J Korean Med Assoc.  2012 Dec;55(12):1193-1198. 10.5124/jkma.2012.55.12.1193.

Video-assisted thoracoscopic lobectomy for lung cancer

  • 1Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea. kimhyunkoo@korea.ac.kr


Video-assisted thoracoscopic surgery (VATS) provides a new approach for treating early-stage lung cancer. VATS lobectomy has significant perioperative advantages such having as a lower rate of morbidity and being less immunosuppressive than open lobectomy, and it also provides a shorter recovery time, less postoperative pain, and faster resumption of a normal lifestyle. However, a clear definition of VATS lobectomy is lacking in the current literature. The generally accepted method of VATS lobectomy is from three to four incisions in number of port, 4.0 to 8.0 cm in utility length, and without rib spreading. However, there is still much debate on the role of VATS in lobectomy for the treatment of lung cancer. Concerns regarding safety, the extent of mediastinal lymph node dissection, and long-term survival have made some surgeons apprehensive of its validity for lung cancer. Nevertheless, recent data have shown that VATS lobectomy appears to have equivalent oncological results compared with open lobectomy for patients with early stage non-small cell lung cancer. With growing experience with VATS and development of thoracoscopic instrument, VATS can be beneficial to patients with early stage of lung cancer.


Video-assisted thoracoscopic surgery; Lobectomy; Lung neoplasms

MeSH Terms

Carcinoma, Non-Small-Cell Lung
Life Style
Lung Neoplasms
Lymph Node Excision
Pain, Postoperative
Thoracic Surgery, Video-Assisted


  • Figure 1 Utility incision and ports placement for video-assisted thoracoscopic surgery right lower lobecotmy.

  • Figure 2 (A) Right inferior pulmonary vein dissection. (B) Division using endostapler.

  • Figure 3 (A) Dissection of pulmonary artery to lower lobe. (B) Division using endostapler.

  • Figure 4 (A) Dissection of right lower lobe bronchus. (B) Division using endostapler.

  • Figure 5 (A) Dissection of subcarinal lymph node. (B) Dissection of right paratracheal lymph node. SVC, superior vena cava.


1. Hoksch B, Birken-Bertsch H, Muller JM. Thoracoscopy before Jacobaeus. Ann Thorac Surg. 2002. 74:1288–1290.
2. Jacobaeus HC. The cauterization of adhesions in artificial pneumothorax treatment of pulmonary tuberculosis under thoracoscopic control. Proc R Soc Med. 1923. 16(Electro Ther Sect):45–62.
3. Boutin C, Astoul P, Seitz B. The role of thoracoscopy in the evaluation and management of pleural effusions. Lung. 1990. 168:Suppl. 1113–1121.
4. Mack MJ, Aronoff RJ, Acuff TE, Douthit MB, Bowman RT, Ryan WH. Present role of thoracoscopy in the diagnosis and treatment of diseases of the chest. Ann Thorac Surg. 1992. 54:403–408.
5. Landreneau RJ, Mack MJ, Hazelrigg SR, Dowling RD, Acuff TE, Magee MJ, Ferson PF. Video-assisted thoracic surgery: basic technical concepts and intercostal approach strategies. Ann Thorac Surg. 1992. 54:800–807.
6. McKenna RJ Jr. Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. J Thorac Cardiovasc Surg. 1994. 107:879–881.
7. Boffa DJ, Allen MS, Grab JD, Gaissert HA, Harpole DH, Wright CD. Data from The Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg. 2008. 135:247–254.
8. Kim KH. Thoracoscopic treatment of spontaneous pneumothorax. Korean J Thorac Cardiovasc Surg. 1991. 24:261–264.
9. Yoon YH, Lee DY, Kim HH, Bae GM. Lobectomy with video-assisted thoracoscopy. Korean J Thorac Cardiovasc Surg. 1993. 26:236–240.
10. Kim K, Kim HK, Park JS, Chang SW, Choi YS, Kim J, Shim YM. Video-assisted thoracic surgery lobectomy: single institutional experience with 704 cases. Ann Thorac Surg. 2010. 89:S2118–S2122.
11. Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW, Stiles BM, Port JL, D'Amico TA. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010. 139:366–378.
12. Lee HS, Lee JW, Kim KI, Cho SW, Park SJ, Kim HS, Shin YC, Shin HS. Video-assisted thoracic surgery lobectomy: experience with 36 cases. Korean J Thorac Cardiovasc Surg. 2009. 42:732–737.
13. Swanson SJ, Herndon JE 2nd, D'Amico TA, Demmy TL, McKenna RJ Jr, Green MR, Sugarbaker DJ. Video-assisted thoracic surgery lobectomy: report of CALGB 39802--a prospective, multi-institution feasibility study. J Clin Oncol. 2007. 25:4993–4997.
14. Zhu M, Fu XN, Chen X. Lobectomy by video-assisted thora coscopic surgery (VATS) for early stage of non-small cell lung cancer. Front Med. 2011. 5:53–60.
15. Whitson BA, D'Cunha J, Andrade RS, Kelly RF, Groth SS, Wu B, Miller JS, Kratzke RA, Maddaus MA. Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity. Ann Thorac Surg. 2008. 86:1735–1744.
16. Hirai T, Matsumoto H, Yamashita K, Urakami A, Iki K, Yamamura M, Tsunoda T. Surgical oncotaxis: excessive surgical stress and postoperative complications contribute to enhancing tumor metastasis, resulting in a poor prognosis for cancer patients. Ann Thorac Cardiovasc Surg. 2005. 11:4–6.
17. Walker WS. Video-assisted thoracic surgery (VATS) lobectomy: the Edinburgh experience. Semin Thorac Cardiovasc Surg. 1998. 10:291–299.
18. Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol. 2009. 27:2553–2562.
19. Nakata M, Saeki H, Yokoyama N, Kurita A, Takiyama W, Takashima S. Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy. Ann Thorac Surg. 2000. 70:938–941.
20. Li WW, Lee RL, Lee TW, Ng CS, Sihoe AD, Wan IY, Arifi AA, Yim AP. The impact of thoracic surgical access on early shoulder function: video-assisted thoracic surgery versus posterolateral thoracotomy. Eur J Cardiothorac Surg. 2003. 23:390–396.
21. Andrade RS, Maddaus MA. Thoracoscopic lobectomy for stage I non-small cell lung cancer. Semin Thorac Cardiovasc Surg. 2010. 22:14–21.
22. Watanabe A, Koyanagi T, Ohsawa H, Mawatari T, Nakashima S, Takahashi N, Sato H, Abe T. Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study. Surgery. 2005. 138:510–517.
23. Sagawa M, Sato M, Sakurada A, Matsumura Y, Endo C, Handa M, Kondo T. A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg. 2002. 73:900–904.
24. Denlinger CE, Fernandez F, Meyers BF, Pratt W, Zoole JB, Patterson GA, Krupnick AS, Kreisel D, Crabtree T. Lymph node evaluation in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy. Ann Thorac Surg. 2010. 89:1730–1735.
25. Yamashita Y, Harada H, Misumi K. Video-assisted thoracic surgery lobectomy for lung cancer: the point at issue. Gen Thorac Cardiovasc Surg. 2011. 59:164–168.
26. Yamamoto K, Ohsumi A, Kojima F, Imanishi N, Matsuoka K, Ueda M, Miyamoto Y. Long-term survival after video-assisted thoracic surgery lobectomy for primary lung cancer. Ann Thorac Surg. 2010. 89:353–359.
27. Nicastri DG, Wisnivesky JP, Litle VR, Yun J, Chin C, Dembitzer FR, Swanson SJ. Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance. J Thorac Cardiovasc Surg. 2008. 135:642–647.
28. Kim HR, Cho JS, Jang HJ, Lee SC, Choi ES, Jheon S, Sung SW. Video-assisted thoracic surgery lobectomy for non-small cell lung cancer: experience of 133 cases. Korean J Thorac Cardiovasc Surg. 2009. 42:615–623.
Full Text Links
  • JKMA
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr