Video-assisted thoracoscopic surgery en bloc chest wall resection

Abstract

In the latest two decades, the video-assisted thoracoscopic surgery (VATS) technique has gained recognition as an effective alternative to conventional open surgery, and the field of its application has gradually extended to more complex diseases, such as locally invasive non-small cell lung cancer (NSCLC) requiring combined lung and chest wall resection. The en bloc chest wall resection can be accomplished by using a typical VATS port placement, each time adjusted to allow a better thoracoscopic guidance and a correct resection of the tumour to achieve negative margins. Different approaches have been described by experienced surgeons, with a remarkable variability in the number and disposition of the ports, in the surgical tools used and in the strategy of sparing the covering tissues. The common denominator of these experiences is the aim of extending the criteria of functional and oncological operability to high-risk patients who are not suitable for a conventional thoracotomy. Indeed, the VATS approach has shown effectiveness in reaching unchanged oncological outcomes in comparison with the thoracotomic technique but involving significantly less postoperative pain, faster recovery, shorter hospitalisation and lower overall complications.

Keywords: Lung cancer; video-assisted thoracic surgery.

Figure 1

(A,B) Preoperative CT scan with evidence of left upper lobe nodule invading the posterior chest wall (courtesy of Piergiorgio Solli).

Figure 2

Surgical specimen after VATS left upper lobectomy with chest wall resection (courtesy of Piergiorgio Solli).