Video-assisted thoracoscopic surgery lobectomy via confronting upside-down monitor setting

Abstract

Video-assisted thoracoscopic surgery (VATS) has been widely accepted as a minimally invasive surgery for treatment of early-stage lung cancer. However, various VATS approaches are available. In patients with lung cancer, VATS should achieve not only minimal invasiveness but also safety and oncological clearance. In this article, we introduce our method of VATS lobectomy.

Keywords: Video-assisted thoracoscopic surgery (VATS); confronting upside-down monitor setting; minimally invasive surgery.

Figure 1

Confronting upside-down monitor setting. Two monitors are installed on the cranial side of the patient, and one of the monitors is placed upside down. The surgeon stands on the right side of the patient regardless of the operation side.

Figure 2

Port placement. Each person is able to view the confronting monitor. The surgeon looks at Monitor 1. In this monitor, the left side is the cranial side of the patient. The camera and second assistants look at Monitor 2. In this monitor, the right side is the cranial side of the patient. If the camera assistant keeps the camera in a horizontal position, mirror images and disorientation can be avoided.

Figure 3

Surgical view of the confronting upside-down monitor setting. (A) Dissection of #2R; (B) final view after dissection of the right upper zone; (C) final view after dissection of station 4L; (D) division of A3 by an endoscopic stapler. Checking both the cartridge and anvil at the same time is important to ensure safe division of vessels. RBCA, right brachiocephalic artery; Az, azygos vein; PA, pulmonary artery; LRLN, left recurrent laryngeal nerve; LMB, left main bronchus.

Figure 4

Video-assisted thoracoscopic surgery right upper lobectomy via confronting upside-down monitor setting (5). Under retraction by the second assistant, the pulmonary vessels are sharply exposed and the fissure is divided without crushing the hilar nodes. Available online: http://www.asvide.com/articles/1716

Figure 5

Hilar node dissection and right upper zone systemic lymph node dissection (6). In this particular patient, we performed en bloc lymph node dissection. The nodes were dissected in conjunction with the right upper lobe. Available online: http://www.asvide.com/articles/1717

Figure 6

Mediastinal lymph node dissection of 4L (7). The upper lobe branch of the vagus nerve is retracted by 2-0 silk. The station 4L lymph nodes are then dissected from the surrounding tissue, including the left recurrent laryngeal nerve. The station 10 to 4L lymph nodes are dissected en bloc. Available online: http://www.asvide.com/articles/1718