Flexible thoracoscopy may facilitate video-assisted thoracoscopic lobectomy

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Surgical Technology

Background:

• Video-assisted thoracoscopic lobectomy (VATS) has faced challenges in widespread adoption despite potential benefits over open thoracotomy.
• Concerns persist regarding postoperative morbidity and long-lasting chest wall pain, possibly linked to intercostal nerve injury.
• This study evaluates the clinical experience with a novel, commercially available flexible thoracoscope for VATS procedures.

Purpose of the Study:

• To assess the benefits of performing VATS lobectomy using a flexible thoracoscope for both patients and surgeons.
• To compare outcomes of flexible VATS with traditional rigid thoracoscopy.

Main Methods:

• A case-control series utilizing prospectively collected data.
• 128 lobectomies were performed using a flexible high-definition thoracoscope over 24 months.
• Outcomes were compared to 15 prior VATS lobectomies using rigid thoracoscopy.

Main Results:

• 47% of lobectomies were performed with the flexible thoracoscope, with a low conversion rate to open surgery (4.6%).
• Median operation time was 105 minutes, and median postoperative hospital stay was 4 days.
• Postoperative pain was significantly lower (2%) with flexible VATS compared to rigid VATS (p = 0.02).

Conclusions:

• Flexible thoracoscopy facilitates feasible, easier, and safer VATS lobectomy compared to rigid thoracoscopy.
• Enhanced visualization and minimized porthole angulation contribute to avoiding surgical pitfalls.
• The flexible VATS approach demonstrates comparable operative times to open surgery and reduced postoperative pain.