2008 Volume 48 Issue 6 Pages 681-687
Objective. There is a wide variety of technical approaches to video-assisted thoracic surgery (VATS) lobectomy. We have reported the clinical outcome of our approach of VATS lobectomy in which only a thoracoscopic view is used. Experience and training along with exact definition of its surgical approach are indispensable for the standardization of VATS lobectomy as lung cancer operation techniques. In this paper, we investigate the feasibility and learning curve for our approach of VATS lobectomy in order to established as one of the standard methods. Methods. We reviewed 80 consecutive patients with clinical T1N0M0 non-small cell lung cancer (NSCLC) from April 2003 to November 2007. Surgery was performed in a similar manner by either of two registered respiratory surgeons with over 25-years-experience. Clinical parameters related to the procedure were compared between the first 40 cases and the last 40 subsequent cases. Results. The background of the patients of the both groups was similar. Values of clinical parameters show in average as follows. Operation time, blood loss during the operation, size of incision for access thoracotomy, duration of chest tube drainage and length of hospital stay changed from 253 to 195 minutes (p<0.0001), from 143 to 94 gram (p=0.009), from 4.0 to 3.4 cm (0.0064), from 3.7 to 2.6 days (p=0.048) and from 8.0 to 6.9 days (p=0.0098) in the first and the last groups, respectively. They were significantly reduced in the last 40 cases than in the first 40 cases. Postoperative morbidity, especially incidence of prolonged air leakage over 7 days was also lower in the last 40 cases, however not with statistical significance. The results of systematic mediastinal lymphadenectomy and rate of conversion to thoracotomy did not significantly differed between the two groups. In the first 40 cases and the last 40 cases, the operation time over 4 hours and blood loss during the operation of more than 100 g were 24 vs 5 cases and 21 vs 13 cases, respectively. Conclusion. Minimally invasive VATS lobectomy under only a thoracoscopic view yields acceptable feasibility and safety. Moreover, most of the clinical parameters improved in the 40 cases with second group. This technique of the VATS seems to be reliably acquired after 20 to 30 cases experience with an appropriate training system.
