[Minimally invasive thoracotomy for the lung resection; without thoracoscopic procedure]

Video-assisted thoracoscopic surgery (VATS) is though to be a minimally invasive surgical procedure of lung resection. But there are some problems still remained about training, cost efficacy and oncological principles. Minimally invasive thoracotomy without thoracoscopic procedure was reviewed in this paper. In case of standard posterolateral thoracotomy with cutting ribs, it brings less postoperative pain and less dislocation of the ribs that fixes the ribs with bioabsorbable poly-L-lactide (PLLA) pins. Muscle sparing thoracotomy is available in broadly peeling off the muscle of trapezius and latissimus dorsi subcutaneously. But sometime much exudate collects subcutaneous wound in postoperative period so that some trouble or complication often occurs in the management of postoperative course. In case of axilloanterior thoracotomy we have proper view which is almost the same as standard posterolateral thoracotomy without cutting thoracic muscles. Skin incision runs from the axillar to the lateral margin of the breast and the 4th or 5th intercostal thoracotomy is performed through thoracodorsal muscle being pressed laterally, anterior serratus muscle being split. There is no need to cut the ribs, and good for the upper or middle lobectomy and the upper mediastinal dissection. Axilloanterior thoracotomy is minimally invasive than standard posterolateral thoracotomy and is useful for the surgery of upper or middle lobe lung cancer. In the procedure of thoracotomy operating with or without thoracoscope is not to be concerned. Important is to perform operation smoothly in adequate time for patients ease.