Video-atlas of thoracoscopic formal lung resections emulating traditional open techniques.

Abstract

Ann Cardiothorac Surg 2012;1(1):88-99 www.annalscts.com Thoracoscopic lobectomy began 20 years ago as a natural extension from performing less complex VATS operations. During this evolution, the traditional open lobectomy steps have been modified in some centers to accommodate the limitations in available technology, most notably resulting from the constraints in exposure, vantage point, and retraction. As an example, one such modification is to divide the interlobar fissure rather than the bronchus last. These modified techniques are quite powerful but require training to become accustomed to the different views of the hilar structures. These variations in the standard thoracotomy approach often reflect individual practices and don’t always build on aggregated surgeons’ experiences, and also may be difficult to use when faced with complex and aberrant anatomy. Given the rising popularity of less invasive surgery, technology has been developed to emulate or even surpass the exposure and retraction options used in traditional open techniques. Specifically, highdefinition thoracoscopic cameras with deflectable optics provide excellent exposures. Angled, low profile (5 mm shaft) retractors and other instruments can be used simultaneously through single small incisions to set up the traction and counter-traction forces that uniformly enable safe dissection techniques. This set of videos demonstrates methods that viewers can use to translate their open operative experiences to a successful minimally invasive practice. Even if the viewer has adopted a different preferred approach, many of the demonstrated techniques (like opening incomplete fissures) will come in handy in the presence of bulky tumors or aberrant vascular anatomy. Table 1 lists the videos and some of the specific maneuvers of interest. The appendix provides a timed narrative to help locate specific points in the procedure. The viewer is encouraged to view all the videos as some basic elements are emphasized in only 1-2 of the compilations. Furthermore, it may be useful to view some portions of the videos repetitively concentrating first on the live action and then later on the side bar animation. The animation provides important information on which ports are used for the camera vantage point and or tool manipulations. Since the tools are constrained by the Masters of Cardiothoracic Surgery