Video-assisted Thoracic Surgery Research Articles

Opioid-free anesthesia for postoperative recovery after video-assisted thoracic surgery: A prospective, randomized controlled trial.

Opioid-based anesthesia is a traditional form of anesthesia that has a significant analgesic effect; however, it can cause nausea, vomiting, delirium, and other side effects. Opioid-free anesthesia with dexmedetomidine and lidocaine has attracted widespread attention. This study aimed to compare the effects of opioid-free and opioid-based anesthesia (OFA and OBA, respectively) on postoperative recovery in patients who had undergone video-assisted thoracic surgery. Eighty patients undergoing video-assisted thoracic surgery were assigned to receive either opioid-free anesthesia (OFA group) or opioid-based anesthesia (OBA group) according to random grouping. The primary outcome of the study was the quality of recovery-40 scores (QoR-40) 24 h postoperatively. The secondary outcome measure was numerical rating scale (NRS) scores at different times 48 h postoperatively. In addition to these measurements, other related parameters were recorded. Patients who received opioid-free anesthesia had higher QoR-40 scores (169.1 ± 5.1 vs. 166.8 ± 4.4, p = 0.034), and the differences were mainly reflected in their comfort and emotional state; however, the difference between the two groups was less than the minimal clinically important difference of 6.3. We also found that the NRS scores were lower in the OFA group than in the OBA group at 0.5 h (both p < 0.05) and 1 h (both p < 0.05) postoperatively and the cumulative 0-24 h postoperative dosage of sufentanil in the OBA group was higher than that in the OFA group (p = 0.030). There were no significant differences in postoperative nausea and vomiting (PONV) (p = 0.159). No surgical or block complications were observed between the groups. Opioid-free analgesia potentially increased the postoperative recovery in patients who underwent video-assisted thoracic surgery. The study protocol was registered in the Chinese Clinical Trial Register under the number ChiCTR2100045344 (http://www.chictr.org.cn/showproj.aspx?proj=125033) on April 13, 2021.

Video-Assisted Thoracic Surgery Core Needle Biopsy for Pulmonary Nodules in Patients with Impaired Lung Function: Is It Feasible and Safe?

The number of patients with incidentally identified pulmonary nodules is increasing. This study attempted to confirm the usefulness and safety of video-assisted thoracic surgery (VATS) core needle biopsy of pulmonary nodules. Data from 18 patients diagnosed with pulmonary nodules who underwent VATS core need biopsy were retrospectively reviewed. Of the 18 patients, 15 had malignancies (primary lung cancer, n=14; metastatic lung cancer, n=1), and 3 had benign nodules. Mortality and pleural metastasis did not occur during the follow-up period. In patients with solitary pulmonary nodules that require tissue confirmation, computed tomography-guided percutaneous cutting needle biopsy or diagnostic pulmonary resection sometimes may not be feasible choices due to the location of the solitary pulmonary nodule or the patient's impaired pulmonary function, VATS core needle biopsy may be performed in these patients as an alternative method.

Oncologic Outcome after Pulmonary Metastasectomy as Part of Multidisciplinary Treatment in a Tertiary Oncological Center

(1) Background: Pulmonary metastases are encountered in approximately one-third of patients with malignancies, especially from colorectal, lung, breast, and renal cancers, and sarcomas. Pulmonary metastasectomy is the ablative approach of choice, when possible, as part of the multidisciplinary effort to integrate and personalize the oncological treatment. (2) Methods: The study includes 58 consecutive cases of pulmonary metastasectomies, retrospectively analyzed, performed in 12 consecutive months, in which the pathology reports confirmed lung metastases. (3) Results: Most frequent pathological types of metastases were: 14 of colorectal cancer, 10 breast, 8 lung, and 8 sarcomas. At the time of primary cancer diagnosis, 14 patients (24.14%) were in the metastatic stage. The surgical approach was minimally invasive through uniportal VATS (Video-Assisted Thoracic Surgery) in 3/4 of cases (43 patients, 74%). Almost 20% of resections were typical (lobectomy, segmentectomy). Lymphadenectomy was associated in almost 1/2 of patients and lymph node metastases were found in 11.11% of cases. The mortality rate (intraoperative and 90 days postoperative) is zero. The OS after pulmonary metastasectomy is 87% at 18 months, and the estimated OS for cancer is 90% at 5 years. The worst outcome presents the patients with sarcomas and the best outcome-colorectal and lung cancer. The patients with 1 or 2 resected metastases presented 96% survival at 24 months. (4) Conclusions: After pulmonary metastasectomy, survival is favored by the small number of metastases resected (1 or 2), and by the dimension of metastases under 20.5 mm. The non-anatomic (wedge) type of lung resection may present a lower risk of death compared to lobectomy. No statistical significance on survival has the presence of lymphadenectomy, the laterality right/left lung, the upper/lower lobes. In the future, longer follow-up and prospective randomized trials are needed for drawing definitive conclusions.

Robotic upper lobe segmentectomy: technical pearls

: Minimally invasive approaches to segmentectomy have grown in popularity as sublobar resection has been increasingly offered as a parenchyma-sparing alternative to lobectomy for amenable lesions. Both video-assisted thoracic surgery and robotic surgery offer advantages over traditional thoracotomy, with fewer complications, shortened hospital stay, and less pain. While segmentectomy has been traditionally performed by video-assisted thoracic surgery, the robotic approach represents a growing subset of minimally invasive sublobar resections. Patient selection for robotic segmentectomy involves a standard preoperative evaluation including pulmonary function tests, cardiac evaluation, and complete staging. Preoperative axial imaging is essential in choosing patients with lesions amenable to segmentectomy, and evaluating the segmental anatomy. Safe robotic segmentectomy centers around thorough knowledge of the segmental vascular and bronchial anatomy and its variants, and preoperative imaging can help the surgeon anticipate variant anatomy intraoperatively. The operative technique generally involves a mediastinal lymph node dissection with frozen section of the N1 nodes and conversion to lobectomy if positive. The segmental resection then proceeds depending on the individual segment to be resected, but generally involves dissection and division of the vessels and bronchus, followed by division of the parenchyma along the intersegmental plane. For most patients, postoperative recovery is short and uncomplicated, with most patients being discharged on the first or second postoperative day.

Anomalous mediastinal left lower lobe anterior segmental artery (A8) accidentally divided during left VATS upper lobectomy: a case report

: Bronchovascular anatomical variations can pose technical challenges during lobectomy and especially segmentectomy where these structures are embedded deep in the lung parenchyma. Familiarity with these anatomical variations helps avoid intraoperative injury and accidental division. Mediastinal origin of left upper lobe apicoposterior (truncus superior) and lingula arterial branches (A4+5) is common. However mediastinal origin of left lower lobe segmental pulmonary branches is very rare and has not been reported in the literature. An anomalous mediastinal origin of left lower lobe anterior segmental artery (A8) noted during a left video-assisted thoracic surgery (VATS) upper lobectomy in a 69 years old male with stage 1 lung cancer is described. The artery was mistaken for a mediastinal lingula branch (A4+5) during surgery and was divided accidentally. The injury was recognised intraoperatively and primary end to end vascular repair was done by VATS, with the patient making an uneventful recovery. Awareness of this rare anatomical variant can help prevent intraoperative vascular injury or accidental ligation during left VATS lobectomy. Injuries due to anomalous bronchovascular anatomical variations can be prevented by preoperative planning by 3-dimensional contrast enhanced computer tomography and by careful intraoperative dissection and identification of mediastinal and interlobar vessels distally into the respective segments before ligation.

Comparison between preoperative hook-wire and liquid material localization for pulmonary nodules: a meta-analysis.

Computed tomography (CT)-guided liquid material (LM) and hook-wire (HW) are usually localized for pulmonary nodules (PNs) before video-assisted thoracic surgery (VATS) resection, but the relative advantages of these 2 techniques remain uncertain. This meta-analysis was conceived to juxtapose the efficacy and safety of HW localization (HWL) and LM localization (LML), both guided by CT, for the preoperative localization of PNs. The PubMed, Web of Science, and Wanfang databases were searched to identify relevant studies published as of March 2023, after which pooled analyses of study outcomes were conducted. A total of 7 studies were included in this meta-analysis from 142 relevant studies. These 7 studies included 551 patients (583 PNs) with CT-guided HWL and 551 patients (612 PNs) with LML. The successful localization rate was significantly higher in the LM group (LMG) than in the HW group (HWG) (p = 0.002). The LMG also exhibited significantly lower pooled total complication and lung haemorrhage rates than the HWG (p = 0.007 and 0.00001, respectively). Pooled localization duration, pneumothorax rates, and VATS procedure duration were comparable in both groups (p = 0.45, 0.15, and 0.74, respectively). Furthermore, the pooled postoperative hospital stay was significantly shorter in the LMG than in the HWG (p = 0.009). Significant heterogeneity was detected in the endpoints of localization duration and pneumothorax rate (I2 = 93% and 66%, respectively). CT-guided LML is safer and more successful than HWL for patients with PNs before VATS resection.

Challenges and Opportunities in Thoracic Robotic Surgery

Robotic surgery is a platform for minimally invasive thoracic surgery with similar general advantages as in VATS (Video Assisted Thoracic Surgery) including small incisions, faster recovery, minimal blood loss and shorter hospital stay. The extra advantages of using a robotic platform in thoracic surgery include a three-dimensional surgical view, elimination of physiological tremors, and enabling surgical manipulation in a natural orientation because of the presence of forceps that move in the same manner as human wrist joints. These advantages allow more complex procedures to be performed safely and easier technically, thus leading to better outcomes and improvement in the overall result. As a new advance in thoracic surgery, it has challenges that may become the reason why this technique has difficulty being adopted by a number of surgeons including cost, advancement in VATS technique and instrumentation. Despite the challenges, robotic thoracic surgery offers the platform for the expansion and improvement of thoracic surgery. Development in instrument technologies and designs, in addition to progress and interest in other futuristic technology, are notable opportunities for thoracic robotic surgery.

Uniportal robotic versus thoracoscopic assisted surgery: a propensity score-matched analysis of the initial 100 cases.

Minimally invasive surgery (MIS) is becoming the standard of care for anatomic lung resections. The advantages of the uniportal approach compared to the conventional multiple incision approach, multiportal video-assisted thoracic surgery (mVATS) and multiportal robotic-assisted thoracic surgery (mRATS), have been previously described. However, no research studies comparing early outcomes between uniportal video-assisted thoracic surgery (uVATS) and uniportal robotic-assisted thoracic surgery (uRATS) have been reported. Anatomic lung resections performed by uVATS and uRATS from August 2010 to October 2022 were enrolled. Early outcomes were compared after propensity score-matched (PSM) analysis by applying a multivariable logistic regression model including gender, age, smoking habit, forced expiratory volume in the first second (FEV1), cardiovascular risk factors (CVRF), pleural adhesions and tumor size. A total of 200 patients who underwent anatomic lung resections by the same surgeon were recruited in this study, including the initial 100 uVATS patients and the initial 100 uRATS patients. After PSM analysis, each group included 68 patients. The comparison of the two groups showed no significant differences according to the TNM stage in patients with lung cancer, surgical time, intraoperative complications, conversion, number of nodal stations explored, opioid usage, prolonged air leak, length of intensive care unit (ICU) and hospitalization, reintervention and mortality. However, there were significant differences concerning the histology and type of resection (anatomic segmentectomies, the proportion of complex segmentectomies and the sleeve technique were significantly higher in the uRATS group), number of resected lymph nodes (significantly higher in the uRATS group), postoperative complications and duration of chest drain (significantly lower in the uRATS group). Judging from the short-term outcomes, our results confirm the safety, feasibility and efficacy of uRATS as a new minimally invasive technique that combines the benefits of the uniportal method and robotic systems.

Current overview of awake, non-intubated, video-assisted thoracic surgery.

Awake video-assisted thoracoscopic surgery (A-VATS) enables the surgeon to penetrate the tissue via a small incision and with less contact between the lung and atmospheric pressure; postoperative respiratory functions are also less affected than in open surgery. A-VATS is a safer technique than traditional VATS and non-intubated video-assisted thoracoscopic surgery (NI-VATS) because it does not require muscle relaxants and sedoanalgesics. In particular, diagnostic VATS for pleural effusions can be easily performed over a single port using only local anaesthetic. Anaesthesia-related risks increase even more for elderly patients and those with severe comorbidities. Although there are long and risky operations in thoracic surgery, general anaesthesia is not required for some thoracic surgery procedures. However, A-VATS is limited to minor procedures. Due to regional anaesthesia and sedation, NI-VATS is a safe and effective method for many indications. The results show that this method can be applied with low mortality and morbidity.

Challenges in Robotic Lung Lobectomy through the Anterior Approach.

Robot-assisted thoracic surgery (RATS) has become popular because of its minimally invasive nature and reduced burden on surgeons. The anterior approach (AA) is beneficial because it utilizes the same field of view and procedures as thoracotomy and video-assisted thoracic surgery, although the disadvantages are less well-known. We retrospectively examined 35 consecutive patients who underwent RATS lobectomy via the AA, focusing on clinical factors and postoperative complications. The study included 12 males and 23 females with a median console time of 177 (120-346) min, median blood loss of 0 (0-100) mL, and median stapler usage of 5 (2-10) units. Postoperative complications, classified as Clavien-Dindo grade ≥III, included three cases of grade IIIa (prolonged air leakage) and one case each of grade IIIb and grade IVa (middle lobe torsion and ventricular arrhythmia). The influence of stapling device operation cannot be ruled out in prolonged air leakage and middle lobe torsion. A moderate correlation (correlation coefficient = 0.492, p = 0.003) was observed between console time and the number of staplers used. Although no severe incidence of vascular injury was observed with the AA, complications related to the use of stapling devices were noted.

Clinically important pulmonary vascular variations: a narrative review.

Pulmonary vascular variations are a major factor in thoracic surgeries. Minimally invasive techniques, such as video-assisted thoracic surgery (VATS) used in non-small lung cancer treatment, have a limited field of view and no haptic feedback. Additionally, new studies suggest that segmentectomies are beneficial for patients. Accurate knowledge of vascular patterns and variants is crucial for conducting such procedures safely. The aim of this review was to systematize data in a useful manner from studies and case reports concerning pulmonary vascular variations and patterns. We conducted a search on the PubMed and Embase databases. We used classifications of Nagashima, Yamashita, Boyden, Maciejewski, and Shimizu. The analysis showed that more data on the incidence rate and vascular patterns of certain bronchopulmonary segments are needed. Venous variations are a major factor in segmental resections, but additional data regarding incidence and pattern types are needed. Surgeons need to be aware of vascular variations as they can influence procedures in seemingly unrelated areas. The majority of studies emphasize the use of three-dimensional (3D) reconstruction of computed tomography (CT) for accurate planning of any thoracic procedures. Abnormal vessels pose a risk in various procedures performed within the thorax, and the data in this review could be valuable in different medical areas in this regard.

Efficacy of ultrasound-guided second serratus anterior plane block on postoperative quality of recovery and analgesia after video-assisted thoracic surgery: a randomized, triple-blind, placebo-controlled study.

Despite widespread application of minimally invasive video-assisted thoracic surgery (VATS), postoperative pain following this procedure is still a constant clinical challenge. Serratus anterior plane (SAP) block is one of the regional analgesic techniques with promising outcomes. However, due to the limited duration of action, optimal analgesia is often not achieved with a single injection. We tested whether in patients who have been subjected to routine SAP block under preoperative anesthesia, the addition of a second SAP block 24 hours after surgery, improves quality of recovery, lowers postoperative opioid consumption, and reduces the prevalence of chronic pain. The present study is a single institutional, prospective, randomized, triple-blinded, placebo-controlled study. Ninety patients undergoing VATS from January 2022 to April 2022 were randomized at 1:1 ratio to receive ultrasound-guided second SAP block with 15 mL 0.375% ropivacaine (SAP block group) or 15 mL normal saline (control group) 24 hours after both groups received routine SAP block with 15 mL 0.375% ropivacaine. The primary outcome was quality of patient recovery, measured using 40-item quality of recovery questionnaire (QoR-40) at postoperative day 2 (POD 2). Secondary outcomes included: postoperative pain scores at rest, postoperative opioid consumptions, number of times that patient controlled analgesia (PCA) pump button was pressed, perioperative complications and adverse effects, prevalence of chronic pain at 2nd and 3rd month postoperatively, and length of hospital stay (LOS). A total of 83 patients completed the study: 43 patients in SAP block group and 40 patients in the control group. The global QoR-40 scores on POD 2 and POD 3 were significantly higher among SAP block group patients (180.07±11.34, 182.09±8.20) compared with the control group (172.18±6.15, 177.50±6.94) (P=0.01, P=0.008) respectively. Postoperative pain scores, opioid consumptions and incidence of postoperative nausea and vomiting were significantly lower among patients in SAP block group versus control group. There were no statistically significant differences in perioperative complications and LOS between the two groups. The prevalence of chronic pain at the 2nd and 3rd month postoperatively for patients in SAP block group and control group was 16.3%, 14%, and 32.5%, 27.5% respectively. In patients undergoing VATS, application of ultrasound-guided second SAP block 24 hours after surgery improved postoperative quality of life, reduced opioid consumption and related side effects, and lowered the prevalence of chronic pain.

Acute management of pneumonia in adult patients.

Acute management of pneumonia in adult patients.

Retracted: Curative Effect Observation and Prognosis Analysis of Video-Assisted Thoracic Surgery and Thoracotomy in Patients with Hemopneumothorax.

[This retracts the article DOI: 10.1155/2021/3937420.].

Spontaneous Hemothorax by Pulmonary Arteriovenous Malformation during Pregnancy

Abstract Background: Pulmonary arteriovenous malformation (PAVM) is a rare vascular malformation that may cause hemothorax, especially during pregnancy. Case Description: A 25-year-old woman presented sudden-onset left chest pain, dizziness, and dyspnea in the 27th week of gestation. Computed tomography angiography showed left pleural effusion with complete hemithorax opacification and an aneurysmal PAVM. She exhibited hemorrhagic shock and received emergency exploratory video-assisted thoracic surgery. A ruptured PAVM was identified and stopped by wedge resection in the upper lobe of the left lung. The patient's postoperative clinical course was uncomplicated. She subsequently delivered a healthy live baby vaginally at 41 weeks gestation. Conclusion: PAVM should be considered in pregnant women with hemothorax. Emergency thoracoscopic surgery is the best treatment option.

A rare cause of spontaneous pneumothorax: radiological findings and surgical approach

Birt-Hogg-Dubé Syndrome (BHDS) is a rare genetic condition that affects the connective tissue of kidneys, lungs, and skin, causing an aberration in the proteic folliculin (FLCN) pathway. In the lungs, the altered FLCN is found in the outer part of the alveoli, particularly in the lower lobes, causing parenchymal weakness and subsequent cystic degeneration. Because of its rarity, a comprehensive management protocol is not available yet. We present a case of a man with left recurrent pneumothorax due to bilateral multiple bullae, as revealed by a preoperative chest Computed Tomography (CT) scan. Given the characteristic radiological features of BHDS, the CT scan should always be considered for the differential diagnosis to exclude other more common cystic diseases, such as lymphoid interstitial pneumonia, Langerhans cell histiocytosis, or lymphangioleiomyomatosis. Considering the different options suitable for bullous diseases, we decided to treat the patient with a pleural abrasion through a biportal Video-Assisted Thoracic Surgery approach and sterile talc pleurodesis. No more spontaneous episodes were reported one year later. Bullectomy was not carried out because the diffuse cystic intraoperative pattern would never be solved by marginal parenchymal resections. Relapsing spontaneous pneumothorax could be a spy of a hidden genetic disease (such as BHSD), and a CT scan should be considered case-by-case because it may provide crucial information regarding the overall lung pattern. In such cases, pleural abrasion with talc pleurodesis is a considerably effective treatment.

Predictive Factors for Psychological Distress in Patients with Lung Cancer Who Underwent Video-Assisted Thoracic Surgery Lobectomy

Predictive Factors for Psychological Distress in Patients with Lung Cancer Who Underwent Video-Assisted Thoracic Surgery Lobectomy

Surgical treatment of congenital diaphragmatic hernia in a single institution

BackgroundThis study aimed to evaluate the effectiveness of video-assisted thoracic surgery for the treatment of congenital diaphragmatic hernia (CDH) in a larger series compared with conventional open surgery. Additionally, we summarized the experience of thoracoscopic surgery in the treatment of CDH in infants.MethodsWe retrospectively analysed the clinical data of 109 children with CDH who underwent surgical treatment at the Department of Cardiothoracic Surgery of Children’s Hospital of Chongqing Medical University from January 2011 to January 2021. According to the surgical method, the children were divided into an open group (62 cases) and a thoracoscopy group (47 cases).Patients who underwent surgical correction had the diaphragmatic defect size graded (A–D) using a standardized system. We compared the operation time, intraoperative blood loss, postoperative mechanical ventilation time, postoperative hospital stay, postoperative CCU admission time and other surgical indicators as well as the recurrence rate, mortality rate and complication rate of the two groups of children.ResultsThe index data on the operation time, intraoperative blood loss, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P < 0.05). We compared the number of incision infections, lung infections, atelectasis, pleural effusion, and chylothorax between the two groups. There were more children in the open group than in the thoracoscopy group. The overall incidence of postoperative complications in the open group (51.61%) was higher than that in the thoracoscopy group (44.68%).The recurrence rate of the thoracoscopy group (8.51%) was higher than that of the open group (3.23%). In the open group, 7 patients died of respiratory distress after surgery, and no patients died in the thoracoscopy group.ConclusionsThoracoscopic surgery and open surgery can effectively treat CDH. Compared with conventional open surgery, thoracoscopy has the advantages of shorter operation time, less trauma, faster recovery and fewer complications. We believe that thoracoscopic surgery for type A/B diaphragmatic defect has certain advantages, but there is a risk of recurrence.

CT-guided placement of microcoil end in the pleural cavity for video-assisted thoracic surgical resection of ground-glass opacity: a retrospective study

BackgroundThe aim of the study was to investigate and summarize the effectiveness and safety of CT-guided microcoil localization before video-assisted thoracic surgery (VATS) for the removal of ground-glass opacity (GGO).MethodsA total of 147 patients with GGO who were treated at our hospital between January 2019 and February 2021 were retrospectively analyzed. They were divided into two groups according to the final position at the end of the microcoil: intracavity (n = 78) and extracavity (n = 69), which were compared based on puncture complications and influence of the coil end position on VATS.ResultsThe proportions of supine and prone positions in the intracavity group were significantly higher than those in the extracavity group (82.1% vs. 66.7%, P < 0.05). The incidence of intrapulmonary hemorrhage, chest pain, and coil displacement in the intracavity group was significantly lower than that in the extracavity group (28.2% vs. 46.4%, 19.2% vs. 39.1%, 1.3% vs. 11.6%, P < 0.05, respectively); however, the incidence of pneumothorax was not significantly different (P > 0.05). The time of VATS and the rate of conversion to thoracotomy in the intracavity group were significantly lower than those in the extracavity group (103.4 ± 21.0 min vs. 112.2 ± 17.3 min, 0% vs. 5.8%, P < 0.05, respectively).ConclusionCT-guided placement of the microcoil is a practical, simple, and convenient localization method before VATS, with a high success rate and few complications. Furthermore, it is a better alternative method to place the end of the coil in the pleural cavity because of the lower complication rate, shorter VATS time, and lower rate of thoracotomy conversion.

A Comparison of Surgical Mediastinal Lymph Node Evaluation in Clinical N0 Non-small Cell Lung Cancer between Video-Assisted Thoracoscopic Lobectomy and Open Lobectomy

Background: Video-assisted thoracoscopic surgery (VATS) for lobectomy is increasingly a procedure for early-stage lung cancer surgery, but the controversy remains on the adequacy of the lymph node evaluation. Objective: To compare the completeness of surgical mediastinal lymph node evaluation between VATS lobectomy and open lobectomy in clinical N0 non-small cell lung cancer (NSCLC). Material and Methods: Between January 2015 and August 2020, 312 patients who underwent lobectomy for clinical N0 NSCLC at Central Chest Institute of Thailand were reviewed, including 149 patients in VATS lobectomy and 163 patients in open lobectomy. Patient characteristics, surgical outcomes, and lymphadenectomy results were analyzed and compared. Results: VATS lobectomy had prolonged operative time minute at 198.4±46.8 versus 160.9±73.6 (p≤0.001) but less blood loss at 100 versus 150 (p=0.034) than open lobectomy. The sampling procedure was more frequently performed in the open lobectomy at 44.2% versus 19.5% (p≤0.001), but the VATS lobectomy used the systematic dissection procedure mainly at 67.1% versus 42.9% (p≤0.001). The median overall number of lymph nodes at 19 versus 12 (p≤0.001) and the number of stations N2 nodes at 12 versus 6 (p≤0.001), especially in station 7 were dissected higher in the VATS lobectomy at 130 versus 100 (p≤0.001), but the number of stations N1 nodes was similar. The rate of lymph node upstaging was not significantly different between the two groups (p=0.176). The risk factor for lymph node upstaging was only the tumor size. There were no differences in complication and mortality. Conclusion: The completeness of mediastinal lymph node evaluation for patients with clinical N0 NSCLC operated on by an experienced surgeon in VATS lobectomy was comparable with the open lobectomy. Keywords: Video-assisted thoracic surgery; Open thoracotomy; Mediastinal lymph node assessment; Non-small cell lung cancer