Although the size of the incisions may not affect survival, the authors cite a number of recent studies indicating that the minimally invasive approach does result in reduced postoperative pain, better postoperative pulmonary function, and a higher level of patient quality of life. Still, some surgeons have expressed concern about the risk of blood loss with the VATS procedure, as well as the surgeon's ability to deal with any bleeding that should occur, but studies have actually shown the VATS procedure to result in less blood loss, and according to the Annals article, only seven of the 1,100 cases were converted to an open surgery to control bleeding.

McKenna, whose thoracic surgery group may be the most active in the western United States, suggests that one reason the VATS technique has yet to become the standard of practice is that it can be technically challenging for surgeons who are not accustomed to performing videoscopic procedures and those who do not specialize in chest and lung surgery. A thoracic surgeon since 1982, McKenna is a pioneer in the videoscopic technology and technique. Well known for his research and involvement in National Institutes of Health-funded studies, he has performed and written about VATS procedures since 1992.

"Surgeons who do not have the volume of cases to do pulmonary procedures consistently and regularly will have difficulty developing the skills and routine to do lung surgery this way," he said. "But we are seeing an increase in the number of institutions and surgeons who are adopting this approach, and thoracic surgeons from around the world come here to learn how to do their lung operations this way."

Of the 1,100 patients included in the study, 595 were women, 505 were men. The average age was 71 years, with 160 patients being 80 years of age or older. The mortality rate was less than one percent, fewer than five percent of p
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Contact: Sandy Van
sandy@prpacific.com
800-880-2397
Cedars-Sinai Medical Center
3-Feb-2006