Surgical Techniques

Surgical Techniques

1. Lateral or posterolateral thoracotomy is an approach for the resection of large pulmonary neoplasms or abscesses. Thoracotomy is often preceded by staging procedures such as bronchoscopy, mediastinoscopy, or thoracoscopy. If the staging procedures are performed at the same sitting, the anesthetic should be planned to accommodate the possibility of a shortened procedure if metastatic disease is discovered.
2. Video-assisted thoracoscopic surgery (VATS) is a common approach for wedge resection, segmentectomy, and lobectomy. Thoracoscopic surgery may result in less postoperative pain and a shorter recovery time. Lung isolation is required for adequate visualization of the surgical field.
3. Robot-assisted thoracoscopic surgery is an emerging technique that is theoretically superior to VATS in that the accuracy of the robotic arm facilitates lymph node resection with the conservation of nerves and improved cure rates.
   1. Good pressure point padding must be ensured due to extremes of positioning with robotic surgery.
   2. When the robot is docked, the surgical bed must not be moved at all.
   3. As with VATS, complete collapse of the operative lung must be maintained.