French-window thoracotomy: postoperative pain avoidance for short-stay lung cancer surgery.
ABSTRACT Although long years have passed since video-assisted thoracic surgery (VATS) lobectomy (VL) appeared as a new approach for resection of lung cancer, its practicality is not clear even today. As the significance of VL has still been under discussion, it has not gained consensus of its superiority to standard lateral thoracotomy. However, we think that returning to the classical posterolateral thoracotomy (PLT) is only a setback, so we developed a new thoracotomy approach that spares the thoracic bony cage by protecting costovertebral and costosternal junctions without spreading the ribs, the same mechanism for avoiding pain as in VL. It was named French-window thoracotomy (FWT). Postoperative pain and length of hospital stay after pulmonary lobectomy were compared between PLT (n = 18) and FWT (n = 13).
An anterolateral skin incision was made along the fifth intercostal space. The operative field was made through double intercostal spaces by cutting two ribs temporally at anterior and posterior points. The bone-muscle flaps were rolled back outside with protection of intercostal neurovascular bundles. The four cut points of the ribs were firmly repaired by the staking technique with stainless steel mesh wire and a stainless steel sleeve after intrathoracic manipulation.
There was a significant difference between PLT and FWT lobectomy (55.6% vs 7.7%, respectively, P = 0.0059) with regard to severe postoperative pain. Patients undergoing a FWT lobectomy had a shorter postoperative stay (6.4 +/- 2.1 vs. 12.3 +/- 3.3 days, P = 0.000003).
The lobectomy patients by FWT complained less of postoperative pain and required a shorter postoperative stay than with patients with the classical rib-spreading thoracotomy. We believe that FWT is an anatomically correct approach for preserving the whole structure of the chest cage.
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ABSTRACT: The aim of this report is to describe technical maneuvers used to complete minimally invasive resections of the chest wall successfully. Case videos of advanced thoracoscopic chest wall resections performed at a comprehensive cancer center were reviewed, as were published reports. These were analyzed for similarities and also categorized to summarize alternative approaches. Limited chest wall resections en bloc with lobectomy can be accomplished with port placement similar to that used for typical thoracoscopic anatomic resections, particularly when the utility incision is close to the region of excision. Generally, chest wall resection precedes lobectomy. Ribs can be transected with Gigli saws, endoscopic shears, or high-speed drills. Division of bone and overlying soft tissue can be planned precisely using thoracoscopic guidance. Isolated primary chest wall masses may require different port position and selective reconstruction using synthetic materials. Patch anchoring can be accomplished by devices that facilitate laparoscopic port site fascial closure. Thoracoscopic chest wall resections have been accomplished safely using tools and maneuvers summarized here. Further outcomes research is necessary to identify the benefits of thoracoscopic chest wall resection over an open approach.The Journal of thoracic and cardiovascular surgery 06/2012; 144(3):S52-7. · 3.41 Impact Factor
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ABSTRACT: Video-assisted thoracic surgery is associated with less pain and shorter recovery than open procedures. Due to limited exposure, video-assisted thoracic surgery is not suitable for the management of all intrathoracic pathology. Muscle-sparing thoracotomies are smaller, but they are not associated with less pain or faster recovery. A modified French window is a useful approach to complex intrathoracic pathology and may result in less postoperative pain and shorter recovery than standard and muscle-sparring thoracotomies. This technique is suitable for the management of complex intrathoracic disease.The Annals of thoracic surgery 09/2009; 88(2):685-7. · 3.45 Impact Factor