Video-Assisted Thoracic Surgery Technique for Chest Wall Resection

Abstract

Chest wall resection is indicated in the management of operable primary chest wall tumors and lung cancers with chest wall invasion in carefully selected patients. Traditionally, chest wall resection has been performed via open thoracotomy, which is associated with significant postoperative pain and other associated morbidities. Furthermore, depending on the size and location of the resulting chest wall defect, chest wall reconstruction is warranted to maintain overall chest wall integrity, preserve inherent respiratory mechanics, and protect underlying intrathoracic structures. Video assisted thoracic surgery (VATS) techniques are an emerging and alternative technique to open chest wall resection, and have the potential benefit of minimizing the overall incision size, avoiding extensive rib spreading, and reducing tissue trauma. Given the technical challenges and lack of robust prospective outcomes data, VATS chest wall resection has not been widely adopted, but early reports appear to demonstrate its feasibility without apparent detriment to safety in selected patient populations. In this review, we detail relevant operative steps related to patient positioning and strategic port placement, anatomical dissection, and reconstruction options, as well as provide useful trouble shooting tips and tricks to help optimize outcomes following VATS chest wall resection. Chest wall resection is indicated in the management of operable primary chest wall tumors and lung cancers with chest wall invasion in carefully selected patients. Traditionally, chest wall resection has been performed via open thoracotomy, which is associated with significant postoperative pain and other associated morbidities. Furthermore, depending on the size and location of the resulting chest wall defect, chest wall reconstruction is warranted to maintain overall chest wall integrity, preserve inherent respiratory mechanics, and protect underlying intrathoracic structures. Video assisted thoracic surgery (VATS) techniques are an emerging and alternative technique to open chest wall resection, and have the potential benefit of minimizing the overall incision size, avoiding extensive rib spreading, and reducing tissue trauma. Given the technical challenges and lack of robust prospective outcomes data, VATS chest wall resection has not been widely adopted, but early reports appear to demonstrate its feasibility without apparent detriment to safety in selected patient populations. In this review, we detail relevant operative steps related to patient positioning and strategic port placement, anatomical dissection, and reconstruction options, as well as provide useful trouble shooting tips and tricks to help optimize outcomes following VATS chest wall resection. Commentary: Reasons to BotherOperative Techniques in Thoracic and Cardiovascular SurgeryVol. 27Issue 3PreviewThe article by Hirji and colleagues is a well-illustrated primer for those wishing to embark on minimally invasive chest wall resection.1 Arguably, the popularity of this approach compared to VATS lobectomy has been tempered by the reasonable question, “Why bother avoiding thoracotomies if cutting through ribs anyway?” Full-Text PDF