Video-assisted Thoracoscopic Surgery Lobectomy: Expanding Indications Based on the Optimization of Surgical Techniques

Video-assisted thoracoscopic surgery(VATS) lobectomy is a less invasive procedure when compared with the traditional thoracotomy. With the development of operative techniques,VATS lobectomy has become a definite procedure for stage I and some stage Ⅱa lung cancer. However, It is still controversial due to operative difficulty whether it is feasible to perform thoracoscopic surgery in anatomic pulmonary segmentectomy, bronchial sleeve lobectomy, bronchial and arterial sleeve lobectomy, large tumor (>5 cm), pneumonectomy and resection of Pancoast tumor. Some difficulties in performing thoracoscopic lobectomy such as:pleural cavity adhesions or atresia, local invasion, interlobar fissure dysplasia, bleeding, as well as "troublesome hilum", were once thought to be indication for conversion to thoracotomy. We proposed a new concept of thoracoscopic lung resection:"single-direction thoracoscopic lobectomy", which has been proved to be simple, safe, and effective and has been widely accepted in our country. In practice, we are still proceeding with further exploration, technical optimization and expanding its application in more complicated lung surgery. For instance, we have developed strategies of "fast recovery" and "mini-invasive diagnosis and synchronous treatment of lung cancer" and a series of stylized techniques such as thoracoscopic adhesiolysis, bloodless technique, suction-compressing angiorrhaphy technique, presumptive control of the main pulmonary artery, hollow-out method in thoracoscopic lobectomy. With accumulative experience utilizing these innovative techniques, we believe that thoracoscopic lobectomy would become the mainstream for surgical management of pulmonary diseases.