Nowadays open-chest surgery in the era of fast-track management

Abstract

In more than a century, approaches to perform thoracic surgical procedures have had profound changes. A milestone of those changes has been the advent of video-assisted techniques which rapidly evolved from minor diagnostic procedures to the performance by video-assisted thoracic surgery (VATS) of almost any major thoracic surgery. Nevertheless, indications remain for open chest procedures along with the fact that thoracotomy techniques have also evolved to minimally invasive ways, far different from the full thoracotomy of the past. This chapter reviews the evolution of open chest techniques and describes in detail present way to perform low invasiveness open chest surgery leading to excellent results through a mild postoperative course. Unsolved issues regarding the comparison of video-assisted and open techniques, particularly in lung cancer surgery are also considered.

Keywords: Video-assisted thoracic surgery (VATS); fast-track management; minimally invasive open chest.

Figure 1

Preoperative chest X-ray and CT scan of a patient with clinical T3 N0 Mo adenocarcinoma.

Figure 2

Schematic view and real photograph of the “tubular” surgical field obtained with Finochietto retractor in small, muscle-sparing thoracotomy.

Figure 3

Schematic view and real photograph obtained with “ad hoc” chest retractor for minimally-invasive open chest surgery.

Figure 4

Minimally-invasive postero-lateral thoracotomy, aimed to show chest aperture and retractor’s setting. Intrathoracic procedure itself can be performed at surgeon’s preference (14). Available online: http://www.asvide.com/articles/1275

Figure 5

Minimally-invasive antero-axillary thoracotomy, aimed to show chest aperture and retractor’setting. Intrathoracic procedure itself can be performed at surgeon’s preference (15). Available online: http://www.asvide.com/articles/1276