Fully thoracoscopic pulmonary lobectomy and specimen extraction through rib segment resection |
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Authors: | E C Poulin R Labbé |
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Institution: | Department of Surgery, H?pital du Saint-Sacrement, Université Laval, 1050 Chemin Ste-Foy, Québec, QC, Canada G1S 2L6, Canada
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Abstract: | Background: A technique of fully thoracoscopic pulmonary lobectomy with rib-segment resection for specimen extraction is described, and
preliminary results in 18 patients are presented.
Methods: Surgery is performed through four 15-mm ports. For all lobes except one, the surgeon operates in front of the patient, where
the rib spaces are widest and rib-space trauma is less. When lobar dissection is complete, specimen extraction is performed
after resection of a rib segment proportional to tumor size. Muscle section is kept to a minimum. There is no rib retraction.
Results: There were no deaths, three conversions to open surgery, and three major complications. Average postoperative stay was 5.4
days for patients without complications and 9.6 days for patients with complications. In total six patients presented with
some degree of air leaks, and two had post-thoracotomy pain (>2 month's duration). The literature is reviewed to analyze current
techniques and to define parameters of a truly minimally invasive pulmonary lobectomy.
Conclusions: This technique is safe and promising; however, thoracoscopic lobectomy still needs refining. Before valid randomized studies
comparing thoracoscopic lobectomy and muscle-sparing thoracotomy or posterolateral thoracotomy can be credible, technical
issues related to the production of a truly minimally invasive procedure should be resolved.
Received: 20 August 1996/Accepted: 19 September 1996 |
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Keywords: | : Thoracoscopy — Pulmonary lobectomy — VATS lobectomy |
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