title: Minithoracotomy combined with mechanically stapled bronchial and vascular ligation for anatomical lung resection.
abstract: BACKGROUND
  The most appropriate approach to anatomic pulmonary resection has been debated with the advance of minimally invasive techniques and especially the common use of mechanical staplers. Video assisted surgery and muscle-sparing thoracotomy are established options of surgical approach for lung resection. We utilize a combined technique of vertical muscle sparing minithoracotomy and mechanical closure of the hilum structures to accomplish lung resection.
  
  
  METHODS
  From December 1995 through January 2002, 713 patients (mean age, 65 +/- 11, 44.6% male) underwent anatomic pulmonary resection including 64 pneumonectomies, 514 lobectomies, and 135 formal segmental resections. Pulmonary resection was approached though a direct access, vertical, minithoracotomy (< 10 cm), and vascular ligation was performed with port-access endostapling instrumentation. Full mediastinal lymph node sampling was performed for primary lung cancer.
  
  
  RESULTS
  The average operative time was 55 minutes for lobectomy-formal segmentectomy and 62 minutes for pneumonectomy. An average of 3.6 staple applications were utilized to ligate the pulmonary vasculature (n = 2548 for 713 patients). Operative vascular complications included 5 minor intimal fractures, 1 posterior segmental arterial avulsion, and 1 staple misfiring for an adverse event rate during stapler application of 0.27%. Only one conversion to standard thoracotomy was necessary to control bleeding from the pulmonary vein. There were no intraoperative deaths.
  
  
  CONCLUSIONS
  Vertical minithoracotomy is a safe and expedited approach for anatomic lung resection. Direct visualization for dissection and effective pulmonary hilum mechanical closure with staplers were demonstrated. This approach is a reasonable option when a complete video-assisted surgery seems to be hazardous and a full open thoracotomy could represent an additional morbidity.
authors.affiliation: Section of Cardiothoracic Surgery, West Virginia University School of Medicine and Morgantown West Virginia Hospital, Morgantown, West Virginia 26506-9238, USA. mszwerc@hsc.wvu.edu
authors.forename: Michael F
authors.initials: MF
authors.lastname: Szwerc
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: Ricardo S
authors.initials: RS
authors.lastname: Santos
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Keenan
authors.forename: Gordon F
authors.initials: GF
authors.lastname: Murray
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001980:Bronchi / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008026:Ligation; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications; D011651:Pulmonary Artery / Q000601:surgery*; D013528:Surgical Staplers; D017792:Surgical Stapling; D013908:Thoracotomy / Q000379:methods*