MUSC Health thoracic surgeon Chadrick E. Denlinger, M.D. discusses video-assisted thoracoscopic surgery for the treatment of stage 1 nonsmall cell lung cancer (NSCLC). Lobectomy is the preferred treatment with optimal oncological outcomes for most patients with stage 1 NSCLC. Traditionally, lobectomy has been performed with a thoracotomy — in which a large incision is made in the chest and a rib spreader used to gain visual and physical access to the chest cavity. The use of a rib spreader can result in rib fractures, which are very painful and require several weeks to heal, delaying recovery.
Video-assisted thoracoscopic surgery (VATS) uses an endoscopic camera inserted through a 2-cm “port” to visualize the surgical field and special instruments to perform the lobectomy through one or two additional 5-8-cm ports. Surgeons watch a monitor displaying the endoscopic images to guide them as they perform surgery through the small ports. Because a rib spreader is not required and incision sizes are much smaller, patients experience less pain and can resume normal activities much sooner than after a thoracotomy.
When performed by an appropriately trained surgeon in a high-volume center, VATS achieves oncologic outcomes as good as those obtained with thoracotomy in patients with stage 1 NSCLC, with decreased pain, reduced hospital length of stay, more rapid return to function and fewer complications. VATS is now considered standard of care for patients with stage 1 NSCLC. More than 95 percent of surgical cases for stage 1 NSCLC at MUSC Health are performed with VATS.
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Chadrick E. Denlinger, M.D., is head of the section of thoracic surgery at the Medical University of South Carolina. He also serves as the surgical director of the lung transplant program. He is certified by the American Board of General ...
