The Use of Energy in VATS Lobectomy

VATS lobectomy is a safe and effective treatment strategy for operable stage I and II lung cancer. It has a similar five-year survival compared to open lobectomy (thoracotomy). VATS lobectomy is associated with less postoperative complications and shorter hospital length of stay when compared to lobectomy by thoracotomy. VATS lobectomy has not been widely adopted by the thoracic surgical community, in part, due to technical reasons. Pulmonary artery branch manipulation in VATS lobectomy is one of the most critical parts of the procedure, especially when endostaplers are used for ligation and division of the vessel. Energy devices have improved in recent years, and their application for VATS lobectomy is gaining traction. There is more and more evidence supporting the safety of ultrasonic shears to seal and divide small pulmonary artery branches. These devices are smaller and finer than endostaplers and have the potential to reduce the risk of PA injury. These more user-friendly devices may enable thoracic surgeons who are currently performing lobectomy by thoracotomy to transition to VATS. Energy devices are also useful for hilar dissection and mediastinal lymph node dissection in VATS lobectomy.