Ann Thorac Surg 2003;76:1667
© 2003 The Society of Thoracic Surgeons
Original article: general thoracic
Invited commentary
Stephen R. Hazelrigg, MDa
a Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, PO Box 19638, Springfield, IL 62794-9638, USA
e-mail: shazelrigg{at}siumed.edu
This manuscript is of interest because of its novel description of a bilateral VATS procedure done using only trocar sites in the right chest. The technique is well described and the pictures support their favorable experience. This approach raises several concerns which include: (a) the ability to adequately explore the contralateral lung for multiple blebs; (b) the potential for injury of mediastinal structures during the dissection or instrument manipulation; (c) the potential for injury to the now ventilated right lung while introducing of instruments for surgery on the left lung; (d) the potential for a tension pneumothorax on the left with just one chest tube if the mediastinum seals and there is a leak on the left; and (e) the potential need to place undue torque on the instruments to address the left side that may produce postoperative pain and offset the main potential benefit of this procedure.
The results, while good, did require that 33% of the cases be eventually converted to a bilateral procedure (staged) and all patients had high-resolution scans to ensure no posterior or basilar disease that they could not reach.
Obviously, we cannot answer the questions raised with only six cases. I believe that this is an interesting procedure to add to one's armamentarium. The precise indications for performing a bilateral resection are still not entirely clear and I wonder if doing bilateral procedures with a 5 mm scope might prove to be better from a visualization perspective and at least comparable to this approach with regard to postoperative pain.
Although I find this description interesting and I agree it can be done, I believe when a bilateral resection is indicated, I will continue to use a bilateral VATS approach. I thank the authors for their continued innovation and look forward to seeing more data in the future to address the potential concerns raised.
