Intrathoracic light-assisted anterior limited thoracotomy in lung cancer surgery.

We recently developed an intrathoracic light-assisted anterior limited thoracotomy (ILAALT) for use in lung cancer surgery. A skin incision 12cm long is made below the breast, then the pectoral major muscle is divided, and the fourth intercostal space is opened with a disconnection of the anterior cartilagenous portion. The posterior skin, including the serratus anterior muscle, is drawn posteriorly using a retractor. To illuminate the posterior and apex portions of the thoracic cavity, a flexible fiber light is introduced into the thoracic cavity through the eighth intercostal space at the posterior axillary line. These techniques provided adequate exposure and sufficient illumination in the thoracic cavity, thus making surgery easy for most thoracic applications. Using this approach, we undertook 28 lung resections with a mediastinal nodal dissection for lung cancer (24 lobectomies, 2 bilobectomies, and 2 pneumonectomies) without difficulty. The mean intrasurgical blood loss was 217ml, the operative time 262min, and chest tube drainage duration 2.3 days. Except for one case, no patients required a blood transfusion. All patients underwent continuous epidural anesthesia until postoperative day (POD) 8. The mean time that other analgesic medication was required was 0.5 times per patient until POD 13, but none from POD 14 on. We thus conclude ILAALT to be low-invasive thoracotomy and is thus indicated for most types of lung cancer surgery, providing a reduction of pain as its main advantage.