Video-assisted thoracoscopic surgery (VATS) major pulmonary resections: the Italian experience

Videoendoscopic lobectomies or pneumonectomies are infrequently performed, mostly because of technical difficulties, concern for intraoperative accidents, and radicality in case of malignancy. The work diffusely describes technical details and a personal experience of videothoracoscopic major pulmonary resections (MPRs). All patients are first explored thoracoscopically. The procedure can then be completed thoracoscopically or converted. Videothoracoscopic exploration was performed in 211 candidates to MPR. Six patients' cases became nonresectable owing to pleural carcinomatosis or mediastinal infiltration, 171 patients completed a thoracoscopic MPR (165 lobectomies and 6 pneumonectomies), and 34 required conversion for technical (20) or oncological (10) reasons. Video MPRs were performed for benign disease (24), for lung metastases (5) and for preoperatively staged T1N0 or T2N0 primary lung cancer (142). No perioperative mortality was recorded. In 154 patients (90%), postoperative course was uneventful. One patient died after 33 days because of contralateral pneumonia; 15 elderly patients had prolonged air leaks. One patient developed partial dehiscence of the bronchial stump (healed conservatively) after a severe respiratory insufficiency on his third postoperative day had required mechanical ventilation. Even though video MPR can present remarkable difficulties, its undeniable advantages will benefit from further improvement of instrumentation. In case of tumors, larger series and longer follow-up will allow evaluation of long-term survival and local recurrence.