Thoracoscopic versus conventional lobectomy : comparable short-term results associated to lower systemic impact

Videotoracoscopy has emerged as an alternative to the conventional technique in thoracic surgery. We compared the outcomes after VTS and coventional lobectomies, in terms of postoperative pain, systemic inflammation and pulmonary function.From October 2010 and May 2011, 57 patients underwent pulmonary lobectomy. Among them, 15 patients received VTS lobectomy and 42 received open lobectomy. 15 patients were selected from the “open” group and used as controls.Operative times differed between the two groups (VTS 238.5 vs open 191.6 min, p 0.01), but we found no difference when we compared chest tube stay (POD 6.0 ± 2.83 vs 5.1 ± 2.94, NS). Perceived postoperative pain (NRS scale) was the same (POD1 3.1 vs 2.7, POD2 2.2 vs 2.2, POD3 1.5 vs 1.3, NS) and the total amount of analgesics per patient, expressed as mg of morphine/Kg, was also not statistically different (4 vs 4.8, NS). Furthermore, no statistical difference was observed in postoperative WBC and CRP between the two groups, although we believe this to be mainly due to the small population size. The average CRP was 7.6 vs. 11.6 on POD3 and 5.07 vs. 8.15 on POD5, in the VTS group and open group respectively. We didn’t have any major complications, but 4 patients who had undergone VTS lobectomy had a late pleural effusion requiring thoracentesis, despite the usual postoperative management. Moreover, a patient in the same group had postoperative pneumonia: we consider it to be related to an underlying HIV-related immunosuppression, rather than to the surgical technique itself. One patient in the “open” group experienced severe postoperative pain. One patient in each group had prolonged air-leaks and after that the “fissureless” technique was introduced when thoracoscopic lobectomies were performed.We believe VTS lobectomy to be a safe technique, associated to a lower systemic impact on the patient compared to the conventional technique.