PURPOSE: To-day technology allows the use of three-dimensional (3D) view for Video-Assisted Thoracic Surgery (VATS), like the robotic systems. First in the world, in our Institute the 3D Viking Video System were employed for VATS and its effectiveness was evaluated in lung cancer staging.
METHODS: From January 2008 to December 2010, 322 patients were submitted to 3D-VATS. Seventeen patients were not operated because of un-collapsed lung; 32 patients had benign diseases (13 bullae, 13 empyemas, 1 left chilothorax, 3 pericardial cysts, 2 sarcoidosis). There were 273 3D-VATS for malignant diseases: 8 lobectomies, 77 sublobar resections, 24 pre-open surgery assessments, 31 pre-operative mediastinal assessments, 117 malignant pleural effusions (72 lung cancers), 16 pleurectomies (all malignant mesotheliomas).
RESULTS: Sublobar resections were performed in 31 cases for solitary pulmonary nodules (SPNs) and in 46 for contralateral nodules to the primary lung tumor. Six SPNs were primary lung tumors and were radically resected in the same surgical session. About 46 cases with contralateral nodules, 27 were no metastases and had radical surgery. T3 chest wall tumors (n° 15) and 9 N2 disease were: 15 T3 all confirmed; 7 cases of 9 suspect N2 were under-staged N0-1 and then submitted to radical surgery in the same surgical session. Thirty-nine pre-operative mediastinal assessments showed 31 N2 disease and 8 T3-4 disease have mediastinal involvement: 2 radical lobectomies with pericardial resection, 4 not operable infiltrations, 2 metastatic no-lung cancers. About the pleurae assessment, there were 8 not diagnosed pre-operatively pleural infiltrations, 50 malignant pleural effusions, 14 malignant pericardial effusions (2 metastatic no-lung cancers).
CONCLUSIONS: 3D-VATS permitted after lung cancer staging 36/92 under-staged tumors: 39% were resected. This is because the accuracy in detecting lesions and the best feasibility of the surgical act by the 3D-view than other invasive staging procedures.
CLINICAL IMPLICATIONS: 3D-VATS has a significant impact for stereoscopic depth and high resolution. It allows the same type of confidence as usual as during open procedures improving surgical staging in lung cancer and cost effective.
DISCLOSURE: The following authors have nothing to disclose: Cosimo Lequaglie, Gabriella Giudice, Rita Marasco, Aniello Della Morte
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