Multiport video-assisted thoracoscopic surgery pneumonectomy

Abstract

Pneumonectomy is an increasingly uncommon procedure for lung cancer, usually only performed if it is not possible for the patient to have a parenchymal sparing operation. Despite the increasingly common utilization of minimally invasive lung operations, adoption of video-assisted thoracoscopic surgery (VATS) pneumonectomy has been considerably slower, with only 5% of pneumonectomies in the United States being performed via VATS. The reasons for this slower adoption are likely multifactorial, including surgeons' concern for injury at the level of the main pulmonary artery, difficult hilar dissection in central tumors, and problems with both retracting and extracting larger specimens. In this review, we examine the history of pneumonectomy, review recent articles comparing VATS versus open pneumonectomy, discuss our preferred technique for VATS pneumonectomy, and discuss methods for overcoming the most difficult portions of the operation.