Skip to Main Content


Video-assisted thoracic surgery (VATS) lobectomy has been used in the treatment of lung cancer since the early 1990s. While there is evidence that lobectomy is better than wedge resection in most patients, there are no large prospective, randomized studies favoring video-assisted lobectomy over conventional lobectomy by thoracotomy.1 However, there are several series that support the use of VATS lobectomy technique. These include some small (n ≤ 100) prospective, randomized studies that compare VATS with lobectomy by thoracotomy (Table 63-1). From these data, as well as data from several exclusively VATS series, it is clear that VATS lobectomy is technically feasible and safe and even may provide better quality-of-life outcomes in patients with resectable lung cancer. Despite these efforts, VATS lobectomies represent only approximately 5% of all lobectomies performed in the United States.2

Table Graphic Jump Location
Table 63-1. Selected VATS versus Thoracotomy Series 

The VATS cancer operation is specifically defined as an anatomic lobectomy (or segmentectomy, when indicated) and consists of individual hilar ligation by means of three or four small incisions and no rib spreading. This anatomic lobectomy should leave the patient with results identical to a cancer resection by thoracotomy. That is, the surgeon resects the tumor with negative margins, performing individual vascular and bronchial ligation and division and a complete hilar lymph node dissection. Furthermore, mediastinal lymph node dissection or sampling is performed as appropriate. Certain aspects of the technique, most notably avoidance of rib spreading or the use of a rib retractor, are emphasized, with the goal of improving the patient's postoperative experience. Cosmetic aspects, such as smaller scars (largest incision is usually 5–8 cm), are also important. One variant, the video-assisted simultaneously stapled lobectomy, does not involve individual hilar ligation. In essence, it is a different operation and is not discussed in this chapter. Nevertheless, some ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.