Q: What is thoracoscopic lobectomy? There is no uniform definition of thoracoscopic lobectomy at home and abroad. The Department of Thoracic Surgery at Beijing Chaoyang Hospital West Hospital divides it into three categories, namely: thoracoscopic lobectomy (VATS lobectomy), thoracoscopic assisted small incision lobectomy (VAMT lobectomy) and combined lumpectomy lobectomy, as shown in the figure below. Above: Thoracoscopic-assisted small-incision lobectomy Above: Thoracoscopic lobectomy Q: When did thoracoscopic lobectomy begin? Is the technique mature? The author first performed VAMT lobectomy on September 10, 1999, and has performed more than one hundred operations since then. The author performed VATS lobectomy on December 4, 2007, when there were no reports in China. Combined lumpectomy lobectomy was first performed in our hospital a few months ago, and no relevant reports have been seen in the literature from home and abroad. With the advancement of industrial technology, thoracoscopic special instruments for lobectomy have been developed and matured, and nearly 10,000 such procedures (VAMT and VATS) have been performed worldwide, VAMT lobectomy has become relatively popular in China, and VATS lobectomy has become the preferred learning technique for thoracic surgeons for further training. It should be said that thoracoscopic lobectomy has entered a mature stage. Q: Why is thoracoscopy not used for all lobectomies? First of all, thoracoscopic lobectomy has certain limitations. Difficult and complicated lobectomy still requires traditional open-heart surgery, specifically central lung cancer (tumors located in the inner 1/2 of the lung) is not suitable for thoracoscopic surgery, and our hospital considers VATS lobectomy first for peripheral lung cancer (tumors located in the outer 1/2 of the lung) less than 5 cm, and VAMT is used on the side if there is difficulty. Secondly, because the development of thoracoscopic lobectomy is extremely uneven in China, and its development was limited in the early stage due to the high cost of surgery and imperfect instruments, the main reason to limit its application is the complexity of technology, such as anesthesia, surgical equipment, surgical operation skills, etc. At present, most large hospitals with first-class conditions are still unable to master the complete surgical technology. Therefore, when patients consult their doctors, most of them will let them choose the traditional surgery. Q: Is my lobectomy procedure suitable for thoracoscopy? First of all, VATS lobectomy is suitable for all patients with benign lung diseases, such as bronchiectasis, tuberculoma, pulmonary isolation, pulmonary alveoli, benign lung tumors, etc. For malignant tumors, our pioneering combined lumpectomy lobectomy is more suitable for peripheral lung cancer with enlarged mediastinal lymph nodes. At present, our surgical indications are: VATS lobectomy is suitable for peripheral type non-small cell lung cancer, lung hilar lymph node enlargement is not obvious, interlobular fissures need to meet the requirements of accurate microscopic identification of each lung lobe, and the tumor body is less than 5cm. Patients who are not suitable for VATS lobectomy are: central lung cancer, huge peri-pulmonary lesions, and patients with extensive pleural cavity adhesions, in addition to the above mentioned limitations of thoracoscopic surgery, the thoracoscope cannot enter the chest cavity at all, so this procedure cannot be used either.