We outline, in detail for each lobe, the technical aspects of video assisted thoracic surgery (VATS) lobectomy and examine the results of our first 50 cases.

VATS lobectomy was performed using a 5cm non-rib spreading incision along with two 10mm ports and an additional 5mm port if neccessary. VATS lobectomy was performed identical to the open procedure, with individual ligation of the pulmonary vein, pulmonary artery and bronchus. Lymph nodes were dissected or sampled. The specimen was retrieved with an endoscopic bag.

For the first 50 cases, the mean age was 68.6 years. Surgery was performed for non-small cell cancer in 45(90%), carcinoid in 2(4%), and 1 each for sequestration, hamartoma, and granuloma. Right upper lobectomy was performed in 20, right middle in 3, right lower in 3, bilobectomy (upper/middle) in 1, left upper in 14, and left lower in 9. Median operative time was 150 minutes and median blood loss was 200 cc. Conversion to open was required in 6(12%) with 4 due to pulmonary artery bleeding, 1 for chest wall adherence and 1 for tumor adherence to the pulmonary artery. There was 1(2%) death and 11(22%) patients experienced one or more complication. Median hospital stay was 6 days.

Lobectomy by VATS can be performed safely with low morbidity and mortality. This minimally invasive approach to lobectomy should be conducted in the same manner as the open procedure. Large randomized trials are needed to confirm the benefits of VATS lobectomy and to assess its long term oncologic efficacy.