[Video-assisted thoracoscopic surgery, with special reference to primary treatment for lung cancer]

From the viewpoint of patients, physicians, and health insurers, the ideal surgical treatment would be based on a precise diagnosis, followed by minimally invasive, high-technology-assisted, potentially curative surgery and the shortest possible period of hospitalization, while incurring the lowest possible medical fees. Such treatment would also be tailored to the medical, social, and employment needs of individual patients. Remarkable advances in video-assisted thoracoscopic surgery (VATS) techniques occurred in the late 20th century, making it minimally invasive compared with conventional thoracotomy. VATS results in less postoperative pain, shortens hospital stay, and improves the postoperative quality of life of patients. Among 570 institutions in Japan, the nationwide statistical record revealed that a total of 34,987 thoracic field surgeries were performed ??BETWEEN 19?? AND 19?? PLEASE GIVE YEARS??, of which 29.4% involved VATS. Of total thoracic surgical procedures recorded, VATS was performed in 76.7% of pneumothorax cases, 58.5% of benign tumor cases, and 38.8% of inflammatory disease cases. In cases of bullous disease excluding pneumothorax, VATS was performed in 44.5% of cases, in 38.0% of pleural tumor cases, and in 30.2% of mediastinal lung disease cases. The technique is also used in lung cancer. Of a total of 11,323 lung cancer lobectomies, VATS was performed in 539 (4.7%). Mediastinal dissection with VATS is becoming increasingly common. Satisfactory results have been achieved in terms of survival in patients with stage T1N0M0 lung cancer, which is recognized as an indication for VATS. This paper describes the current status of VATS in the field of general thoracic surgery as well in lung cancer.