Thoracoscopic major lung resection--indications, technique, and early results: experience from two centers in Asia

The application of video-assisted thoracic surgery (VATS) to major lung resection is controversial. We reviewed our combined experience in this technique from two centers in Asia. From January 1993 to December 1995, 78 patients (44 male and 34 female patients with ages ranging from 16 to 85 years) successfully underwent VATS major lung resections. Selection criteria for this approach include (a) lesions < 5 cm in maximal diameter; (b) for primary lung carcinomas, clinical stage I status; (c) absence of chest wall involvement; (d) absence of pleural symphysis; and (e) complete or near complete interlobar fissures. Procedures included segmentectomy (1), lobectomy (69), bilobectomy (2), and pneumonectomy (6) together with mediastinal lymph node sampling in cases of primary malignancy. We emphasized not spreading ribs and using conventional thoracic instruments for dissection together with wound protection on specimen retrieval. There was one perioperative death and five nonfatal complications that included persistent air leak over 10 days in two patients, pneumonia in one, and persistent dysesthesia related to surgery in two. We conclude that VATS major lung resection is technically feasible. Stringent patient selection is important. Specific complications exist and special training is needed. The exact role of this approach in thoracic surgery remains to be defined by prospective randomized study compared with conventional thoracotomy with long-term follow-up.