2003 Volume 43 Issue 2 Pages 91-98
Objective. Recently, lobectomy by video-assisted thoracic surgery (VATS lobectomy) has been adopted by many institutions because of its less invasive approach for small peripheral lung cancer. The purpose of this retrospective study was to evaluate the practical applicability of the auscultatory triangle approach in VATS lobectomy. Methods. From February 1998 to March 2002, a total of 59 patients with clinical T1NOMO or T2NOMO lung cancer underwent lobectomy with lymphadenectomy in our hospital. Of these, 31 underwent VATS lobectomy (VL group), and 28 underwent standard thoracotomy (ST group). In the VL group, a small incision measuring 6 cm was made for minithoracotomy in the chest above the auscultatory triangle by a muscle-sparing procedure. Next, the fourth or fifth intercostal space (ICS) was entered without rib resection. After starting with dissection of the lymph nodes of the upper mediastinal space, hilar dissection was performed with conventional thoracotomy instruments. Pulmonary arteries and veins were then divided prior to endoscopic stapling. After stapling of the vessels and bronchus, the resected pulmonary lobe was finally removed from the thorax through the mini-thoracotomy using a plastic retrieval bag. In the ST group, patients had a posterolateral thoracotomy with a skin incision 12 to 13 cm in length, and were entered through the fourth or fifth ICS with rib spreading to obtain a sufficient working space. Hilar and mediastinal lymph nodes were dissected, followed by resection of the designated pulmonary lobe in a conventional manner. Results. Although a statistically significant increase in operating time was seen in the VL group compared to the ST group, no significant differences were found between the two groups with respect to the total number of mediastinal lymph nodes dissected or the mean value of surgical blood loss. Statistically significant decreases in duration of postoperative pain and hospitalization were seen in the VL group compared to the ST group (p<0.0001). In addition, the CRP level in serum was significantly lower in the VL group on both the second and seventh postoperative days compared to the ST group (p<0.0001, p=0.013 respectively). Conclusion. The present study showed the technical feasibility of this unique thoracoscopic approach in appropriately selected patients with clinical stage I lung cancer. Due to its low degree of invasiveness, we suggest that VATS lobectomy with an auscultatory triangle approach contributes to improvement of the quality of life following surgery for lung cancer. Longer follow-up will be necessary to determine the long-term survival of patients who underwent VATS lobectomy.
