Video-Assisted Lobectomy: General Considerations

Published on 13/02/2015 by admin

Filed under Cardiothoracic Surgery

Last modified 13/02/2015

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CHAPTER 6 Video-Assisted Lobectomy

General Considerations

Criteria

Indications and contraindications for a VATS-type lobectomy are given in Table 6-1. Most lobectomies can be performed by VATS. We perform more than 90% of our lobectomies by VATS. The ribs are not spread. Larger tumors (5 to 8 cm) can be resected through a 5- to 6-cm incision if the rib is shingled posteriorly. Because tumors larger than 8 cm in diameter take up so much space in the chest, it is difficult to manipulate the lobe to perform the dissection, and these large tumors require a thoracotomy.

Table 6-1 Indications and Contraindications for Video-Assisted Lobectomy

Indications Relative Contraindications Contraindications
Stage 1 lung cancer Tumor 5-8 cm in diameter Tumors >8 cm in diameter
Tumor <6 cm Preoperative irradiation Mediastinal invasion
Benign disease (e.g., bronchiectasis) Preoperative chemotherapy Surgeon discomfort
  Sleeve resections  
  Chest wall invasion  

Relative contraindications are factors that may make the procedure difficult or unsafe. Dissection of abnormal nodes adherent to the vessels, preoperative chemotherapy, and preoperative radiation therapy may mandate a thoracotomy. However, we have performed 18 bronchial sleeve resections, and we usually can perform lobectomies1 and full node dissections after neoadjuvant chemotherapy for stage III lung cancers.2,3

Absolute contraindications are factors that make a VATS-type resection almost impossible. If the tumor is too large, it cannot fit through the small incision used in VATS. Tumors attached to the chest wall, including Pancoast tumors, require a thoracotomy and rib resection. Combined chemotherapy and radiation therapy usually make enough scar tissue around the vessels that a thoracotomy is needed to complete the nodes dissection and to safely dissect around vessels.