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J.S. Shin



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    P2.24 - Poster Session 2 - Supportive Care (ID 157)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P2.24-060 - VATS lobectomy using subcostal incision in NSCLC (ID 3490)

      09:30 - 09:30  |  Author(s): J.S. Shin

      • Abstract

      Background
      VATS lobectomy for Non-small cell lung cancer usually can be performed using one working window, and two or more ports for endoscopic instruments. The working window are made on the intercostal space space. However, these narrow Intercostal space could be the obstacle for the extraction of congested or huge resected lung lobe. So, we performed VATS lobectomy using 3 interocostal ports and the 3 cm subcostal incision.

      Methods
      Since March 2012, In Korea University Ansan Hospital, 20 VATS lobectomies was done for lung cancer. Of 20, we performed 4 cases of subcostal incision VATS lobectomy. At first, we performed entire procedure through the intercostal ports (10mm). After resection of lung, the subcostal incision (3cm ) was made anterior to the 10th rib. Because the 11th costal cartilage is abscent, there is no limitation during spreading the 10th intercostal space for the extraction of resected lung (Fig 1). And then, we dissect mediastinal lymph nodes systemically. During the subcostal incision, rectus muscle is resected partially. And the chest cavity was entered through the costophrenic junction. So,at the end the repair of diaphragm is needed. The chest tube can be placed properly through one of the intercostal ports.

      Results
      The characteristics of patients is summerized in Table 1.Of 4 cases of subcostal incision lobectomy, one case should be conversed to the anterior thoracotomy.That case was 6.5cm sized right middel lobe tumor.In the third case, we used two intercostal ports and one subcostal incision. In the question of post operative intercostal pain at operation day, patients did not complain severe pain (more than VAS score 5). However, we did not compare the pain score after this operation with conventional VATS lobectomy.

      Talble 1.The patient's characteristics
      Case No. G/A Lobe Tumor size LND pTNM 3 ports subcostal
      1 M/67 LLL 3.5cm 30 T2aN0M0 5th/6th/7th 3cm
      2 M/62 LUL 3.5cm 16 T2aN0M0 4th/6th/6th 3cm
      3 F/69 RUL 1.8cm 47 T1aN1M0 5th/6th 3cm
      4 F/43 RML 6.5cm 29 T2bN2M0 5th/6th/6th 1cm
      Figure 1 Fig 1. Three intercostal ports (10mm) and one Subcostal incision (3cm)

      Conclusion
      The subcostal incision for extraction of lung specimen was useful in VATS lobectomy.