title: Video-assisted thoracoscopic pneumonectomy: the anterior approach.
abstract: BACKGROUND
  Video-assisted thoracoscopic surgery (VATS) lobectomy is now a well-accepted way to perform a minimally invasive lobectomy. VATS lobectomy is different from the conventional surgery. Different incisions, instruments and camera positions have also been described in the past two decades. There are no fixed patterns in VATS lobectomy. We here describe our method for fissure-based VATS lobectomy using an anterior approach. The aim of this paper is to show our technique for VATS lobectomy and our experience and outcomes obtained.
  
  
  METHODS
  A 57-year-old man, who was admitted to the Affiliated Hospital of the Guangdong Medical College, had coughing up blood tinged sputum, right chest pain for one month. Thoracic CT imaging revealed a 22 mm × 22 mm × 20 mm, T1bN1M0 lesion in the right lower lobe. The patient for clinical stage II non-small cell lung cancer underwent VATS lobectomy by using an anterior approach on January 2013.
  
  
  RESULTS
  Total volume of chest tube drainage after operation was 450 mL, intraoperative blood loss was 80 mL, operation time was 105.8 min, chest tube duration was three days, length of postoperative hospital stay was eight days. Follow-up no recurrence and metastasis for six months.
  
  
  CONCLUSIONS
  The main advantages of the anterior approach in our experience are easy to deal with the absence or incomplete fissure by the "tunneling" approach. In addition, the mediastinal node packets are clearly seen, allowing thorough lymphadenectomy. Therefore, VATS lobectomy by the anterior approach is a safe, feasible procedure.
authors.affiliation: The Affiliated Hospital of the Guangdong Medical College, Zhanjiang 524001, China.
authors.forename: Zhu
authors.initials: Z
authors.lastname: Liang
authors.affiliation: The Affiliated Hospital of the Guangdong Medical College, Zhanjiang 524001, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: The Affiliated Hospital of the Guangdong Medical College, Zhanjiang 524001, China.
authors.forename: Zhan
authors.initials: Z
authors.lastname: He
authors.affiliation: The Affiliated Hospital of the Guangdong Medical College, Zhanjiang 524001, China.
authors.forename: Liyao
authors.initials: L
authors.lastname: Lin
authors.affiliation: The Affiliated Hospital of the Guangdong Medical College, Zhanjiang 524001, China.
authors.forename: Jianlong
authors.initials: J
authors.lastname: Xie
authors.affiliation: The Affiliated Hospital of the Guangdong Medical College, Zhanjiang 524001, China.
authors.forename: Xianjie
authors.initials: X
authors.lastname: Fu
keywords: Video-assisted thoracoscopic surgery (VATS); lung cancer; lung lobectomy; minimally invasive surgery; thoracoscopy