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Minimally Invasive Thoracic Surgery: Video-Assisted Lobectomy

Lung cancer is the leading cause of cancer death in the United States, with approximately 180,000 new cases diagnosed each year.

While surgical resection offers the best chance of a cure for those with early-stage lung cancer, the traditional open-chest approach (called a thoracotomy) typically requires 5 to 7 days of recovery in the hospital, with an extended recovery at home.

Cleveland Clinic thoracic surgeons offer a less invasive surgical approach called a video-assisted lobectomy for select patients as treatment of early-stage lung cancer. This video-assisted thoracic surgery (VATS) technique reduces a patient’s hospital stay to about 3 to 4 days and the patient experiences a more rapid recovery with less pain after surgery as compared with the traditional thoracotomy approach.

Cleveland Clinic is one of the few centers in the nation with significant experience in video-assisted lobectomy. In addition, the surgical outcomes of video-assisted lobectomy are comparable to traditional lobectomy outcomes.

What is a lobectomy?
A lobectomy is the surgical removal of a large section of lung. Lobectomy is the most common surgery performed to treat lung cancer.

Lobectomy has been traditionally performed during thoracotomy surgery. During thoracotomy surgery, an incision is made on the side of the chest between the ribs. The ribs are then spread apart so the surgeon can see into the chest cavity and remove the tumor or affected tissue.

What happens during lobectomy?
Video-assisted lobectomy is less invasive than traditional thoracotomy. During VATS lobectomy, three 1-inch incisions and one 3- to 4-inch incision are made in the chest to provide access to the chest cavity without spreading of the ribs.

During a VATS lobectomy, a thorascope (small video camera) and surgical instruments are inserted into the incisions. The thoracic surgeon is guided by the images of the operative area transmitted from the thorascope. The images are projected onto a computer monitor that is positioned next to the patient.

Cutline: Position of small incisions
front view
side view
front view
side view

Your surgeon will remove the tumor or affected tissue from the lung through the small incisions. If an early-stage cancer tumor is being removed, the lymph nodes (small, bean-shaped structures) in the mid-chest area may also be removed or biopsied to ensure that the cancer has not spread.

Before completing the VATS procedure, the surgeon will check that there are no areas of bleeding, rinse out the chest cavity and close the small incisions. One or two drains remain in place after the surgery to remove excess fluid and air from around the lung. The drains are removed at a later time during the patient’s recovery.

Which patients are candidates for VATS lobectomy?
Patients who need a variety of diagnostic and/or therapeutic procedures of the outer area of the lung may be candidates for video-assisted surgery. The best candidates for VATS lobectomy include patients with stage I non-small cell lung cancer (a small, primary tumor, under 3 cm, in the first stage of cancer that has not spread beyond the lungs) or patients who have a single enlarging pulmonary nodule.  

Although minimally invasive approaches are considered for every patient, some patients may not be candidates for video-assisted lobectomy. Traditional thoracotomy may be more appropriate for some patients with large tumors, involved lymph nodes or prior chest surgery.

Lobectomies represented fifty percent of the pulmonary resections completed by Cleveland Clinic thoracic surgeons in 2005.

How can I be evaluated for VATS, and what tests do I need?


McKenna RJ, Houck W, Beeman Fuller C. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. The Annals of Thoracic Surgery, February 2006. 81(2):421-426.

Roviaro G, et al. Long-term survival after videothoracoscopic lobectomy for stage I lung cancer. Chest. September 2004. 126(3):725-732.

Lung/Thoracic Surgery, The Society of Thoracic Surgeons http://www.sts.org/sections/patientinformation/lungthoracicsurgery/ (web site accessed 8/11/06)

VATS Lobectomy For Early Stage Lung Cancer, Flores RM, The Cardiothoracic Surgery Network. http://www.ctsnet.org/sections/clinicalresources/thoracic/expert_tech-.html (web site accessed 8/12/06)


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This information is provided for education purposes only and is not intended to replace the medical advice of your doctor or health care provider. While we strive to keep our website current, medical practices sometimes change quickly. Please consult your health care provider for advice about a specific medical condition. 

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