Video-assisted thoracoscopic surgery lobectomy using 'the caudal approach': results and evolution

Background: Video-assisted thoracoscopic surgery (VATS) has become a common surgical approach in the diagnosis and treatment of lung and mediastinal diseases. In this study, we reported our current experience of thoracoscopic surgery using a new caudal position technique for anatomical lung resections and compared it with the standard anterior VATS technique. Methods: From January 2016 to October 2017, 92 consecutive patients with lung cancer underwent VATS lobectomy. Among these, 34 patients were treated by conventional anterior three portal VATS lobectomy, and 58 patients were treated using the caudal three port VATS lobectomy. The mean operative time, conversion rate, hospital stay, post-operative drainage, reoperation, post operative pain were compared between each group. Results: No differences between the two groups are showed in terms of surgical time, post-operative drainage, incidence of prolonged air leaks and post-operative pain. Conclusions: The caudal approach to major pulmonary resection of thoracoscopic lobectomy results in a reliable and comfortable procedure for the surgeon. Once demonstrated the reliability of the VATS lobectomy with three accesses using the caudal position, we are starting to standardize biportal and uniportal VATS with the surgeon in the caudal position.