title: Thoracoscopic anterior 'fissure first' technique for left lung cancer with an incomplete fissure.
abstract: BACKGROUND
  Dealing with incomplete lung fissures during thoracoscopic surgery is difficult. Our objective was to evaluate the efficacy and safety of a thoracoscopic anterior 'fissure first' technique for dealing with incomplete left lung fissures.
  
  
  METHODS
  One hundred and seventy patients underwent left upper lobectomy or left lower lobectomy between April 2008 and July 2014. Of these, 34 patients underwent surgery using a thoracoscopic anterior 'fissure first' technique for incomplete fissures (group A) and 136 underwent surgery using a conventional thoracoscopic method for unfused fissures (group B). A four-port complete thoracoscopic approach was used in all patients. After completion of the fissure, hilar lymphadenectomy was performed in the conventional manner.
  
  
  RESULTS
  There were no significant differences between the two groups in operating time, blood loss, or duration of chest tube drainage. Patients in group A required more staple cartridges than those in group B (mean number of cartridges, 2.4vs. 1.1; P<0.01). The two groups did not significantly differ with regard to the prevalence of air leaks (12%vs. 4%; P=0.11), either prolonged or delayed.
  
  
  CONCLUSIONS
  We found that a thoracoscopic anterior 'fissure first' technique for left lung cancer with an incomplete fissure enabled hilar lymphadenectomy to be performed in the conventional manner without any increase in the prevalence of air leaks, operating time, or duration of chest tube drainage. This technique should be considered for use in left upper lobectomy or left lower lobectomy in patients with an incomplete fissure.
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;; Department of Surgery, Yokohama City University School of Medicine, Kanagawa, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Samejima
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Mingyon
authors.initials: M
authors.lastname: Mun
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Matsuura
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakao
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Uehara
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Nakagawa
authors.affiliation: Department of Surgery, Yokohama City University School of Medicine, Kanagawa, Japan.
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
authors.affiliation: Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Okumura
keywords: Lung/AB; lung neoplasms/SU; thoracoscopy/MT