title: Hybrid video-assisted and limited open (VALO) resection of superior sulcus tumors.
abstract: OBJECTIVE
  To compare the postoperative recovery of patients with superior sulcus tumors (Pancoast tumors) following conventional open surgery vs. a hybrid video-assisted and limited open approach (VALO).
  
  
  METHODS
  The subjects of this retrospective study were 20 patients we operated on to resect a Pancoast tumor. All patients received induction chemo-radiation followed by surgery, performed via either a conventional thoracotomy approach (n = 10) or the hybrid VALO approach (n = 10). In the hybrid VALO group, lobectomy and internal chest wall preparation were performed using a video technique, with rib resection and specimen removal through a limited incision.
  
  
  RESULTS
  There was no mortality in either group. Two patients from the thoracotomy group required mechanical ventilation, but there was no major morbidity in the hybrid VALO group. The operative times were similar for the two procedures. The average length of hospital stay was shorter and the average pain scores were significantly lower in the hybrid VALO group. The incidence of chronic pain was 10 % in the hybrid VALO group vs. 50 % in the thoracotomy group.
  
  
  CONCLUSIONS
  Hybrid VALO resection of Pancoast tumors is feasible and safe, resulting in faster patient recovery and a significantly lower incidence of severe chronic pain than open thoracotomy. We conclude that centers experienced with video-assisted lobectomy should consider hybrid VALO surgery as the procedure of choice for Pancoast tumors.
authors.affiliation: Department of General Thoracic Surgery, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel. alon.bennun@sheba.health.gov.il.
authors.forename: Alon Ben
authors.initials: AB
authors.lastname: Nun
authors.affiliation: Department of General Thoracic Surgery, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Simansky
authors.affiliation: Department of General Thoracic Surgery, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
authors.forename: Merav
authors.initials: M
authors.lastname: Rokah
authors.affiliation: Department of General Thoracic Surgery, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
authors.forename: Nona
authors.initials: N
authors.lastname: Zeitlin
authors.affiliation: Department of General Thoracic Surgery, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
authors.forename: Roni Ben
authors.initials: RB
authors.lastname: Avi
authors.affiliation: Department of Imaging, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
authors.forename: Michalle
authors.initials: M
authors.lastname: Soudack
authors.affiliation: Department of General Thoracic Surgery, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
authors.forename: Nir
authors.initials: N
authors.lastname: Golan
authors.affiliation: Department of Oncology, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
authors.forename: Sarit
authors.initials: S
authors.lastname: Apel
authors.affiliation: Department of Oncology, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
authors.forename: Jair
authors.initials: J
authors.lastname: Bar
authors.affiliation: Department of General Thoracic Surgery, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Yelin
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D010178:Pancoast Syndrome / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D020535:Video-Assisted Surgery
keywords: Lung cancer; Surgical techniques; Thoracoscopy/VATS