Revisiting the prone position in video-assisted thoracoscopic surgery

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• The fully prone position for thoracic surgery is now obsolete.
• Video-assisted thoracoscopic surgery (VATS) requires optimal patient positioning for enhanced visualization.
• Improved access to the posterior mediastinum is crucial for lung cancer resections.

Purpose of the Study:

• To evaluate the efficacy and safety of a modified semiprone position for VATS lobectomy.
• To assess the impact of this position on surgical exposure and port placement.
• To determine the benefits for procedures involving mediastinal lymphadenectomy.

Main Methods:

• A modified semiprone position was utilized in 358 patients undergoing VATS lobectomy with mediastinal lymphadenectomy.
• Patients were placed in the lateral decubitus position and then rotated 45-60 degrees towards the surgeon.
• Ports were placed while the patient was in this modified position.

Main Results:

• The modified semiprone position enhanced exposure of the posterior mediastinum, esophagus, subcarinal, and paratracheal spaces.
• Lung displacement under gravity improved visualization of the operative field.
• The position was found to be safe and well-tolerated by patients.

Conclusions:

• The modified semiprone position offers significant advantages for VATS lobectomy and mediastinal lymphadenectomy.
• This positioning facilitates more ergonomic and anatomical port placement.
• It represents a valuable alternative to previous positioning methods in thoracic surgery.