Anatomic thoracoscopic lobectomy (ATL) without minithoracotomy: preliminary experience

The purpose of this review is to outline our experience with a completely thoracoscopic approach to major pulmonary resection (lobectomy). There were 23 patients in this study selected by the usual criteria of resectability. The preoperative workup included chest x-ray, pulmonary function studies, computed tomography (CT) of the chest and abdomen, bronchoscopy, mediastinoscopy, and brain and bone scans in the majority of patients. ATL was attempted in 23 patients. In four patients the procedure was converted to the "open" approach for the following reasons: inability to identify the location of the primary lesion (two patients), obscurative bleeding (one patient), and inability to diagnose the pathology (one patient). The underlying pathology of the ATL group was as follows: bronchiolitis obliterans-organizing pneumonia = 1, granuloma = 2, non-small cell lung cancer = 14, solitary colonic metastases = 2. The breakdown by site of the 19 ATL resections is as follows: right upper lobe = 5, right middle lobe = 1, right lower lobe = 1, right upper and right middle lobes = 1, left upper lobe = 6, left lower lobe = 5. Group A patients (n = 11) were those who had no postoperative complications. Length of stay was short, ranging from 4 to 8 days, median 5 days. Group B patients (n = 8) had complications (prolonged air leak = 4, supplemental postoperative oxygen requirement = 3, pain control = 1) and stayed longer (range 10-21 days, median 13). There were no deaths, no blood transfusions, no chest tube reinsertions and no reoperations. The most significant complication in the ATL group was prolonged air leak in one patient (21 days).

(a) ATL without minithoracotomy is feasible; (b) ATL has potential benefits in terms of reduction of pain and hospital stay; (c) ATL had better cosmetic and functional results.