title: Indications for conversion of thoracoscopic to open thoracotomy in video-assisted thoracoscopic lobectomy.
abstract: BACKGROUND
  The study aims to discuss indications for conversion to thoracotomy in completely thoracoscopic lobectomy.
  
  
  METHODS
  From September 2006 to April 2010, 306 patients (164 men, 142 women, median age 58.1 years, range 15 to 86 years) underwent completely thoracoscopic lobectomy. There were 223 cases of primary lung cancer, 11 other malignant diseases and 72 cases of benign disease. The steps of the thoracoscopic procedures are almost identical to those of traditional open lobectomy, which requires standard mediastinal lymph node dissection for primary lung cancer patients. When conversion to an open procedure is necessary, such as in the presence of lymph node adhesions or metastases and bleeding, operative incisions are extended 12-15 cm towards lower angle of the scapula, retractors are used to separate the ribs, and the procedure is completely under direct visualization.
  
  
  RESULTS
  All procedures were performed without significant complications or intraoperative deaths. The average surgical duration was 195 min, and average blood loss was 256 mL with no blood transfusions required. The average chest tube drainage duration was 7.45 days. The average post-operative hospital stay was 10.34 days. There were 27 cases (8.8%) of conversion to open thoracotomy, for the reasons of interference by lymph nodes (n = 18), bleeding (n = 4), inflammatory adhesions of arteries (n = 3) and large size tumours (n = 2).
  
  
  CONCLUSIONS
  Adhesions or lymph node metastases and bleeding were the most important causes of conversion to thoracotomy in completely thoracoscopic lobectomy. Large tumours, fused fissures and dense pleural adhesions can always be managed thoracoscopically.
authors.affiliation: Department of Thoracic Surgery, People's Hospital of Peking University, Beijing, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.forename: Fan
authors.initials: F
authors.lastname: Yang
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Li
authors.forename: Guanchao
authors.initials: G
authors.lastname: Jiang
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D020775:Thoracic Surgery, Video-Assisted; D013906:Thoracoscopy; D013908:Thoracotomy; D000267:Tissue Adhesions; D055815:Young Adult