[Minimally invasive surgery for lung cancer using thoracoscope as a 'microscopic surgery'; for the safety endoscopic...

Video-assisted thoracoscopic surgery (VATS) is now turned to be common procedure for lung cancer treatment, however, controversy still remains regarding to its adequacy and safety. We developed VATS procedure aiming at 'the equality to traditional open thoracotomy'. Important points to perform VATS are (1) incisions are placed to facilitate converting to open thoracotomy if necessary, (2) surgical operator positions at the anterior side of patient lying lateral decubitus position, (3) using instruments for open thoracotomy, or making new instruments for VATS which can utilize for open thoracotomy either, (4) the endoscope is held by instrument, not by hand, to keep proper position. Surgical operator performs VATS watching at the television monitor, not through the incision, (5) to divide vessels, such as pulmonary artery or vein, ligature by silk threads is usually put at the proximal side of transecting vessel. Underlying difference between VATS and open thoracotomy is simply the way of approach to the pleural cavity. Appropriate skills and instruments are required to perform a kind of 'microscopic surgery', so that operators are sure to perform adequate operation for lung cancer including en bloc nodal dissection at VATS safely.