Lung cancer surgery through thoracoscopy

  Surgery is the only way to cure lung cancer, but the traditional surgical method of lung cancer treatment requires making an incision of about 30 cm long in the skin of the chest, cutting the muscles of the chest wall, cutting the muscles between the two ribs, propping up the ribs to make the incision 10-15 cm wide, and sometimes breaking 1-2 ribs. Only in this way can the surgical area be fully exposed and the lesioned lung lobe be removed with direct visual access to the chest cavity. Traditional dissection of the chest is very traumatic and it takes about two weeks to be discharged from the hospital after surgery, and some patients are lost because their physical condition cannot withstand the trauma of surgery.  People often only pay attention to the length of the incision, but the width of the incision (i.e., the width of the ribs held open during surgery) is actually the main factor causing postoperative pain. Previous surgeries required direct visualization of the lesion to complete the surgery, which required the incision to be widened, otherwise a narrow slit between the ribs, even if long, would not be clearly visible, i.e., no matter how small the incision was, as long as the operation was performed under direct vision, it was inevitable that the ribs would be propped open and the incision widened.  Thoracoscopic lobectomy for lung cancer only makes two 1 cm long incisions in the chest and one 4 cm long incision. Not only is the length of the incision significantly shorter than that of the previous surgery, but more crucially, it does not require the opening of the ribs and avoids the trauma caused by the opening of the ribs. Unlike traditional surgery, the surgeon does not perform the operation under direct visualization. During surgery, a 1 cm diameter tubular endoscope is placed into the chest through one incision, and an external fiber optic cable transmits the intra-thoracic situation to the TV monitor, while two other incisions are made to place special long-handled instruments of 0.5 to 1 cm diameter. The operator looks at the TV, and instead of entering the chest, he or she operates these long-handled special instruments outside the chest cavity to complete the radical lung cancer surgery. The advantages of thoracoscopic lobectomy are: first, less trauma and less bleeding; second, less postoperative pain and faster recovery, and you can get out of bed the next day; and third, aesthetic wound.  People may have the following concerns about this new surgical method.  Firstly, whether this method can treat lung cancer thoroughly. This was a central topic of debate in thoracic surgery and oncology worldwide more than a decade ago. Many research findings and data data in recent years have answered these questions. In a review of thousands of data data from 21 centers, the analysis found that thoracoscopic lobectomy can completely clear all groups of lymph nodes in the chest cavity exactly like traditional open surgery, and showed significantly better five-year survival rates than traditional open surgery. As early as 2006, the National Comprehensive Cancer Network (NCCN) guidelines for the treatment of lung cancer clearly stated that “thoracoscopic lobectomy is a viable option for resectable lung cancer,” which means that the indications for total thoracoscopic lobectomy have been internationally recognized. In fact, the effectiveness of thoracoscopic lobectomy in the treatment of lung cancer mainly depends on two points: 1. This type of surgery requires the operator to have rich experience in thoracoscopic surgery, and at the same time to have done a large number of traditional open lobectomies and be familiar with the anatomy in the chest cavity.  2. Selection of patients for surgery. Of course, not all lung cancer patients are suitable for thoracoscopic surgery. Generally speaking, patients whose masses are within the lung, without obvious invasion of surrounding organs and mediastinal lymph node enlargement are not obvious can be treated for lung cancer through thoracoscopic lobectomy. Based on our experience of thoracoscopic lobectomy completed in recent years, the thoracoscopic operation is actually clearer and easier than the open-chest direct vision operation. And the amount of bleeding is only one-fifth of that of traditional surgery. Usually patients can get out of bed in a day or two after surgery and can be discharged from the hospital in about a week.