• Alan D L Sihoe, Surbhi Chawla, Sohini Paul, Arun Nair, Jesse Lee, and Kanhua Yin.
• Division of Cardiothoracic Surgery, Department of Surgery, The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
• Asian Cardiovasc Thorac Ann. 2014 Mar 1; 22 (3): 319-28.

BackgroundThe optimal technique for delivering large tumors during video-assisted thoracoscopic lobectomy remains uncertain.MethodsIn 258 patients receiving video-assisted thoracoscopic lobectomy for lung cancer, techniques for delivering the resected lobe included complete video-assisted thoracoscopic lobectomy without rib spreading (n = 206, 80%), resection of a short rib segment (n = 9, 3%), brief rib spreading (n = 12, 5%), and conversion to a minithoracotomy (n = 21, 8%). In 10 (4%) patients, a novel anterior rib cutting technique was used: one rib at the utility port was cut near its anterior end to widen the intercostal space without forcible rib spreading for lobe delivery.ResultsThere was no mortality or major morbidity using the anterior rib cutting technique, and it delivered tumors of a larger mean diameter than complete video-assisted thoracoscopic lobectomy (5.4 ± 3.4 vs. 2.3 ± 1.4 cm, p = 0.017) whilst yielding a similar mean operation time and blood loss to the other non-complete video-assisted thoracoscopic lobectomy techniques. The anterior rib cutting technique gave similar postoperative patient pain scores and analgesic use to complete video-assisted thoracoscopic lobectomy, and shorter mean hospital stay than the other non-complete video-assisted thoracoscopic lobectomy techniques (5.6 ± 2.8 vs. 10.0 ± 7.1 days, p = 0.003).ConclusionsIn video-assisted thoracoscopic lobectomy, the anterior rib cutting technique is a safe and feasible procedure for delivering large tumors, causing no more pain than complete video-assisted thoracoscopic lobectomy, and allowing faster recovery than other non-complete video-assisted thoracoscopic lobectomy techniques.

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