Thoracoscopic surgery for lung cancer using the two small skin incisional method. Two windows method

Pulmonary lobectomy and mediastinal lymph node dissection was performed in 25 patients with Stage I lung cancer under thoracoscopic guidance using the two-windows method. A posterior skin incision (3 cm) and lateral skin incision (2 cm) were made in the 4th intercostal space centering on the inferior angle of the scapula. The site closest to the operating surgeon was used for direct vision, while the distant site was used for insertion of the thoracoscope. The mean operative time was 2 hours and 15 minutes, and the mean blood loss was 82.6 ml. The mean number of dissected mediastinal lymph nodes was 32. The length of hospitalization ranged from 5 to 17 days. Recovery was uneventful, and analgesics were not required by postoperative day 6. The two-windows method overcomes the three-dimentional inaccuracy due to the one-directional observation of the operative field employed during conventional thoracoscopy. In addition, since we developed this method for mediastinal lymph node dissection, the tracheal bifurcation can be confirmed under direct vision, increasing the accuracy of the procedure. The advantages of the two-window thoracoscopic method of pulmonary lobectomy are cosmesis, preservation of respiratory function, and reduced postoperative pain. In addition, there is reduced intraoperative bleeding and shortened operative time, while achieving mediastinal dissection similar to that of standard thoracotomy. The two-windows method of thoracoscopic pulmonary lobectomy is equal or superior to standard thoracotomy in every respect. This method should become the standard surgical technique for Stage I lung cancer.