Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases.

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Surgical Outcomes

Background:

• Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique for lung resections.
• Lobectomy is a common surgical procedure for lung cancer treatment.

Purpose of the Study:

• To analyze the evolution of the VATS approach for lobectomy.
• To evaluate surgical outcomes during the initial three years of a VATS program.

Main Methods:

• Analysis of 200 VATS lobectomies performed between July 2007 and July 2010.
• Comparison of outcomes based on surgical approach (3-port, 2-port, single-port), conversion rates, surgical time, lymphadenectomy extent, and survival.
• Introduction of a 2-port approach in February 2009.

Main Results:

• Case volume increased annually (32, 65, 103).
• Overall conversion rate decreased significantly from 25% to 7.8% (p=0.017).
• Surgical time, lymph node yield, and explored stations improved with experience and less invasive approaches (p<0.05).
• Median chest tube duration was 3 days, and median length of stay was 4 days.
• Disease-free survival at 30 months was 85% for Stage I and 62% for non-Stage I patients.

Conclusions:

• Increasing experience and adoption of less invasive VATS approaches correlate with improved surgical outcomes.
• A clear trend towards a less invasive 2-port approach was observed.
• Single-port VATS lobectomy was successfully implemented in selected cases.