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Evolution to video-assisted thoracic surgery lobectomy after training: initial results of the first 30 patients.
J Am Coll Surg. 2006 Oct; 203(4):551-7.JA

Abstract

BACKGROUND

In early-stage lung cancer, evidence is accumulating for the benefits of lobectomy by video-assisted thoracic surgery (VATS) over open lobectomy. Few thoracic training programs offer sufficient experience in this technically demanding procedure. This article describes the evolution of a new graduate's practice from open thoracotomy to VATS lobectomy.

STUDY DESIGN

Our model involves a transition in technique from posterolateral thoracotomy to muscle-sparing thoracotomy and, ultimately, to VATS lobectomy. This approach was evaluated by examining outcomes of open thoracotomy patients before VATS lobectomy and outcomes of the initial 30 VATS patients. Data were collected prospectively.

RESULTS

Before undertaking VATS lobectomy, 94 major pulmonary resections were performed by thoracotomy. Mortality was 1.2% for lobectomy and 0% for pneumonectomy. Use of the muscle-sparing thoracotomy increased from 17% of patients in the first half to 70% in the latter half of this group. For the first 30 VATS lobectomy patients, the mean operative time was 168 minutes. Median blood loss was 200 mL. Conversion rate to open thoracotomy was 13.3%. Mortality was 3.3% and morbidity was 26.7%. After short-term followup (mean followup 16 months), overall survival for stage I lung cancer was 96%.

CONCLUSIONS

With our approach, new graduates of thoracic surgery programs can safely transition to VATS lobectomy. Gaining experience with the lateral muscle-sparing thoracotomy is an important step in the transition, as it offers similar operative exposure. Longterm disease-free and overall survival data are needed to evaluate our oncologic efficacy with this approach.

Authors+Show Affiliations

Department of Surgery, Brown Medical School, 2 Dudley Street, Providence, RI 02905, USA. tng@usasurg.orgNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17000401

Citation

Ng, Thomas, and Beth A. Ryder. "Evolution to Video-assisted Thoracic Surgery Lobectomy After Training: Initial Results of the First 30 Patients." Journal of the American College of Surgeons, vol. 203, no. 4, 2006, pp. 551-7.
Ng T, Ryder BA. Evolution to video-assisted thoracic surgery lobectomy after training: initial results of the first 30 patients. J Am Coll Surg. 2006;203(4):551-7.
Ng, T., & Ryder, B. A. (2006). Evolution to video-assisted thoracic surgery lobectomy after training: initial results of the first 30 patients. Journal of the American College of Surgeons, 203(4), 551-7.
Ng T, Ryder BA. Evolution to Video-assisted Thoracic Surgery Lobectomy After Training: Initial Results of the First 30 Patients. J Am Coll Surg. 2006;203(4):551-7. PubMed PMID: 17000401.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evolution to video-assisted thoracic surgery lobectomy after training: initial results of the first 30 patients. AU - Ng,Thomas, AU - Ryder,Beth A, Y1 - 2006/08/24/ PY - 2006/02/28/received PY - 2006/06/03/revised PY - 2006/06/05/accepted PY - 2006/9/27/pubmed PY - 2006/11/11/medline PY - 2006/9/27/entrez SP - 551 EP - 7 JF - Journal of the American College of Surgeons JO - J. Am. Coll. Surg. VL - 203 IS - 4 N2 - BACKGROUND: In early-stage lung cancer, evidence is accumulating for the benefits of lobectomy by video-assisted thoracic surgery (VATS) over open lobectomy. Few thoracic training programs offer sufficient experience in this technically demanding procedure. This article describes the evolution of a new graduate's practice from open thoracotomy to VATS lobectomy. STUDY DESIGN: Our model involves a transition in technique from posterolateral thoracotomy to muscle-sparing thoracotomy and, ultimately, to VATS lobectomy. This approach was evaluated by examining outcomes of open thoracotomy patients before VATS lobectomy and outcomes of the initial 30 VATS patients. Data were collected prospectively. RESULTS: Before undertaking VATS lobectomy, 94 major pulmonary resections were performed by thoracotomy. Mortality was 1.2% for lobectomy and 0% for pneumonectomy. Use of the muscle-sparing thoracotomy increased from 17% of patients in the first half to 70% in the latter half of this group. For the first 30 VATS lobectomy patients, the mean operative time was 168 minutes. Median blood loss was 200 mL. Conversion rate to open thoracotomy was 13.3%. Mortality was 3.3% and morbidity was 26.7%. After short-term followup (mean followup 16 months), overall survival for stage I lung cancer was 96%. CONCLUSIONS: With our approach, new graduates of thoracic surgery programs can safely transition to VATS lobectomy. Gaining experience with the lateral muscle-sparing thoracotomy is an important step in the transition, as it offers similar operative exposure. Longterm disease-free and overall survival data are needed to evaluate our oncologic efficacy with this approach. SN - 1072-7515 UR - https://www.unboundmedicine.com/medline/citation/17000401/Evolution_to_video_assisted_thoracic_surgery_lobectomy_after_training:_initial_results_of_the_first_30_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(06)00894-5 DB - PRIME DP - Unbound Medicine ER -