The current concern of colleagues should be how to better master and carry out this operation, otherwise the thoracic surgery technology in your hospital will be further outdated”. This assertion was made, a stone stirred up a thousand waves, about the thoracoscopic lobectomy issues soon became the domestic thoracic surgery scholars to discuss the hot spot; the public is also full of novelty of this new treatment, hope to have more understanding. In order to better interpret this new technology, we would like to introduce several issues of public concern to you as follows.
1.What is the status of total thoracoscopic lobectomy for early stage lung cancer in the international arena?
As early as 1992, the first case of thoracoscopic lobectomy for lung cancer was reported by an American physician. However, until 2003, less than 5% of lung cancers were treated with thoracoscopic lobectomy across the United States, reflecting the technical difficulty of performing lobectomy under full thoracoscopy, the long process of growing up as a specialist, and the complex process of people gradually accepting the new thing. In recent years, as thoracoscopic techniques have become more widespread worldwide and some of the early units have gained experience in performing complex thoracoscopic procedures, total thoracoscopic lobectomy has quickly become a challenging new technique in thoracic surgery that is popular worldwide. Mckenna, this rate even reached more than 94%. In the last two years, this percentage has reached nearly 50% in the Thoracic Surgery Center of Peking University People’s Hospital, which can be said to be gradually approaching the international leading level. Experts expect that in the next five years, about 60% of lung cancer surgeries in the United States will be done under thoracoscopy; in 2006, thoracoscopic surgery was written into the NCCN lung cancer treatment guidelines for the first time in the United States, becoming the standard procedure of choice for early lung cancer treatment. It can be seen that thoracoscopic lobectomy for lung cancer has become a definite conclusion and is no longer a problem! If some people were understandably skeptical or wait-and-see about this technology ten years ago, then if they are still talking about it now, they are either ignorant or “intentional”. We have reason to predict that in a near future, a thoracic surgeon who does not master thoracoscopic lobectomy will find it difficult to gain a foothold in the field of lung cancer surgery.
2.What are the advantages of total thoracoscopic lobectomy for early stage lung cancer?
Like all minimally invasive techniques, the biggest advantage of thoracoscopic lobectomy for lung cancer treatment is its minimally invasive nature – less invasive surgery, less pain for patients, faster recovery and fewer sequelae. Compared with traditional open-heart surgery and small incision surgery, thoracoscopic surgery is revolutionary in terms of reducing trauma. The patient’s “vitality” and immunity are maximally protected by the absence of the “painful” step that is typical of open-heart surgery: “propping up the ribs”. This has been confirmed by many comparative studies internationally. Immunity protection is especially important for an elderly patient with malignant lung cancer. A positive emotional state, good physical condition and an effective immune system are the last important lines of defense against the disease. Thoracoscopic surgery preserves this line of defense while thoroughly treating tumors, which is the fundamental reason for the good long-term results and high patient satisfaction of lung cancer patients treated by this method.
3.What are the technical requirements of surgeons for carrying out total thoracoscopic lobectomy for early stage lung cancer?
”Minimally invasive surgery must be able to achieve the same surgical quality and similar surgical results as traditional surgery”. This is the most fundamental principle of “minimally invasive” and is the current accepted standard in surgery. This principle is particularly important in the treatment of cancer. As a new modern technique, thoracoscopy does not meet the fundamental requirement of lung cancer surgery for all thoracic surgeons, which is “exact removal of the diseased lobe and systematic clearance of lymph nodes in the suspected area”. Thoracoscopic lobectomy is a complex and high-risk thoracic surgery. It requires, on the one hand, that the patient be a qualified lung cancer patient and, on the other hand, that the surgeon be a thoracic surgeon with extensive experience in both open-heart and thoracoscopic surgery. Thoracoscopic lobectomy performed by incompetent surgeons on unsuitable patients may lead to serious consequences, including avoidable intraoperative hemorrhage, normal lung damage, and compromised tumor resection, or even life-threatening in severe cases.
At present, as the international call for thoracoscopic surgery to treat early stage lung cancer is getting higher and higher, the enthusiasm of domestic thoracic surgery colleagues to try this new technology is increasing, which is a good phenomenon worthy of recognition. However, it has been repeatedly emphasized by industry aspirants that as a class of complex thoracoscopic surgery, it must be carried out with clinical caution by any unit or individual. Our recommendation to interested thoracic surgeons is that they should systematically complete certain training in a technical pioneer unit, gradually accumulate relevant experience, and humbly seek advice and receive guidance from experienced surgeons. This is the only way to ensure the safety of patients and the smooth development of work.
4.How to view “small incision surgery” and “thoracoscopic surgery” in the treatment of lung cancer
At present, colleagues should be concerned about how to better master and carry out this surgery, otherwise the thoracic surgery technology in your hospital will be further outdated”. This assertion has stirred up a thousand waves, and the issue of thoracoscopic lobectomy soon became a hot topic of discussion among scholars in the domestic thoracic surgery field; the public is also full of novelty and hope to know more about this new treatment. In order to better interpret this new technology, we would like to introduce several issues of public concern to you as follows.
1.What is the status of total thoracoscopic lobectomy for early stage lung cancer in the international arena?
As early as 1992, the first case of thoracoscopic lobectomy for lung cancer was reported by an American physician. However, until 2003, less than 5% of lung cancers were treated with thoracoscopic lobectomy across the United States, reflecting the technical difficulty of performing lobectomy under full thoracoscopy, the long process of growing up as a specialist, and the complex process of people gradually accepting the new thing. In recent years, as thoracoscopic techniques have become more widespread worldwide and some of the early units have gained experience in performing complex thoracoscopic procedures, total thoracoscopic lobectomy has quickly become a challenging new technique in thoracic surgery that is popular worldwide. Mckenna, this rate even reached more than 94%. In the last two years, this percentage has reached nearly 50% in the Thoracic Surgery Center of Peking University People’s Hospital, which can be said to be gradually approaching the international leading level. Experts expect that in the next five years, about 60% of lung cancer surgeries in the United States will be done under thoracoscopy; in 2006, thoracoscopic surgery was written into the NCCN lung cancer treatment guidelines for the first time in the United States, becoming the standard procedure of choice for early lung cancer treatment. It can be seen that thoracoscopic lobectomy for lung cancer has become a definite conclusion and is no longer a problem! If some people were understandably skeptical or wait-and-see about this technology ten years ago, then if they are still talking about it now, they are either ignorant or “intentional”. We have reason to predict that in a near future, a thoracic surgeon who does not master thoracoscopic lobectomy will find it difficult to gain a foothold in the field of lung cancer surgery.
2.What are the advantages of total thoracoscopic lobectomy for early stage lung cancer?
Like all minimally invasive techniques, the biggest advantage of thoracoscopic lobectomy for lung cancer treatment is its minimally invasive nature – less invasive surgery, less pain for patients, faster recovery and fewer sequelae. Compared with traditional open-heart surgery and small incision surgery, thoracoscopic surgery is revolutionary in terms of reducing trauma. The patient’s “vitality” and immunity are maximally protected by the absence of the “painful” step that is typical of open-heart surgery: “propping up the ribs”. This has been confirmed by many comparative studies internationally. Immunity protection is especially important for an elderly patient with malignant lung cancer. A positive emotional state, good physical condition and an effective immune system are the last important lines of defense against the disease. Thoracoscopic surgery preserves this line of defense while thoroughly treating tumors, which is the fundamental reason for the good long-term results and high patient satisfaction of lung cancer patients treated by this method.
3.What are the technical requirements of surgeons for carrying out total thoracoscopic lobectomy for early stage lung cancer?
”Minimally invasive surgery must be able to achieve the same surgical quality and similar surgical results as traditional surgery”. This is the most fundamental principle of “minimally invasive” and is the current accepted standard in surgery. This principle is particularly important in the treatment of cancer. As a new modern technique, thoracoscopy does not meet the fundamental requirement of lung cancer surgery for all thoracic surgeons, which is “exact removal of the diseased lobe and systematic clearance of lymph nodes in the suspected area”. Thoracoscopic lobectomy is a complex and high-risk thoracic surgery. It requires, on the one hand, that the patient be a qualified lung cancer patient and, on the other hand, that the surgeon be a thoracic surgeon with extensive experience in both open-heart and thoracoscopic surgery. Thoracoscopic lobectomy performed by incompetent surgeons on unsuitable patients may lead to serious consequences, including avoidable intraoperative hemorrhage, normal lung damage, and compromised tumor resection, or even life-threatening in severe cases.
At present, as the international call for thoracoscopic surgery to treat early stage lung cancer is getting higher and higher, the enthusiasm of domestic thoracic surgery colleagues to try this new technology is increasing, which is a good phenomenon worthy of recognition. However, it has been repeatedly emphasized by industry aspirants that as a class of complex thoracoscopic surgery, it must be carried out with clinical caution by any unit or individual. Our recommendation to interested thoracic surgeons is that they should systematically complete certain training in a technical pioneer unit, gradually accumulate relevant experience, and humbly seek advice and receive guidance from experienced surgeons. This is the only way to ensure the safety of patients and the smooth development of work.
4.How to view the difference between “small incision surgery” and “thoracoscopic surgery” in the treatment of lung cancer
Compared with the traditional standard open-heart surgery, “small incision surgery” is indeed a considerable progress, which largely reduces surgical trauma and patient pain. For a thoracic surgeon who has been performing thoracoscopic surgery for a short period of time and is relatively less confident, the use of “thoracoscopic-assisted small incision surgery”, in which routine operations are done under the thoracoscope and complex operations are done under the direct view of the small incision, can indeed ensure patient safety and facilitate early technical progress. It can be said that “thoracoscopic assisted small incision surgery” is a stage of practical importance in the development of thoracoscopic surgery. However, as mentioned before, the disadvantages of small incision surgery are also relatively obvious. If the “small incision” is compared to a crutch in toddlerhood, then for a growing thoracoscopic surgeon, this “crutch” must eventually be discarded. Efforts to explore the smallest possible incision without auxiliary support to open the ribs and complete lobectomy completely thoracoscopically is undoubtedly a hot topic and a direction for quite some time now and in the future. Of course, technological progress is always a continuous process, and no technology can become eternally new. In a foreseeable future, thoracoscopic surgery will be gradually replaced by “robotic surgery” or even “remote surgery”. However, it is conceivable that without the basic surgical skills of fully lumpectomy, thoracic surgeons will find it difficult to adapt to the new developments of minimally invasive surgery in the future.
The difference
Compared with the traditional standard open-heart surgery, “small incision surgery” is indeed a considerable progress, which largely reduces the surgical trauma and patient pain. For a thoracic surgeon who has been performing thoracoscopic surgery for a short period of time and is relatively less confident, the use of “thoracoscopic assisted small incision surgery”, in which routine operations are done under the thoracoscope and complex operations are done under the direct view of the small incision, can indeed ensure patient safety and facilitate early technical progress. It can be said that “thoracoscopic assisted small incision surgery” is a stage of practical importance in the development of thoracoscopic surgery. However, as mentioned before, the disadvantages of small incision surgery are also relatively obvious. If the “small incision” is compared to a crutch in toddlerhood, then for a growing thoracoscopic surgeon, this “crutch” must eventually be discarded. Efforts to explore the smallest possible incision without auxiliary support to open the ribs and complete lobectomy completely thoracoscopically is undoubtedly a hot topic and a direction for quite some time now and in the future. Of course, technological progress is always a continuous process, and no technology can become eternally new. In a foreseeable future, thoracoscopic surgery will be gradually replaced by “robotic surgery” or even “remote surgery”. However, it is conceivable that without basic surgical skills in full lumpectomy, thoracic surgeons will find it difficult to adapt to the new development of minimally invasive surgery in the future.