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Updated: Feb 1, 2026

Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Non-intercostal access for video-assisted thoracic surgery-analysis of technical advantages and disadvantages
Marcin Zieliński1, Pawel Gwozdz1, Michal Wilkojc1
1Department of the Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland.
Background:
Video-assisted thoracoscopic surgery (VATS) lobectomy has become an accepted method for the treatment of early-stage non-small-cell lung cancer (NSCLC). The standard VATS approach is an intercostal one which is often followed by postoperative pain due to injury of the intercostal nerve. The non-intercostal techniques of VATS include the subxiphoid, transcervical, transdiaphragmatic and transoral procedures.
Methods:
The technical difficulty of operative management of the anatomical structures during VATS anatomical resection are compared for the intercostal, subxiphoid and transcervical approaches.
Results:
Some operative steps have different range of difficulty, which are analyzed in detail.
Conclusions:
The clearest advantages of the non-intercostal approaches include less postoperative pain and superradial bilateral mediastinal lymphadenectomy in case of the transcervical approach. However, the non-intercostal approaches are more technically demanding procedures, which therapeutic role has to be clarified in the future.
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