vats in thoracic malignancies by juan antonio torrecilla
TRANSCRIPT
VATS in thoracic malignanciesJuan Antonio Torrecilla Medina
Thoracic Surgery Department
H. Univ. Son Espases
I’d like you to know…
What’s VATS?
History of video-surgery in Thoracic Surgery
Indications of VATS
Mediastinum
Pleura
Lung
VATS in major lung resections
V
A
T
S
ideo
ssisted
horacic
urgery
Minimally invasive surgery in
thoracic cavity through an utility
incision with no rib spreading,
looking through an endoscopic
camera and a monitor
Is VATS a new thing?
1913
1959 - 1973
1959
1992
1992
1994
1970s
1980s
Stapling devices
First stapling device, Hultl (Hungary, 1908)
1950 – 1980s
Stapling devices
First commercially produced
re-usable stapling devices
(Former USSR, 1950)
1950 – 1980s
Stapling devices
Modern staplers, Hirsch (U.S, 1964)
1950 – 1980s
Stapling devices
Endoscopic staplers (late 1980s)
1950 – 1980s
Which are the indications?
Thymoma
Enlarged lymph nodes
Tumours in posterior
mediastinum
Mediastinum
Mediastinoscopy
EBUS
VATS
Thoracocentesis: positive in
65%.
Close pleural biopsy:
sensivity 65% (esp. 99%).
Surgery
- Biopsy
- Poudrage (talc)
- Pericardial window
Thoracocentesis: positive in
65%.
Close pleural biopsy:
sensivity 65% (esp. 99%).
Surgery
- Biopsy
- Poudrage (talc)
- Pericardial window
Pleura
Thoracocentesis: positive in
65%.
Close pleural biopsy:
sensivity 65% (esp. 99%).
Surgery
- Biopsy
- Poudrage (talc)
- Pericardial window
Lung
Wedge / anatomic
segmentectomy
- Pulmonary
metastases
- NSCLC
Lobectomy
Pneumonectomy
Lung metastases
Lung metastases
Limited resection in NSCLC
VATS lobectomy: when?
Any resectable NSCLC
Same goal as in open surgery (R0, lymph node
dissection)
contraindications:
- Sleeve resections
- Endobronchial tumours
- Chest wall involvement
- Tumours larger than 5 cm
- Induction chemotherapy
FormerRelative
VATS lobectomy: pros
Less pain, morbidity and early discharge
Less postoperative systemic inflammation
Less lost of postoperative lung function
Best quality of life
Best adherence to adjuvant treatment
As safe as thoracotomy in long-term survival
VATS lobectomy: pros
VATS lobectomy: pros
VATS lobectomy: pros
VATS lobectomy: pros
VATS lobectomy: pros
VATS lobectomy: pros
VATS lobectomy: pros
VATS lobectomy: pros
VATS lobectomy: cons
VATS lobectomy: cons
VATS lobectomy: cons
Just to finish… VATS is a minimally invasive procedure using an utility
incision with no rib spreading
It’s a cutting-edge technique with more than 100 years
of history
It’s used in the resection of non-advanced thymomas
and mediastinal staging in NSCLC
It’s a usual technique in the management of malignant
effusions
Just to finish… VATS is an alternative to thoracotomy approach for
periferal lung metastases
Sublobar resections (by VATS) may be an alternative in
early stages of NSLC
VATS lobectomy…
- Is as safe as thoracotomy, with less perioperative
morbidity and it’s related to better quality of life
- Is not an easy technique, with a long learning curve
- Is cheaper in developed countries, but probably more
expensive in the rest of the world
