Complete versus assisted thoracoscopic approach: a prospective randomized trial comparing a variety of video-assisted thoracoscopic lobectomy techniques.
BACKGROUND
Video-assisted thoracoscopic surgery (VATS) lobectomy does not represent a unified approach, but rather a spectrum of operative techniques ranging from a complete endoscopic thoracotomy to a minithoracotomy. A prospective randomized trial was conducted to compare the differences in these techniques and their results to determine the best of VATS lobectomy for lung cancer.


METHODS
This study randomized 39 consecutive patients with clinical stage I lung cancer to undergo either a complete (C-VATS, n = 20) or an assisted (A-VATS, n = 19) VATS approach for pulmonary lobectomy.


RESULTS
The operating time was longer (p = 0.002) and blood loss was less (p = 0.004) with C-VATS than with A-VATS. Although there was no significant difference in analgesic use or duration of thoracic drainage between the groups, a shorter hospitalization was observed after C-VATS. Serum peak levels of postoperative inflammatory markers (white blood cell count, C-reactive protein, creatine phosphokinase) were lower with C-VATS and an earlier return to normalization than with A-VATS.


CONCLUSIONS
Various differences exist among the VATS lobectomy techniques, and complete VATS lobectomy as a purely endoscopic surgery may be technically feasible and a satisfactory alternative to the conventional procedure for stage I lung cancer.
Shigemura
N
N
Division of the General Thoracic Surgery, Takarazuka Municipal Hospital, Hyogo, Japan. n shige@blue.ocn.ne.jp
Akashi
A
A
Nakagiri
T
T
Ohta
M
M
Matsuda
H
H
D000368:Aged; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods*