PURPOSE: In our institution VATS (thoracoscopic) lobectomies have been performed since 1999 with the majority of the cases from 2004. This paper describes the result of the learning curve.
METHODS: A program was in 1999 set up with VATS lobectomies. Until 2004 a posterior approach with the camera and in total 4 ports was used but this was then changed to an anterior 3 port technique. At the same time there was a changed focus on lymph node sampling.All operations are done by a single surgeon well trained in VATS and VATS lobectomies before start.
RESULTS: By 24’th of April 2006 there have been performed 102 major VATS resections as 95 lobectomies, 5 bi-lobectomies, 2 pneumonectomies. In the period there have been 23 cases converted to an open procedure.Until 1’th January 2005 61 cases was performed with 23.9% converted to an open procedure. 8 out of 17 (47,1%) of the conversions was due to surgically complications and 5 patients had a new operation (2 empyema, 2 bleeding from node site, one prolonged air-leakage). In this period 7.7% of the patient was changed from an pre-operative N0 status to N1 or N2.In the second half since 1’th January 2005 the conversion rate has been 11.1% and all due to unexpected pathology (adhesions, big nodes or single lumen ventilation not possible). Only one re-operation due to need of pneumonectomy. In this period the node status was changed in 17.7%.
CONCLUSION: Our series shows that VATS lobectomy is a difficult procedure but that with a big number of cases, proper training, the right approach, port placement and the right instruments, it is possible to introduce a VATS lobectomy program.Our number indicates that with focus on lymph node sampling it is possible to perform a proper lymph node assessment by VATS lobectomies.
CLINICAL IMPLICATIONS: The final radomised study of VATS lobectomies is still missing but more and more papers indicates that it is the right approach to early stage lung cancer surgery.
DISCLOSURE: Henrik Hansen, None.