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Lobectomy in most hospitals is performed exclusively by a procedured called a thoracotomy. This means that the ribs are spread apart to provide access to the chest, and this rib spreading and cutting of muscle is associated with a significant amount of discomfort after surgery. Video-Assisted Thoracic Surgery (VATS) Lobectomy allows surgeons to carry out exactly the same operation within the chest that is performed by thoracotomy, but it is done through three to four small incisions without rib spreading rather than the large incision with rib spreading that a thoracotomy entails. The surgeon gains a view inside the chest from a small video camera inserted through one of the small incisions, and the procedure is carried out with long instruments passed through the other small incisions. Patients who have undergone VATS lobectomy have less pain and recover faster from surgery. In general, VATS lobectomy is an option only for patients with Stage I lung cancer.
A guiding philosophy in the management of resectable lung cancer at Stanford is to avoid pneumonectomy ifat all possible. This approach can only be practiced by surgeons skilled in sleeve lobectomy and experienced enough to know when lobectomy will provide an equivalent chance of cure as the more morbid pneumonectomy. Avoidance of complete removal of a lung reduces both early complications and long-term disability due to shortness of breath.
Sleeve lobectomy is possible when a tumor affects the origin of the airway that connects to a lobe of the lung. Sleeve lobectomy allows complete removal of the tumor without complete removal of the lung. Instead, you surgeon would remove a small portion of the airway that conducts air to the remaining lobe(s). The airway would then be reconnected to the remaining lobe(s) so that they can continue to function in the usual manner. This approach provides the same chance of cure as pneumonectomy with far lower operative complications and better quality of life.