Thoracoscopic Lung Lobectomy Frequently Asked Questions 1. What is thoracoscopic lobectomy? The so-called thoracoscopic lobectomy is a lobectomy surgery in which three small incisions of 1-2cm are made in different parts of the lateral chest wall, through which a camera lens and various special surgical instruments are inserted, and the surgeon observes the images through video transmission and operates with various surgical instruments outside the body to complete the lobectomy. 2.What kind of situation is thoracoscopic lobectomy suitable for? For benign diseases that require lobectomy, such as bronchiectasis, pulmonary isolation, benign lung tumors, etc., most of the surgeries can be completed through thoracoscopic surgery. For lung cancer, the internationally authoritative National Comprehensive Cancer Network (NCCN) Lung Cancer Treatment Guidelines and the American College of Chest Physicians (ACCP) Guidelines have listed thoracoscopic lobectomy alongside open-heart surgery as their standard treatment since 2006 and 2007, respectively. However, there are some peculiarities of thoracoscopic surgical operations, and the best patients in terms of surgical difficulty are those who present with so-called peripheral-type lesions with isolated shadows/nodules in the lungs, while some patients with involvement of hilar structures or those who require bronchial/vascular molding are more suited for open thoracic surgery. Of course, the specifics of the surgery are up to the surgeon. 3. Is thoracoscopic lobectomy safe? Yes, it is safe. Thoracoscopic lobectomy is a well-established surgical procedure. Since the thoracoscope is equivalent to a camera next to the surgical field, it has a magnifying effect and shows the fine structure of the surgical field much better than open heart surgery which is viewed “from afar” through the traditional incision. Therefore, for doctors with some experience in thoracoscopic surgery, thoracoscopic surgery is more delicate and safer than open thoracic surgery. Overseas statistics and our experience show that intraoperative bleeding and the need for blood transfusion are lower in thoracoscopic surgery than in open thoracic surgery. Foreign literature summarizes that intraoperative bleeding in thoracoscopic lobectomy is nearly half of that in open thoracic surgery. Moreover, due to the minimally invasive nature of thoracoscopic surgery, there are fewer perioperative deaths than open thoracic surgery. 4.Is it possible to encounter the situation of transferring to open chest during thoracoscopic surgery? There is a proportion of cases in which the chest may be opened, and this proportion is about 10%. The main reasons are severe adhesion and hemorrhage, while open thoracic surgery is easier to deal with adhesion and control bleeding; if intraoperative tumor invasion of hilar structures or large blood vessels is found to require intrapericardial treatment of vascularization or bronchial/vascularization, the thoracoscopic operation is difficult and time-consuming, in which case open thoracic surgery is safer and more thorough. As the purpose of minimally invasive surgery is to benefit the patient, never minimally invasive for the sake of minimally invasive, for the difficult circumstances of the initiative to intermediate open-heart surgery is not a failure of thoracoscopic surgery, but more responsible for the patient’s practice. 5.Some people say that thoracoscopic surgery is not clean for lung cancer, is that so? This is the biggest misunderstanding of thoracoscopic surgery! At present, total thoracoscopic lobectomy has been developed and matured, and our department is one of the earliest large comprehensive hospitals in China to carry out this operation. The surgery is fully capable of completely removing the diseased lung lobe where the lung cancer is located and sweeping the mediastinal lymph nodes, i.e. the so-called radical lung cancer resection. Foreign literature reports that its long-term survival rate is higher than that of open thoracic surgery, which fully reflects the cleanliness of resection, its local recurrence rate is not high, and the rate of distant metastasis is low. Thoracoscopic lobectomy is a brand-new surgical technique, and some doctors may not have enough knowledge about it, or their mastery of surgical technique may not meet the corresponding requirements, which is why there is the saying that lung cancer is not cleanly resected. 6. What is the surgical effect of thoracoscopic lobectomy on lung cancer? At present, the efficacy of thoracoscopic lobectomy for lung cancer treatment has been internationally recognized, especially for the treatment of early-stage lung cancer, and it has been written into NCCN lung cancer treatment guidelines. The efficacy of thoracoscopic lobectomy in treating lung cancer is not inferior to that of open-heart surgery, or even better. Thousands of cases abroad summarize the bulk of literature reports that the 5-year survival rate of lung cancer treated by thoracoscopic lobectomy can be increased by 15% compared with that of open thoracic surgery. 7. Is thoracoscopic lobectomy very expensive? Thoracoscopic surgery requires the so-called endoscopic cutting and suturing device to complete the cutting and suturing of blood vessels, bronchial tubes and lung lobes. This is a high-tech instrument that is currently completely imported. As a single-use consumable, the endoscopic cutting and suturing device is an out-of-pocket expense under health insurance. Total thoracoscopic lobectomy adds an average of$10,000 to$20,000 to the cost of surgery over open surgery. However, because thoracoscopic surgery greatly reduces the chance of surgical complications and the need for expensive antibiotics and intensive care, the difference is not significant if the total hospitalization costs for the elderly and infirm are counted. 8, thoracoscopic lobectomy surgery in addition to less trauma, there are other advantages? The minimally invasive nature of thoracoscopic lobectomy is not only manifested in the small trauma of the surface wound, but also has its extensive connotation, such as fewer surgical complications; light influence on lung function after operation and fast recovery; small blow to the organism, and the lung cancer patients can receive further chemotherapy as soon as possible to ensure the most timely treatment and the best therapeutic effect. 9. Is there any difference between small incision open heart surgery and thoracoscopic surgery? Small incision open heart surgery and thoracoscopic surgery are two completely different concepts. Some hospitals are now publicizing the concept of thoracoscopic surgery, but in fact it is an auxiliary surgery of thoracoscopy, which must also enter the chest from the narrow intercostal space and open up the ribs in order to get a sufficient space for surgical operation. Although the external wound is small, the internal trauma is also very large, and there is a high possibility of rib fracture (traditional standard posterior posterolateral thoracotomy incision needs to resect even 1 rib in order to get a satisfactory surgical exposure), and it is very difficult for the patient to have a satisfactory surgical exposure. Surgical exposure), the role of postoperative pain, the impact of pulmonary function, and postoperative recovery is not essentially improved. 10.When lung cancer is treated by thoracoscopic surgery, its incision is small, how to take out the resected diseased lung tissue specimen? The removal of specimens during thoracoscopic lobectomy is indeed one of the difficulties of the surgery. The largest surgical incision in this type of surgery is only about 2cm, while the specimen of lobectomy or even combined lobectomy is often larger than the incision. Our method is to use a special sterile specimen bag placed in the thoracic cavity after the lobes are removed, and the specimen is placed in the bag and removed from the incision, which ensures that the incision is in line with the thoracic cavity. If the specimen is too large, it may be removed gradually by the method of removing it in pieces.