CHAPTER 1 General Setup and Techniques
Definition and Philosophy
A VATS procedure is not a compromise operation; it is the same operation that can be performed by a thoracotomy.1,2 The standard operation is performed with visualization on a monitor and through incisions without spreading the ribs. Procedures such as a video-assisted lobectomy provide the same complete cancer operation that is performed through a thoracotomy.3–12
Positioning
Incisions
Placement of the incisions (Figure 1-2) is key to the performance of VATS. Proper placement of the incisions creates the best angles for the instruments to perform these procedures.
Incision 1
Incision 2
Incision 3
Instruments
Visualization and Lenses
Operative Techniques and Complications
Decompression of the Lung
Hypoxia During Video-Assisted Thoracic Surgery
Dissection
Stapling Blood Vessels

Alternative Techniques for Vessels
Stapling Parenchyma
Suturing
Removal of Specimens
1 McKenna R.J.Jr, Houck W., Fuller C.B. Video-assisted thoracic surgery lobectomy: experience with 1100 cases. Ann Thorac Surg. 2006;81:421-426.
2 Onaitis M.W., Petersen R.P., Balderson S.S., et al. Thoracoscopic lobectomy is a safe and versatile procedure: experience with 500 consecutive patients. Ann Surg. 2006;244:420-425.
3 Mahtabifard A., Fuller C.B., McKenna R.J.Jr. VATS sleeve lobectomy. Ann Thorac Surg. 2008;85(2):5279-5332.
4 McKenna R.J.Jr, Mahtabifard A., Fuller C.B. Fast tracking after VATS pulmonary resection. Ann Thorac Surg. 2007;84(5):1663-1667.
5 Cerfolio R.J., Bass C., Katholi C.R. Prospective, randomized trial compares suction versus water seal for air leaks. Ann Thorac Surg. 2002;73:1727-1731.
6 Whitson B.A., Boettcher A., Bardales R., Kratzke R.A., Dahlberg P.S., Andrade R.S., Maddaus M.A. Comparison of video assisted thoracoscopic surgery to thoracotomy for resection of clinical stage I non-small cell lung cancer. Presented at the American College of Surgeons Congress, Chicago, IL, October 10; 2006.
7 Nomori H., Ohtsuka T., Horio H., et al. Difference in the impairment of vital capacity and 6-minute walking after a lobectomy performed by thoracoscopic surgery, an anterior limited thoracotomy, an antero-axillary thoracotomy, and a posterolateral thoracotomy. Surg Today. 2003;33:7-12.
8 Nakata M., Saeki H., Yokoyama N., et al. Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 2000;70:938-941.
9 Demmy T.L., Curtis J.J. Minimally invasive lobectomy directed toward frail and high-risk patients: a case-control study. Ann Thorac Surg. 1999;68:194-200.
10 Demmy T.L., Plante A.J., Nwogu C.E., et al. Discharge independence with minimally invasive lobectomy. Am J Surg. 2004;188:698-702.
11 Nakajima J., Takamoto S., Kohno T., Ohtsuka T. Costs of videothoracoscopic surgery versus open resection for patients with lung carcinoma. Cancer. 2000;89(Suppl):2497-2501.
12 Petersen R.P., Pham D., Burfeind W.R., et al. Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg. 2007;83:1245-1249. discussion 1250