Video-assisted thoracoscopic surgery lobectomy: The first Indian report

Abstract

Introduction:The fear of pleural adhesions and densely stuck lymph nodes in India, a country where tuberculosis is endemic, is one major factor keeping our surgeons away from video-assisted thoracoscopic surgery (VATS) lobectomy. In this paper, we aim to report our experience with performing VATS lobectomy in 102 cases using a standardised three-port anterior approach.Materials and Methods:Between March 2012 and September 2016, we performed 102 VATS lobectomies. Sixty patients (58.8%) were males and 42 females (41.2%), with a mean age of 42.02 years. Diagnoses were as follows: benign disease (72), lung cancer (27) and pulmonary metastases (3). Among the cases with primary lung cancer, twenty out of 27 (74%) were adenocarcinoma and 7 cases of squamous carcinoma (25.92%). All patients underwent lobectomy by a standardised three-port anterior approach.Results:The overall conversion rate was 8.82% (n = 9). We observed no postoperative complications in 82 (80.4%) patients. The average blood loss was 211.37 ml. Mean operative time was 173 min. Median length of hospital stay was 5 with median chest tube duration of 4.9 days. There was no in hospital or 30-day mortality. The most common complication was prolonged air leak.Conclusion:From this first Indian series, it is clear that VATS lobectomy is feasible in both benign and malignant cases. It also shows that the fear of adhesions is unwarranted and properly selected benign cases can also undergo VATS lobectomy safely.

Video-assisted thoracoscopic surgery versus open thoracotomy in the management of empyema

“…[ 29 ] also concluded shorter operative time for VATS (193.24 ± 72.64 min) as compared with 208.05 ± 61.97 min for OT. In the latest study by Kumar et al .,[ 28 ] the mean duration of VATS lobectomy was 169.30 min, a figure quite close to that of our study.…”

“…which included 102 patients who underwent VATS lobectomy. [ 28 ] However, the conversion rate observed in his study was 8.82%. Excessive bleeding necessitating the conversion of VATS to OT was seen in one patient which was due to iatrogenic intraoperative vascular injury to the interlobar branch of the right pulmonary artery which got torn while decorticating over the right oblique fissure.…”

“…In their evaluation of VATS lobectomy of 102 patients, Kumar et al . [ 28 ] reported an almost similar mean intraoperative blood loss of 198.88 ml. Al-Tarshihi[ 30 ] in 2008 in their study comparing VATS with OT in the management of primary pneumothorax also came to a similar conclusion of decreased intraoperative blood loss in the VATS group.…”

“…Consistent with our findings, the mean VAS scores on POD 1 and POD 30 in a study by Kumar et al . [ 28 ] on 102 patients undergoing VATS lobectomy were 5.09 and 0.02, respectively. In a study by Andreetti et al .,[ 31 ] lower pain scores were found in patients who underwent VATS lobectomy.…”

Lung Cancer in India

“…A single highvolume center reported the safety of video-assisted thoracoscopic surgery with a conversion rate to open thoracotomy of 8.82% and no postoperative complications in 80.4% of patients revealing the feasibility of the technique in our setting. 22 The most often used perioperative analgesia is epidural analgesia (84%) followed by paravertebral block (40%), and intercostal block in addition to epidural may not offer any additional benefit. 15,23 The median hospital stay among patients undergoing surgery for lung cancer is 5 to 6 days.…”