Video Assisted Thoracoscopic Surgery to Treat Non Small Cell Lung Cancer

Today, lung cancer is treated with medications and surgery, with fairly good treatment outcomes. Dr. Kittichai Lueangthawibun, Medical Specialist in Thoracic Surgery, Phyathai 2 Hospital, will explain the pros and cons of video-assisted thoracoscopic surgery used to treat non-small-cell lung cancer along with other treatment information.

 

Surgeries assisted by viewing or use of a camera are a type of surgery that aims to reduce the size of the surgical wound. Normally for open thoracic surgery, doctors have to cut a particular chest muscle, namely, the latissimus dorsi and make their way through the serratus anterior, along with muscles between the ribs. Therefore, the patient’s breathing can be mildly affected, and some patients who experience pain while coughing will feel reluctant to cough heavily or to take deep breaths, thus creating risk of atelectasis. The surgery also affects the movement of the shoulders.

 

Open surgery and video-assisted surgery are identical in every way in that it is necessary to separate blood vessels from the bronchi, and lymph nodes have to be cut, but they also differ in that surgeons do not come into direct contact with the tissues when performing video-assisted surgery, so they cannot palpate the lungs to determine the location of the tumor. They have to rely on tools to assist them such as stents or dyes in finding the location of the tumor. If the tumor is embedded more than 1 centimeter deep into the lungs, small key-hole surgery requires use of an automatic stitching tool to divide and stitch the pulmonary arteries and the bronchi, and this tool is more expensive than the use of threads to tie or stitch the wound, with its price potentially as high as nearly ten thousand baht per stitch. Because each patient might require as many as 5 stitches, the price of the stitching device alone can be as high as fifty thousand baht.

 

Studies have found that surgeons who have become proficient in performing video-assisted surgery require less time to perform operations than open surgeries, and video-assisted surgery offers the advantage of producing less wound pain and fewer initial complications and requiring possibly less than one day of hospitalization. However, cancer treatment outcomes can still be the same as in the case open surgery. If the cancer is in Stage 1, the full remission rate and treatment outcomes are not very different between the two methods. 

 

Thoracic surgery and incisions of the chest muscles produce no long-term negative impacts. Pain symptoms occurring from parting of the ribs are few. However, there might be sensitivity under the breasts due to binding of the ribs together. After open surgery, skin nerves might be tied in under the breast of the same side. Nevertheless, the stitches normally fully dissolve within 2 months after surgery, so sensitivity and numbness symptoms will gradually improve. The patient’s movements can positively affect wound healing and prevent frozen shoulders, which is a long-term problem that is difficult to correct but can be prevented by immediately moving the shoulders after surgery. 

 

In 2012, a meeting was held to provide a definition for the term “Video-Assisted Thoracoscopic Lobectomy” as follows: 

 

Accordingly, patients with low lung capacity who cannot bear inhaling medication by using one lung are not eligible for this surgery, because the camera’s view would be hindered. This differs from the case of open surgery, which still can be performed. Meanwhile, in patients with significant development of fibrosis in the lungs, for example, in cases where there is prior history of lung surgery or lung infection, video-assisted surgery is more difficulted than open surgery.