title: Management of the pulmonary artery during video-assisted thoracoscopic left upper lobectomy.
abstract: BACKGROUND
  Complete video-assisted thoracoscopic surgery (c-VATS) for left upper lobectomy is difficult due to the branching pattern of the left pulmonary artery.
  
  
  OBJECTIVE
  Our purpose was to report outcomes of a modified technique of c-VATS left upper lobectomy.
  
  
  METHODS
  We retrospectively compared the outcomes of 83 patients with stage I/II non-small-cell lung cancer (NSCLC) who received left upper lobectomy between 2008 and 2011; 32 underwent conventional c-VATS and 50 received modified c-VATS. In the modified procedure, the order in which hilum of lung was treated was from the lingular segmental artery to the superior pulmonary vein to the bronchus, and then finally the pulmonary artery.
  
  
  RESULTS
  The mean patient age was 63.6 ± 8.4 years, and no differences were observed in age, gender, and largest tumor diameter between the two groups. No conversion occurred in either group. The surgical time for modified c-VATS was significantly shorter than that for conventional c-VATS (210 vs. 270 min, p < 0.001). Drainage time after surgery and length of hospitalization for the modified c-VATS group were significantly less than those for the conventional group (drainage 3 vs. 4 days, respectively, p = 0.041; length of hospitalization 7 versus 12 days, respectively; p < 0.001). Surgical margins were clear in all cases. Four (8.0 %) complications occurred in the modified procedure group compared with ten (31.3 %) in the conventional group (p = 0.015).
  
  
  CONCLUSIONS
  This new technique offers shorter surgical and postoperative drainage time, shorter hospital stays, and fewer complications than conventional c-VATS upper left lobectomy.
authors.affiliation: Department of Thoracic Surgery, Fujian Medical University Union Hospital, NO.29, Xinquan Road, Fuzhou, 350000, Fujian, China.
authors.forename: Zhao-hui
authors.initials: ZH
authors.lastname: Guo
authors.forename: Ming-qiang
authors.initials: MQ
authors.lastname: Kang
authors.forename: Ruo-bai
authors.initials: RB
authors.lastname: Lin
authors.forename: Wei
authors.initials: W
authors.lastname: Zheng
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhu
authors.forename: Bin
authors.initials: B
authors.lastname: Zheng
authors.forename: Guo-bing
authors.initials: GB
authors.lastname: Xu
authors.forename: Chun
authors.initials: C
authors.lastname: Chen
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D061646:Operative Time; D011013:Pneumonectomy / Q000379:methods*; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*