title: Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases.
abstract: OBJECTIVE
  To analyse the evolution of the video-assisted thoracoscopic (VATS) approach for lobectomy and results during the first 3 years of program.
  
  
  METHODS
  From 1(st) July-2007 to 31(th) July-2010 we carried out 200 lobectomies by VATS. In February 2009 we started performing VATS lobectomies with only 2 incisions .We have analyzed both annual and overall outcomes regarding type of approach, conversion rate, surgical time, lymphadenectomy and overall survival.
  
  
  RESULTS
  Distribution of the cases per year were as follows: first-year 32, second-year 65, third-year 103. Overall conversion rate was 14,5% (first-year 25%, second-year 20%, third-year 7.8%; p = 0.017). Surgical approach was: 4 ports (1 case), 3 ports (99 cases, 100% in first-year), 2 ports (99 cases, 80% in third-year), single-port (1 case, third-year) Mean surgical time in successful VATS was 193.8 min (210.8 first-year, 207.9 second-year, 181.1 third-year; p = 0.011), mean number of lymph nodes were 11.9 (9.3 first-year, 10.1 second-year, 13.9 third-year; p = 0.003) and mean explored stations was 4.2 (3.6 first-year, 3.8 second-year, 4.5 third-year; p < 0.001). Globally median chest tube duration was 3 days. Median length of stay was 4 days. The disease-free survival at 30 months was 85% for Stage I patients and 62% for non-stage I patients.
  
  
  CONCLUSIONS
  As we gain more experience over time, with more cases performed each year and less invasive approaches, results improve in terms of less surgical time and more extended lymphadenectomies. Furthermore, we have observed a clear evolution in our surgical approach to a less invasive 2-port approach. In selected cases we have implemented the single-port lobectomy.
authors: Department of Thoracic Surgery, Coruña University Hospital, Xubias 84, 15006 Corunna, Spain. diego.gonzalez.rivas@sergas.es
authors: Diego
authors: D
authors: Gonzalez
authors: Mercedes
authors: M
authors: de la Torre
authors: Marina
authors: M
authors: Paradela
authors: Ricardo
authors: R
authors: Fernandez
authors: Maria
authors: M
authors: Delgado
authors: Jose
authors: J
authors: Garcia
authors: Eva
authors: E
authors: Fieira
authors: Lucia
authors: L
authors: Mendez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D016896:Treatment Outcome