title: Outcomes of a hybrid technique for video-assisted thoracoscopic surgery (VATS) pulmonary resection in a community setting.
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) for pulmonary resection was first described 18 years ago; however, it has yet to gain widespread acceptance in community hospitals in the United States. The majority of surgeons who routinely perform VATS resections work in academic or government institutions. There is little data reporting outcomes of VATS pulmonary resections by community-based surgeons. This article reports the outcomes of a hybrid technique for VATS pulmonary resection in a single-surgeon, community-based practice.
  
  
  METHODS
  A retrospective study was performed on all VATS pulmonary resections performed from January 2000 to March 2008 by a community-based, solo-practice surgeon using a hybrid VATS technique, which utilizes dual access through a thoracoscopy port and a utility incision.
  
  
  RESULTS
  A total of 1170 VATS pulmonary resections were performed over the study period, which is the largest single-surgeon series on VATS pulmonary resection to our knowledge. Among them, 746 cases were for malignant disease. Mean operative time was 52 minutes (median 48 minutes). Mean length of stay was 7 days (median 4 days). Mean length of ICU stay was 1.4 days, with 83% of patients having no days spent in the ICU. Mean length of chest tube duration was 4.5 days. The morbidity rate was 21.1 %, with neuropraxia as the most frequent complication. Perioperative mortality was 4.3% and overall mortality was 16.4%, with a mean follow-up of 425 days.
  
  
  CONCLUSIONS
  This series shows that our hybrid VATS approach to pulmonary resection is safe and feasible at community hospital-based practices.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Louisiana State University Health Sciences Center - Shreveport and Feist-Weiller Cancer Center, Shreveport, LA, USA;
authors.forename: Roger H
authors.initials: RH
authors.lastname: Kim
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Takabe
authors.forename: Charles G
authors.initials: CG
authors.lastname: Lockhart