Technique of Video-Assisted Thoracoscopic Chest Wall Resection

Abstract

c t m ( s w s Operative procedures used for cancerous chest wall invasion involve complete resection of the lung mass en loc with adjacent segments of ribs, traditionally involving a otentially disfiguring resection, lengthy hospitalization, and painful and protracted recovery period. As video-assisted horacoscopic surgery experience has grown, the proportion f patients deemed suitable for this type of approach as oposed to the traditional thoracotomy for lung resection has ncreased. Although experience with this approach is still merging, there is sufficient evidence demonstrating dereased morbidity and hospital stays with oncologic equivaency.1-3 As thoracoscopic resection for lung cancer evolved and became our predominant approach with the ability to perform an equivalent dissection to open procedures, we have naturally extended its indications to more complex situations. There have been few reports of thoracoscopic chest wall resection in an en bloc fashion, possibly because the perception that any benefit gained by avoiding rib spreading and the incision of other chest wall tissue would be eclipsed by perturbing the rib cage.4,5 For those interested in pursuing en bloc thoracoscopic resection, patients whose chest wall invasion lies near enough to an access incision favorable for lung resection and who require resection of 4 or fewer ribs are optimal candidates. The staging workup for all patients with chest wall invasion includes preoperative computed tomography scans in addition to positron emission tomography demonstrating no evidence of metastatic disease prior to being considered for chest wall resection. Moreover, preoperative imaging should demonstrate that the musculature and soft tissues superficial to the rib are uninvolved. Patients with larger tumors or with hilar lymph node involvement may not be suitable candidates for the hybrid approach secondary to limited mobility of the tumor and