BACKGROUND:In early-stage lung cancer, evidence is accumulating for the benefits of lobectomy by video-assisted thoracic surgery (VATS) over open lobectomy. Few thoracic training programs offer sufficient experience in this technically demanding procedure. This article describes the evolution of a new graduate's practice from open thoracotomy to VATS lobectomy. STUDY DESIGN:Our model involves a transition in technique from posterolateral thoracotomy to muscle-sparing thoracotomy and, ultimately, to VATS lobectomy. This approach was evaluated by examining outcomes of open thoracotomy patients before VATS lobectomy and outcomes of the initial 30 VATS patients. Data were collected prospectively. RESULTS:Before undertaking VATS lobectomy, 94 major pulmonary resections were performed by thoracotomy. Mortality was 1.2% for lobectomy and 0% for pneumonectomy. Use of the muscle-sparing thoracotomy increased from 17% of patients in the first half to 70% in the latter half of this group. For the first 30 VATS lobectomy patients, the mean operative time was 168 minutes. Median blood loss was 200 mL. Conversion rate to open thoracotomy was 13.3%. Mortality was 3.3% and morbidity was 26.7%. After short-term followup (mean followup 16 months), overall survival for stage I lung cancer was 96%. CONCLUSIONS:With our approach, new graduates of thoracic surgery programs can safely transition to VATS lobectomy. Gaining experience with the lateral muscle-sparing thoracotomy is an important step in the transition, as it offers similar operative exposure. Longterm disease-free and overall survival data are needed to evaluate our oncologic efficacy with this approach.

译文

背景:在早期肺癌中,越来越多的证据表明,通过电视辅助胸腔手术(VATS)进行肺叶切除术比开放性肺叶切除术具有更大的益处。很少有胸部训练计划能够提供这种技术要求很高的程序的足够经验。本文介绍了新毕业生从开放式开胸手术到VATS肺叶切除术的发展历程。
研究设计:我们的模型涉及从后外侧胸廓切开术到保留肌肉的胸廓切开术,以及最终到VATS肺叶切除术的技术过渡。通过检查VATS肺叶切除术前开胸患者的结局和最初的30例VATS患者的结局来评估该方法。数据是前瞻性收集的。
结果:在进行VATS肺叶切除术之前,通过开胸手术进行了94例主要的肺切除。肺叶切除术的死亡率为1.2%,肺叶切除术的死亡率为0%。保留肌肉的开胸手术的比例从上半部分的17%上升到下半部分的70%。对于最初的30例VATS肺叶切除术患者,平均手术时间为168分钟。失血量中位数为200毫升。开胸手术的转化率为13.3%。死亡率为3.3%,发病率为26.7%。短期随访(平均随访16个月)后,I期肺癌的总生存率为96%。
结论:采用我们的方法,新的胸外科课程毕业生可以安全地过渡到VATS肺叶切除术。获得保留侧肌的开胸手术的经验是过渡过程中的重要一步,因为它提供了类似的手术暴露。需要长期无病和总体生存数据来评估我们使用这种方法的肿瘤学疗效。

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