIC MAJOR LUNG RESECTION - INDICATIONS, TECHNIQUE, AND EARLY RESULTS - EXPERIENCE FROM 2 CENTERS IN ASIA

The application of video-assisted thoracic surgery (VATS) to major lun g resection is controversial. We reviewed our combined experience in t his technique from two centers in Asia. From January 1993 to December 1995, 78 patients (44 male and 34 female patients with ages ranging fr om 16 to 85 years) successfully underwent VATS major lung resections. Selection criteria for this approach include (a) lesions <5 cm in maxi mal diameter; (b) for primary lung carcinomas, clinical stage I status ; (c) absence of chest wall involvement; (d) absence of pleural symphy sis; and (e) complete or near complete interlobar fissures. Procedures included segmentectomy (1), lobectomy (69), bilobectomy (2), and pneu monectomy (6) together with mediastinal lymph node sampling in cases o f primary malignancy. We emphasized not spreading ribs and using conve ntional thoracic instruments for dissection together with wound protec tion on specimen retrieval. There was one perioperative death and five nonfatal complications that included persistent air leak over 10 days in two patients, pneumonia in one, and persistent dysesthesia related to surgery in two. We conclude that VATS major lung resection is tech nically feasible. Stringent patient selection is important. Specific c omplications exist and special training is needed. The exact role of t his approach in thoracic surgery remains to be defined by prospective randomized study compared with conventional thoracotomy with long-term follow-up.