The Future of Thoracoscopic Lobectomy in Lung Cancer

Abstract

Various methods have been proposed and used foranatomical lung resection since thedevelopment of lungsurgery. Among the many procedures performed bythoracic surgeons, the posterolateral thoracotomy hasbeen considered the standard incision for anatomicallung resection. The posterolateral thoracotomy providesa superb surgical field for the lung and posteriormediastinum. However, the posterolateral thoracotomyhas several major disadvantages. The procedure per seresults in significant destruction of chest wall structures.It requires division of the latissimus dorsi or serratusanterior muscle, spreading of ribs, and intentional orunintentional rib fractures. All of the injuries incurredduring a posterolateral thoracotomy result in destructionof the respiratory mechanics of the chest wall and areaccompanied by severe postoperative pain. In the earlyperiod of thoracic surgery, these adverse effects wereconsidered inevitable because no other options foranatomical lung resection existed at that time. On theother hand, current trends in medical practice focus ondifferent aspects of treatment. Although the treatment ofprimary disease (surgical cure of lung cancer) is ofutmost importance in our practice, avoidance of adverseeffects caused by the treatment has also been empha-sized. Fast recovery and improved quality of life aftersurgery have now became important parameters in theevaluation of treatment.Initially introduced for diagnostic or minor surgicalprocedures, thoracoscopic surgery has a long history,as have other endoscopic operations. As with manyminimally invasive procedures, only a few peoplethought that thoracoscopic surgery could replace openthoracotomy in major lung surgery. Nevertheless, recentstudies have confirmed that thoracoscopic surgery canbeappliedinmajorthoracicoperations.