Thoracoscopic lobectomy is defined as the anatomic resection of an entire lobe of the lung, using a videoscope and an access incision, without the use of a mechanical retractor and without rib-spreading. As the video reveals, the anatomic resection includes individual dissection and stapling of the involved pulmonary vein, pulmonary artery and bronchus and appropriate management of the mediastinal lymph nodes, as would be performed with thoracotomy. In order to be considered a viable alternative to conventional lobectomy, thoracoscopic lobectomy must be applied with the same oncologic principles: individual vessel ligation, complete anatomic resection with negative margins, complete hilar lymph node dissection, and appropriate management of the mediastinal lymph nodes. Potential advantages include reduced surgical trauma, decreased postoperative pain, faster return to full activity, shorter chest tube duration, shorter length of stay, preserved pulmonary function, and superior cosmetic result when compared to lobectomy via open thoracotomy.

Individual vessel dissection is not performed through the fissure; rather, dissection is performed beginning with the anterior hilum, and continuing posteriorly. For any anatomic thoracoscopic lobectomy, hilar dissection is begun with mobilization of the pulmonary vein. For upper lobectomy, the lung is reflected posteriorly and inferiorly to facilitate dissection. For lower lobectomy, the lung is retracted superiorly. Moving the thoracoscope to the anterior incision may improve visualization of the superior hilum and may facilitate placement of the linear stapler for upper lobectomy, if introduced through the midaxillary port. After dissection and division of the appropriate vein, arteries, and bronchus, the fissure is stapled to complete the resection.

The safety and efficacy of thoracoscopic lobectomy for patients with early-stage lung cancer has been established. Although there are no prospective, randomized series that compare thoracoscopic lobectomy to conventional approaches, a sufficient number of series have been published, both single-institution and multi-institution experiences, to conclude that thoracoscopic lobectomy is a reasonable strategy for patients with clinical stage I lung cancer.