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P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
P1.02-018 - Needlescopic Lobectomy and Segmentectomy for Primary Lung Cancer: Less Invasive Surgery Using Fine Scope and Forceps (ID 610)
09:30 - 17:00 | Author(s): H. Arai
If we can maintain a satisfactory technical level, safeness and prognosis equal to conventional surgery, a less invasive procedure will bring more benefits to patients. We have performed thoracoscopic anatomical lobectomy and segmentectomy for primary lung cancer for twenty years. At first we used and slid 10mm-diameter scope and forceps through three or four ports. Later we changed to 5mm-diameter scope and forceps, and presently we start performing the needlescopic surgery（1 port+3 punctures method）using a 3mm-diameter scope and forceps, which we have used since September 2012. Now we would like to explain this operative procedure and effectiveness.
【Patients】One hundred and eleven patients underwent the needlescopic anatomical lobectomy and segmentectomy of the lung between September 2012 to March 2015. They had clinical stage IA or IB lung cancer. We compared the operation time, blood loss volume, post-operative creatinine phosphokinase (CK) and other peri-operative parameters of this method with those of the conventional method using a 5mm-diameter scope which were performed on 73 patients from January 2012 to August 2012. 【Operative procedure】1. We make a 2 to 3 cm length skin incision on the 4th or 6th intercostal space of the chest trunk and set the polyurethane-made retractor. We use it as the main port. 2. We puncture the skin with three 3mm-diameter trocars. Then we insert and slide a 3mm-diameter scope and forceps through them. We observe thoracic lumen and perform various manipulations using them. 3. Endostaplers, energy devices and electric cautery of which diameters are larger than 3mm go into the thoracic lumen through the main port. 4. Finally we remove specimens and set the chest tube within the main port incision at the end of surgery.
We performed 15 segmentectomies and 96 lobectomies of the lung using this method for the lung cancer. We dissected mediastinal nodes in all cases. We had one case that was converted to the conventional method, and one case that was converted to the open method. However we elongated the incision of one puncture from 3 mm to 10 mm in four cases in order to insert endostaplers for dissecting pulmonary veins and arteries. Mean operation time was 220±63 minutes. It was not significantly different from that of the conventional method. Mean blood loss volume was 16.6±22.3 ml. It was significantly less than that of the conventional method. Post-operative peak titers of CK and CRP of this method were significantly lower than that of the conventional method. We had no severe intraoperative accidents or postoperative complications. All patients were smoothly discharged.
This one plus three method is less invasive than a conventional procedure. We were able to successfully perform the needlescopic lobectomy and segmentectomy for lung cancer as well as conventional thoracoscopic surgery. This method would be the optimal and optional method if and when we appropriately select cases.