HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Larkin J. Daniels Thomas A. D’Amico Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Daniels, L. J. Articles by D’Amico, T. A. Search for Related Content PubMed PubMed Citation Articles by Daniels, L. J. Articles by D’Amico, T. A. Related Collections Lung - cancer

Ann Thorac Surg 2002;74:860-864
© 2002 The Society of Thoracic Surgeons

---

Original article: general thoracic

Thoracoscopic lobectomy: a safe and effective strategy for patients with stage i lung cancer

^a Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA

* Address reprint requests to Dr D’Amico, Department of Surgery, Duke University Medical Center, Box 3496, 3589 Clin Res II, Durham, NC 27710 USA
e-mail: damic001{at}mc.duke.edu

Presented at the Video Session of the Forty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 8–10, 2001.

	Abstract

Top Abstract Introduction Patients and methods Results Comment Acknowledgments References

 
Background. Thoracoscopic lobectomy is emerging as a potential alternative to thoracotomy for early stage lung cancer. The issues of safety and oncologic efficacy should be analyzed before recommending this procedure for widespread use.

Methods. Thoracoscopic lobectomy was attempted in 110 consecutive patients (age, 35 to 81years) with tumors that were judged to be amenable to lobectomy over a 26-month period. Exclusion criteria included tumors greater than 5 cm in diameter, T3 tumors, endobronchial tumors visible at bronchoscopy, the use of induction therapy, extensive N1 disease on computed tomographic scan, and N2 disease at mediastinoscopy. The procedures were performed without rib spreading using two ports and included anatomic hilar dissection and individual vessel stapling.

Results. Thoracoscopic lobectomy and mediastinal lymph dissection was successfully performed in 108 patients (98.2%); 2 patients required conversion to thoracotomy to control bleeding in the setting of dense hilar adenopathy. There were no intraoperative deaths and 4 perioperative deaths (3.6%) caused by pneumonia and associated adult respiratory distress syndrome (3 patients) and stroke (1 patient). Major complications included pneumonia (5 patients), stroke (1 patient), and return to the operating room to revise the bronchial closure (1 patient). Minor complications included prolonged air leak (6 patients), atrial fibrillation (4 patients), blood transfusion (2 patients) and ileus (1 patient). Median time to chest tube removal was 3 days, and median length of stay was 3 days.

Conclusions. Thoracoscopic lobectomy is a safe and effective strategy for patients with early stage lung cancer. Long-term follow-up is required to determine if recurrence rate and 5-year survival are comparable with thoracotomy for lobectomy.

	Introduction

Top Abstract Introduction Patients and methods Results Comment Acknowledgments References

 
Thoracoscopic lobectomy (TL) has recently been acknowledged by some thoracic surgeons as an effective technique for treatment of early stage lung cancer. A number of studies have now been published demonstrating the safety and efficacy of this technique [1–6]. Currently the technique is used for both benign and malignant disease [7, 8]. Several studies have suggested improvements in postoperative pain control, earlier return to normal activities, earlier discharge, lower levels of perioperative inflammatory cytokine levels, and lower complication rates compared with open thoracotomy procedures [9–12].

There are significant questions that remain unanswered among those surgeons who have not accepted TL as an appropriate oncologic procedure. Concerns include possible selection bias in the studies, the absence of large randomized, prospective trials, the lack of standardization of operative techniques to achieve a thoracoscopic lobectomy, questionable oncologic efficacy, and differences in whether mediastinoscopy, lymph node dissection, or sampling is performed in the available studies [13–18].

This series reflects the experience with thoracoscopic lobectomy at a large, academic teaching institution by a single surgeon, using a standardized technique and limiting the operation to clinical stage I lung cancer patients. The objective of this study was to evaluate the technique for safety and efficacy in a large group of patients that could be followed up long-term in our thoracic oncology clinic.

	Patients and methods

Top Abstract Introduction Patients and methods Results Comment Acknowledgments References

 
Between June 1999 and August 2001, TL was attempted on 110 patients at Duke University Medical Center. Patients with known or suspected lung cancer (clinical stage I) were included in this study. Preoperative evaluation included comprehensive history and physical examination, computed tomographic scan, and pulmonary function tests. In addition, all patients underwent mediastinoscopy at the time of TL. Inclusion criteria were the predicted ability to achieve complete resection by lobectomy and the physiologic capacity of the patient to tolerate lobectomy. Exclusion criteria included tumors greater than 5 cm in diameter, T3 tumors, extensive N1 disease on computed tomographic scan, endobronchial tumors visible at bronchoscopy, the use of induction therapy, and N2 disease at mediastinoscopy. Previous thoracic operations, incomplete fissures, and pleural adhesions were not considered contraindications to the procedure.

Operative technique
All patients underwent bronchoscopy and mediastinoscopy, with frozen section of biopsy specimens, before proceeding with the thoracoscopic procedure. After mediastinoscopy, single lung anesthesia is established using a dual lumen endotracheal tube or bronchial blocker. The patient is turned to the lateral decubitus position and secured to prevent neurologic injury. Before sterile preparation and draping, the chest is marked for placement of thoracoscopic incisions.

We use two incisions: (1) a camera port in the seventh or eighth intercostal space in the midaxillary line (2 cm), and (2) an access port placed anteriorly in the fifth or sixth intercostal space (4.5 cm). Self-retaining retractors are not used. Additional incisions may be used, either posteriorly or superiorly, to provide optimal access for hilar dissection, retraction, and control of the pulmonary vascular structures. The anterior incision is positioned to provide adequate thoracoscopic visualization of the entire thorax, and most importantly, of the anterior hilar structures. Before making the anterior incision, evidence of unresectability, such as parietal pleural involvement, should be excluded. This anterior incision, in the fifth or sixth intercostal space, should be placed where the intercostal spaces are the widest and should be aligned with the major fissure. A 4- to 5-cm incision is this location allows access for multiple thoracoscopic instruments simultaneously, and provides for removal of the lobe in a protective specimen bag without difficulty.

After the placement of the anterior incision, the surgeon performs thoracoscopic exploration, division of the pulmonary ligament, and hilar mobilization. If a malignant diagnosis has not been achieved preoperatively, thoracoscopic wedge resection is performed using an automatic stapling device, such as the EndoGIA (US Surgical, Norwalk, CT), and the specimen is removed in a protective bag. After frozen section confirms a malignant diagnosis, thoracoscopic lobectomy may then be completed. In patients in which the lesions are located close to hilar structures, lobectomy is required to obtain diagnosis.

Mediastinal lymph node dissection may be performed at this point or may be deferred until the lobectomy has been completed. On the right, paratracheal lymph nodes (levels 2 and 4) are resected en bloc and separated on the back table. The subcarinal station (level 7) is resected after reflecting the lung anteriorly, exposing the inferior margin of the right main stem bronchus and carina. On the left, the aortopulmonary window lymph nodes and the anterior aortic nodes (levels 5 and 6) are dissected separately, with attention to preserving the recurrent laryngeal nerve. The subcarinal nodal station is more difficult to approach from the left side, but is accomplished with mobilization of the left inferior pulmonary vein.

Postoperative care
After the procedure, patients are taken to a cardiothoracic recovery area briefly; then they are transferred to a monitored cardiothoracic step-down unit for the remainder of their stay. The majority of patients do not receive epidural analgesia. Epidurals have been selectively used for some debilitated patients with other medical comorbidities, which would make it unlikely that they would resume normal activities in the immediate postoperative period; this population accounted for less than 10% of the patients. All other patients receive paravertebral blockade (T3 to T10) with 0.25% bupivicaine before operative induction and postoperative patient-controlled analgesia with intravenous narcotics for 24 hours. Pain symptoms are subsequently managed with oral narcotics depending on the severity of their pain symptoms. Ketorolac (Roche Laboratories) is also given for 24 hours postoperatively to patients without contraindications such as renal dysfunction, peptic ulcer disease, platelet dysfunction or bleeding diathesis. Chest tubes are removed after demonstrating no air leaks and less than 150 mL of fluid output for 24 hours.

Patient follow-up
Patients are seen in the clinic 2 weeks after discharge. They are subsequently followed-up at 4-month intervals for the first year with chest x-rays in the clinic, and annually thereafter. Data were collected on each patient including lobe resected, final pathologic stage and histology, time to chest tube removal, discharge from the hospital, complications, need for transfusion, reoperation, readmission, and tumor recurrence.

	Results

Top Abstract Introduction Patients and methods Results Comment Acknowledgments References

 
The mean age of the patients in this study was 65 ± 9 years. The median follow-up for the group is 16 months. TL was successfully completed in 108 of 110 patients (98.2%). The final pathology (Table 1) included primary lung cancer (90 patients), solitary pulmonary metastases (7 patients), and bronchial carcinoid (5 patients). Of the 108 thoracoscopic resections, there were 41 left upper lobes, 42 left lower lobes, 29 right upper lobes, 10 right middle lobes, 13 right lower lobes, and 3 resections of the right middle and upper lobes (Table 2). Resection of the upper and middle lobes was performed when a right upper lobe tumor crossed the horizontal fissure to involve the medial segment of the middle lobe.

There were 22 complications documented in 21 patients (19.1%). Complications included air leak lasting longer than 7 days (6 patients), pneumonia (5 patients), atrial fibrillation (4 patients), lower extremity vascular insufficiency (2 patients), hemorrhage greater than 500 mL (2 patients), aspiration (1 patient), and stroke (1 patient). In another patient, the left upper lobe bronchus was narrowed during left lower lobectomy, which required subsequent bronchoplasty repair; the patient recovered with no further complications.

The median time to chest tube removal was 3 days (range, 1 to 53 days). The median length of stay was 3 days (range, 1 to 75 days). There were 2 patient readmissions in the group within 30 days of operation (1.8%). One patient was readmitted for ileus and the other for elective reoperation, who underwent thoracoscopic right lower lobectomy. Initial frozen section pathology showed mediastinal lymph nodes were all negative, but final pathology showed metastatic focus in a level 7 lymph node, as well as a concern that the tumor had crossed the fissure into the middle lobe. After counseling, the patient underwent thoracotomy for completion bilobectomy. There was no residual disease identified in the middle lobe, and further mediastinal lymph node dissection was entirely negative.

There were 4 deaths in the series during their postoperative hospital stay (3.6%). Three of the deaths were secondary to pneumonia and associated adult respiratory distress syndrome; the fourth death was caused by a massive postoperative stroke. There have been 2 additional deaths in the series, at approximately 2 months after resection and 1 year after resection from unrelated medical conditions.

The final pathologic diagnoses of the patients in this series are profiled in Table 1. Of the 110 patients in this series with preoperatively presumed lung cancer, 90 patients had pathologically confirmed lung cancer after their operation. Of the 90 patients with primary lung cancer, 79 were pathologic stage I (90%) (Table 3). Of the 11 patients who were upstaged from clinical stage I based on their operative pathology specimens, 5 patients were upstaged to stage II, and 3 were upstaged to stage IIIA. Three additional patients were upstaged to IIIB because of T4 tumor status secondary to satellite nodules in the resected lobe. At this time, there has been only 1 patient with documented recurrence (distant) in the 90 patients with lung cancer that underwent TL (1.1%).

	Comment

Top Abstract Introduction Patients and methods Results Comment Acknowledgments References

The oncologic efficacy of TL lobectomy should be judged by the ability to achieve complete anatomic resection and to perform adequate mediastinal lymph node staging. TL provides complete and magnified visualization or the entire thorax, and the technique of TL involves individual vessel dissection and division. In this series, complete anatomic resection (with full hilar and mediastinal nodal dissection) was achieved in all patients. The completeness of resection, as measured by recurrence rate, is outstanding, as there are no local recurrences with a median follow-up of 16 months. There is one distant recurrence, involving a patient with a cerebral metastasis that was diagnosed 5 months after resection. It is also noteworthy that although studies have reported port site recurrences and dissemination of tumor from TL [19], we have not had any in our series.

Inadequate sampling and staging is considered by some surgeons and oncologists to be the greatest potential flaw of TL, as inadequate staging precludes appropriate treatment [20–23]. In this group of patients with clinical stage I lung cancer, mediastinal lymph node dissection was accomplished in all, and 11 patients (12.5%) were upstaged based on operative findings and final pathology. The methods of lymph node dissection used in thoracoscopy are no different than the methods we use during open thoracotomy. As noted, all of our patients undergo bronchoscopy and mediastinoscopy before TL to appropriately define the extent of the disease.

The mortality rate in our series of 3.6% is comparable with other series [4, 5, 24, 25] and includes all patients regardless of comorbidities. Although we have not included objective data with regard to each of these patients, the series includes a large percentage of patients with compromised pulmonary function and significant conditions of comorbidity. Some authors have advocated TL for higher risk patients because of the potential limited physiologic stress associated with TL [25]. Although there is limited data on appropriate selection criteria for TL compared with open thoracotomy, we have noted favorable overall mortality in our patients regardless of their associated medical conditions.

As with other studies available with this technique [1, 7, 12, 13, 16], our series also demonstrates that patients had a short time to chest tube removal (median of 3 days) and short length of stay (median of 3 days), with a low readmission rate (2.8%). Though not objectively documented, as some other studies have shown [10, 11], our experience has provided us with the general impression that these patients experience less postoperative pain and need for narcotics compared with patients who underwent open operations concurrently on the service.

Finally, this experience at a large, academic teaching center has demonstrated TL to be a reproducible procedure with a high success rate (98.2%) and low overall complication rate (19.1%). This complication rate compares favorably with other thoracoscopic lobectomy series in the literature [1, 5, 7, 25]. It should be noted that the majority of cases were performed with assistance of cardiothoracic surgery residents. Because of the large volume of patients on our general thoracic surgery service, residents are active participants in the procedures and become facile with the procedure during their training. As this procedure becomes more common, we believe it should be readily teachable to surgeons with laparoscopic and thoracoscopic training, leading to more widespread use.

As this technique has been in existence for less than a decade, further long-term outcome studies are required to document its utility as an appropriate oncologic procedure. Sugi and colleagues [8] have reported 5-year follow-up data on a small series of TL patients and found recurrence and survival data to be excellent in stage I lung cancer patients. As experience continues to accumulate in the United States and other countries, we will be able to compare this technique with thoracotomy in larger series.

	Acknowledgments

Top Abstract Introduction Patients and methods Results Comment Acknowledgments References

 
Supported by a grant from the Herman and Ruth Albert Thoracic Oncology Research Fund.

	References

Top Abstract Introduction Patients and methods Results Comment Acknowledgments References

 

1. Lewis R.J., Caccavale R.J., Sisler G.E., MacKenzie J.W. One hundred consecutive patients undergoing video-assisted thoracic operations. Ann Thorac Surg 1992;54:421-426.[Abstract]
2. Roviaro G., Rebuffat C., Varoli F., et al. Videoendoscopic pulmonary lobectomy for cancer. Surg Laparosc Endosc 1992;2:244-247.[Medline]
3. Lewis R.J., Sisler G.E., Caccavale R.J. Imaged thoracic lobectomy: should it be done?. Ann Thorac Surg 1992;54:80-83.[Abstract]
4. Kirby T.J., Rice T.W. Thoracoscopic lobectomy. Ann Thorac Surg 1993;56:784-786.[Abstract]
5. Roviaro G., Varoli F., Rebuffat C., Vergani C., D’Hoore A., Scalambro S.M., Maciocco M., Grignani F. Major pulmonary resections: pneumonectomies and lobectomies. Ann Thorac Surg 1993;56:779-783.[Abstract]
6. Walker W.S., Carnochan F.M., Mattar S. Video-assisted thoracoscopic pneumonectomy. Br J Surg 1994;81:81-82.[Medline]
7. Weber A., Stammberger U., Inci I., et al. Thoracoscopic lobectomy for benign disease—a single centre study on 64 cases. Eur J Cardiothor Surg 2001;20:443-448.[Abstract/Free Full Text]
8. Sugi K., Kaneda Y., Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg 2000;24:27-31.[Medline]
9. Yim A.P.C., Wan S., Lee T.W., Arifi A.A. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg 2000;70:243-247.[Abstract/Free Full Text]
10. Nagahiro I., Andou A., Aoe M., et al. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure. Ann Thorac Surg 2001;72:363-365.
11. Sugiura H., Morikawa T., Kaji M., et al. Long-term benefits for the quality of life after video-assisted thoracoscopic lobectomy in patients with lung cancer. Surg Laparosc Endosc 1999;9:403-408.
12. Solaini L., Prusciano F., Bagioni P., et al. Video-assisted thoracic surgery major pulmonary resections: present experience. Eur J Cardiothor Surg 2001;20:437-442.[Abstract/Free Full Text]
13. Roberts J.R., DeCamp M.M., Mentzer M.D., Sugarbaker D.J. Prospective comparison of open and video assisted lobectomy. Chest 1996;110:45S.[Free Full Text]
14. Kirby T.J., Mack M.J., Landraneau R.J., Rice T.W. Lobectomy—video-assisted thoracic surgery versus muscle-sparing thoracotomy: a randomized trial. J Thorac Cardiovasc Surg 1995;109:997-1002.[Abstract]
15. Yim A.P.C., Landreneau R.J., Izzat M.B., et al. Is video-assisted thoracoscopic lobectomy a unified approach?. Ann Thorac Surg 1998;66:1155-1158.[Abstract/Free Full Text]
16. McKenna R.J., Wolf R.K., Brenner M., et al. Is lobectomy by video-assisted thoracic surgery an adequate cancer operation?. Ann Thorac Surg 1998;66:1903-1908.[Abstract/Free Full Text]
17. Nomori H., Horio H., Naruke T., Suemasu K. What is the advantage of a thoracoscopic lobectomy over a limited thoracotomy procedure for lung cancer surgery?. Ann Thorac Surg 2001;72:879-884.[Abstract/Free Full Text]
18. Hazelrigg S.R., Mulder D.S., Naunheim K.S., Sugarbaker D.J. Session IX: Panel discussion on thoracoscopic lobectomy. Ann Thorac Surg 1993;56:787-791.
19. Downey R.J., McCormack P., LoCicero J., et al. Dissemination of malignant tumors after video-assisted thoracic surgery: a report of 20 cases. J Thorac Cardiovasc Surg 1996;111:954-960.[Abstract/Free Full Text]
20. Staples C.A., Muller N.L., Miller R.R., et al. Mediastinal nodes in bronchogenic carcinoma: comparison between CT scan and mediastinoscopy. Radiology 1988;67:367-372.
21. McLloud T.C., Bourgouin P.M., Greenberg R.W., et al. Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling. Radiology 1992;182:319-323.
22. Mountain C.F. Assessment of the role of surgery for control of lung cancer. Ann Thorac Surg 1977;24:365-373.[Abstract]
23. Martini N. Mediastinal lymph node dissection for lung cancer. The Memorial experience. Chest Surg Clin North Am 1995;5:189-203.[Medline]
24. Martini N., Brain M.S., Burt M.E., et al. Incidence of local recurrence and second primary tumors in resected tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 1995;109:120-129.[Abstract/Free Full Text]
25. Demmy T.L., Curtis J.J. Minimally invasive lobectomy directed toward frail and high-risk patients: a case-controlled study. Ann Thorac Surg 1999;68:194-200.[Abstract/Free Full Text]

This article has been cited by other articles:

				T. Sakuragi, Y. Okazaki, M. Mitsuoka, and T. Itoh Dramatic hemostasis of the transected pulmonary artery model using SOFT COAG electrosurgical output Interactive CardioVascular and Thoracic Surgery, October 1, 2008; 7(5): 764 - 766. [Abstract] [Full Text] [PDF]

				E. L. Grogan, G. J. Stukenborg, A. S. Nagji, W. Simmons, B. D. Kozower, D. R. Jones, and T. M. Daniel Radiotracer-Guided Thoracoscopic Resection is a Cost-Effective Technique for the Evaluation of Subcentimeter Pulmonary Nodules Ann. Thorac. Surg., September 1, 2008; 86(3): 934 - 940. [Abstract] [Full Text] [PDF]

				Y. Sato, Y. Tezuka, Y. Kanai, S. Otani, S. Yamamoto, K. Tetsuka, and Y. Sohara Novel Retractor for Lymph Node Dissection by Video-Assisted Thoracic Surgery Ann. Thorac. Surg., September 1, 2008; 86(3): 1036 - 1037. [Abstract] [Full Text] [PDF]

				R. Bordoni Consensus Conference: Multimodality Management of Early- and Intermediate-Stage Non-Small Cell Lung Cancer Oncologist, September 1, 2008; 13(9): 945 - 953. [Abstract] [Full Text] [PDF]

				M. F. Reed, M. W. Lucia, S. L. Starnes, W. H. Merrill, and J. A. Howington Thoracoscopic lobectomy: introduction of a new technique into a thoracic surgery training program. J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 376 - 381. [Abstract] [Full Text] [PDF]

				F. Gharagozloo, M. Margolis, and B. Tempesta Robot-assisted thoracoscopic lobectomy for early-stage lung cancer. Ann. Thorac. Surg., June 1, 2008; 85(6): 1880 - 1885. [Abstract] [Full Text] [PDF]

				J. P. Shaw, F. R. Dembitzer, J. P. Wisnivesky, V. R. Litle, T. S. Weiser, J. Yun, C. Chin, and S. J. Swanson Video-Assisted Thoracoscopic Lobectomy: State of the Art and Future Directions Ann. Thorac. Surg., February 1, 2008; 85(2): S705 - S709. [Abstract] [Full Text] [PDF]

				T. L. Demmy and C. Nwogu Is Video-Assisted Thoracic Surgery Lobectomy Better? Quality of Life Considerations Ann. Thorac. Surg., February 1, 2008; 85(2): S719 - S728. [Abstract] [Full Text] [PDF]

				S. J. Swanson, J. E. Herndon II, T. A. D'Amico, T. L. Demmy, R. J. McKenna Jr, M. R. Green, and D. J. Sugarbaker Video-Assisted Thoracic Surgery Lobectomy: Report of CALGB 39802 A Prospective, Multi-Institution Feasibility Study J. Clin. Oncol., November 1, 2007; 25(31): 4993 - 4997. [Abstract] [Full Text] [PDF]

				R. J. McKenna Jr, A. Mahtabifard, A. Pickens, D. Kusuanco, and C. B. Fuller Fast-Tracking After Video-Assisted Thoracoscopic Surgery Lobectomy, Segmentectomy, and Pneumonectomy Ann. Thorac. Surg., November 1, 2007; 84(5): 1663 - 1668. [Abstract] [Full Text] [PDF]

				P. Solli and L. Spaggiari Indications and Developments of Video-Assisted Thoracic Surgery in the Treatment of Lung Cancer Oncologist, October 1, 2007; 12(10): 1205 - 1214. [Abstract] [Full Text] [PDF]

				W. J. Scott, J. Howington, S. Feigenberg, B. Movsas, and K. Pisters Treatment of Non-small Cell Lung Cancer Stage I and Stage II: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 234S - 242S. [Abstract] [Full Text] [PDF]

				R. P. Petersen, D. Pham, W. R. Burfeind, S. I. Hanish, E. M. Toloza, D. H. Harpole Jr, and T. A. D'Amico Thoracoscopic Lobectomy Facilitates the Delivery of Chemotherapy after Resection for Lung Cancer Ann. Thorac. Surg., April 1, 2007; 83(4): 1245 - 1250. [Abstract] [Full Text] [PDF]

				B. J. Park, H. Zhang, V. W. Rusch, and D. Amar Video-assisted thoracic surgery does not reduce the incidence of postoperative atrial fibrillation after pulmonary lobectomy J. Thorac. Cardiovasc. Surg., March 1, 2007; 133(3): 775 - 779. [Abstract] [Full Text] [PDF]

				A. Watanabe, T. Koyanagi, S. Nakashima, and T. Higami How to clamp the main pulmonary artery during video-assisted thoracoscopic surgery lobectomy Eur. J. Cardiothorac. Surg., January 1, 2007; 31(1): 129 - 131. [Abstract] [Full Text] [PDF]

				T. A. D'Amico Thoracoscopic lobectomy: Evolving and improving. J. Thorac. Cardiovasc. Surg., September 1, 2006; 132(3): 464 - 465. [Full Text] [PDF]

				N. Shigemura, A. Akashi, S. Funaki, T. Nakagiri, M. Inoue, N. Sawabata, H. Shiono, M. Minami, Y. Takeuchi, M. Okumura, et al. Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stage IA lung cancer: A multi-institutional study. J. Thorac. Cardiovasc. Surg., September 1, 2006; 132(3): 507 - 512. [Abstract] [Full Text] [PDF]

				R. P. Petersen, D. Pham, E. M. Toloza, W. R. Burfeind, D. H. Harpole Jr, S. I. Hanish, and T. A. D'Amico Thoracoscopic lobectomy: a safe and effective strategy for patients receiving induction therapy for non-small cell lung cancer. Ann. Thorac. Surg., July 1, 2006; 82(1): 214 - 218. [Abstract] [Full Text] [PDF]

				R. J. McKenna Jr, W. Houck, and C. B. Fuller Video-Assisted Thoracic Surgery Lobectomy: Experience With 1,100 Cases Ann. Thorac. Surg., February 1, 2006; 81(2): 421 - 426. [Abstract] [Full Text] [PDF]

				T. A. D'Amico Robotics in thoracic surgery: Applications and outcomes J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 19 - 20. [Full Text] [PDF]

				B. J. Park, R. M. Flores, and V. W. Rusch Robotic assistance for video-assisted thoracic surgical lobectomy: Technique and initial results J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 54 - 59. [Abstract] [Full Text] [PDF]

				T. L. Demmy, T. A. James, S. J. Swanson, R. J. McKenna Jr, and T. A. D'Amico Troubleshooting Video-Assisted Thoracic Surgery Lobectomy Ann. Thorac. Surg., May 1, 2005; 79(5): 1744 - 1752. [Abstract] [Full Text] [PDF]

				M. Sondhi, J. R. Goffin, B. J. Cohen, J. B. Wong, and S. G. Pauker DEALE-ing with Lung Cancer and Heart Failure Med Decis Making, January 1, 2005; 25(1): 82 - 94. [PDF]

				A. Iwasaki, T. Shirakusa, T. Shiraishi, and S. Yamamoto Results of video-assisted thoracic surgery for stage I/II non-small cell lung cancer Eur. J. Cardiothorac. Surg., July 1, 2004; 26(1): 158 - 164. [Abstract] [Full Text] [PDF]

				M. F. Szwerc, R. J. Landreneau, R. S. Santos, R. J. Keenan, and G. F. Murray Minithoracotomy combined with mechanically stapled bronchial and vascular ligation for anatomical lung resection Ann. Thorac. Surg., June 1, 2004; 77(6): 1904 - 1910. [Abstract] [Full Text] [PDF]

				Y. Doki, K. Ichiki, M. Tsuda, M. Toge, T. Misaki, K. Usuda, and S. Sugiyama Complete port-accessed lobectomy by the muscle-sparing method Ann. Thorac. Surg., June 1, 2004; 77(6): 2230 - 2231. [Abstract] [Full Text] [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Larkin J. Daniels Thomas A. D’Amico Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Daniels, L. J. Articles by D’Amico, T. A. Search for Related Content PubMed PubMed Citation Articles by Daniels, L. J. Articles by D’Amico, T. A. Related Collections Lung - cancer