Video-Assisted Thoracoscopic Surgery Technique for Pneumonectomy Shown to Be Safe

“In the largest series of its kind to date, researchers at Roswell Park Cancer Institute (RPCI) have shown that performing thoracoscopic pneumonectomy, removal of the entire lung through a minimally invasive endoscopic approach, at a high-volume center appears to be safe and may provide pain and survival advantages in the long term.

“ ‘During the past 20 years, portions of the lungs have been removed for lung cancer through lobectomies, and that has been shown to be better done through small incisions or through thoracoscopic lobectomy compared with standard, open lobectomy,’ says Todd Demmy, MD, FACS, Clinical Chair of the Department of Thoracic Surgery and Professor of Oncology at RPCI. ‘We wanted to see if any of the benefits of the lobectomy — which typically involves removal of 20-50% of the organ — carry forward when you take the whole lung out in a pneumonectomy.’

“Dr. Demmy and his colleagues retrospectively reviewed all patients who underwent pneumonectomy at RPCI from 2002 through 2012. Of the 107 consecutive pneumonectomies performed during this time period, 40 cases were done through an open technique, 50 were done through successful video-assisted thoracoscopic surgery (VATS), and 17 were converted from VATS to an open procedure.

“ ‘We performed a relatively large number of pneumonectomies without a significant event in the operating room such as excessive bleeding, which has been one of the major concerns that have prevented other surgeons from trying this technique,’ Dr. Demmy says.”

Giving Lung Cancer Surgeons a 3-D View

Minimally invasive surgery (MIS) is performed using surgical tools on long, thin ‘stalks’ that are inserted through small incisions (less than 1 inch). A small video camera on a flexible tube is introduced through another small hole to guide the surgeon’s work. MIS offers less pain and faster recovery than traditional surgery. However, previously, the camera had only been able to transmit two-dimensional images to the surgeon, who had to perform the surgery without proper depth perception. Now, three-dimensional (3-D) video-assisted thoracoscopic surgery (VATS) adds a new dimension. Surgeons wear 3-D goggles during the surgery, giving them a clearer picture of the region on which they are operating. VATS can be used for various chest surgeries, including lung cancer surgeries.