[Video assisted lung resection and mediastinal lymph nodes dissection for lung cancer: small incisions for 4th intercostal space].

We established a thoracotomy method in which visual observation and a thoracoscope are used in combination. This method requires only small dermal incision--a three-cm-long posterior and two-cm-long anterior incision--in the fourth intercostal space around the angulus inferior scapulae. Using this method, we performed lobectomy and mediastinal lymph node dissection on 20 lung cancer cases (preoperatively diagnosed as stage I, T1N0M0 cases). Because the conventional thoracoscopic surgery relies strictly on two-dimensional images obtained from a thoracoscope, stereoscopic information on the location of the operation could not be obtained. Our new method, however, in corporates both a direct view obtained from two small incisions and a view on a video monitor, so the surgeon has constant access to a stereoscopic information on the location of the operation. We found that this thoracotomy using a thoracoscope was not only very useful in terms of respiratory function, the alleviation of pain, and aesthetic appearance, but that it also reduced hemorrhaging during surgery, decreased the length of time required for the thoracotomy and suturing, and enabled mediastinal dissection equal to that of standard thoracotomy.