Table Of ContentTechniques in
Minimally Invasive
Thoracic Surgery
Kwhanmien Kim
Seokjin Haam
Hyun Koo Kim
Editors
123
Techniques in Minimally Invasive
Thoracic Surgery
Kwhanmien Kim • Seokjin Haam
Hyun Koo Kim
Editors
Techniques in Minimally
Invasive Thoracic
Surgery
Editors
Kwhanmien Kim Seokjin Haam
Department of Thoracic and Department of Thoracic and
Cardiovascular Surgery Cardiovascular Surgery
Seoul National University Ajou University Hospital
Bundang Hospital Suwon, Republic of Korea
Seongnam, Republic of Korea
Hyun Koo Kim
Department of Thoracic and
Cardiovascular Surgery
Korea University Guro Hospital
Seoul, Republic of Korea
ISBN 978-981-19-2471-2 ISBN 978-981-19-2472-9 (eBook)
https://doi.org/10.1007/978-981-19-2472-9
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
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Preface
In Korea, video-assisted thoracic surgery (VATS) was first used to treat pneu-
mothorax in 1992. Thereafter, VATS lobectomy was introduced in Korea in a
patient with benign lung disease in 1993. The first anatomical VATS lobec-
tomy with complete mediastinal lymph node dissection was performed on a
lung cancer patient in 2003 by Kwhanmien Kim, one of the editors of this
book. Since then, VATS has rapidly replaced open thoracotomies and has
become the dominant procedure in Korea through the well-designed training
program formulated by the Korean Association of Thoracic Surgical Oncology
(KATSO). Furthermore, robot-assisted thoracic surgery (RATS) has emerged
as an alternative procedure for treating esophageal cancer, mediastinal tumor,
and lung cancer. The surgical techniques developed by Korean thoracic sur-
geons have spread globally and received recognition owing to the enthusiasm
of some pioneers and well-established training programs.
Techniques in Minimally Invasive Thoracic Surgery is not intended to be a
textbook of thoracic surgery. Instead, this book is designed to provide readers
with a wide range of sound techniques and efficient measures that have
proved safe and effective in our experience. Techniques in Minimally Invasive
Thoracic Surgery comprises the three most popular thoracic surgery sections:
pulmonary resections, esophagectomy and thymectomy by VATS or RATS
and the management of postoperative complications, and nonintubated tho-
racic surgery. The editors and contributors have ably met their goal of inform-
ing the reader about accurate surgical principles needed to treat thoracic
diseases.
We would like to gratefully acknowledge the favor of authors who are
members of KATSO. Without their dedication and sponsorship from KATSO,
this book could not have been compiled. We hope that Techniques in
Minimally Invasive Thoracic Surgery will help readers consolidate their
understanding of surgical procedures and promote their technical standards to
a higher level.
Seongnam, Republic of Korea Kwhanmien Kim
Suwon, Republic of Korea Seokjin Haam
Seoul, Republic of Korea Hyun Koo Kim
v
Contents
Part I Lung
1 Establishment of a Minimally Invasive
Thoracic Surgery Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Jong Ho Cho
2 Video-Assisted Thoracic Surgery Wedge Resection for
Primary Spontaneous Pneumothorax . . . . . . . . . . . . . . . . . . . . . . 9
Duk Hwan Moon, Bong Jun Kim, Wongi Woo,
and Sungsoo Lee
3 Surgical Planning and the Division of the Intersegmental
Plane During Thoracoscopic Segmentectomy . . . . . . . . . . . . . . . 13
Ha Eun Kim, Young Ho Yang, and Chang Young Lee
4 Video-Assisted Thoracic Surgery Lobectomy . . . . . . . . . . . . . . . 23
Hong Kwan Kim
5 Video-Assisted Thoracic Surgery Bronchial
Sleeve Lobectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Hyeong Ryul Kim
6 Video-Assisted Thoracic Surgery for Pneumonectomy . . . . . . . . 37
Seokjin Haam
7 Video-Assisted Thoracic Surgery Mediastinal Lymph Node
Dissection in Lung Cancer Surgery . . . . . . . . . . . . . . . . . . . . . . . . 43
Kwhanmien Kim
8 Prevention and Management of Complications
During Video- Assisted Thoracic Surgery
Lung Resection and Lymph Node Dissection . . . . . . . . . . . . . . . . 49
Yong Soo Choi
9 Robot-Assisted Thoracic Surgery in Non-Small
Cell Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Jun Hee Lee, Kook Nam Han, and Hyun Koo Kim
vii
viii Contents
Part II Esophagus
10 Thoracoscopic Esophagectomy for Esophageal
Cancer: Detailed Procedures and Review. . . . . . . . . . . . . . . . . . . 75
Seong Yong Park
11 Video-Assisted Thoracoscopic Surgery Intrathoracic
Anastomosis Technique ─ The Extracorporeal
Anastomosis Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Yong Won Seong
12 Robot-Assisted Thoracoscopic Esophagectomy
with Total Mediastinal Lymphadenectomy:
A Guide to a Systematic Approach Using the
Concept of Fascial Plane Dissection . . . . . . . . . . . . . . . . . . . . . . . 95
Byung Jo Park and Dae Joon Kim
13 Totally Robotic Esophagectomy . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Chang Hyun Kang
14 Management of Anastomotic Leakage . . . . . . . . . . . . . . . . . . . . . 115
Jae Hyun Jeon
Part III Others
15 Video-Assisted Thoracoscopic Surgery
Thymectomy: Transpleural Approach . . . . . . . . . . . . . . . . . . . . . 125
In Kyu Park
16 Video-Assisted Thoracic Surgery
Thymectomy: Subxiphoid Approach . . . . . . . . . . . . . . . . . . . . . . . 131
Sukki Cho
17 Robot-Assisted Thoracic Surgery Thymectomy . . . . . . . . . . . . . . 137
Samina Park
18 Non-Conservative Management of Chylothorax . . . . . . . . . . . . . 145
Hyo Yeong Ahn and Hoseok I
19 Non-Intubated Video-Assisted Thoracic Surgery . . . . . . . . . . . . 153
Kyung Soo Kim and Won Jung Hwang
Part I
Lung
1
Establishment of a Minimally
Invasive Thoracic Surgery Program
Jong Ho Cho
Abstract 1.1 I ntroduction
The establishment of minimally invasive sur-
In recent years, there has been a shift towards
gery is a complex and difficult task. Video-
video-assisted thoracic surgery (VATS) in the
assisted thoracic surgery (VATS) refers to a
field of thoracic surgery. VATS refers to surgery
minimally invasive surgical technique that
to remove lung cancer, esophageal cancer, or
represents a less invasive approach to thoracic
mediastinal tumors without rib cutting or ster-
surgery using thoracoscopy. For lung cancer
notomy, as was done in the past. In general, mini-
or esophageal cancer surgery, planning and
mally invasive surgery is associated with less
establishing a team for minimally invasive
pain, shorter hospital stays, and fewer complica-
surgery for the first time is not a simple task.
tions [1]. It also has allowed surgeons to perform
Technical advances in surgical devices and the
new, complex, and conventional procedures with-
enhanced skill of surgeons are cornerstones of
out the major risks associated with a large open
the development of minimally invasive sur-
incision.
gery. Here, we review the meaning of mini-
VATS is just one of the first types of mini-
mally invasive thoracic surgery and discuss
mally invasive surgery. One subtype of minimally
how to establish a team approach for VATS
invasive surgery is robotic surgery, which offers
procedures.
surgeons a magnified, three-dimensional view of
the surgical site with better flexibility and con-
Keywords
trol. We can use these advanced robotic surgical
Video-assisted thoracic surgery · Minimally techniques to achieve excellent surgical out-
invasive surgery · Surgery comes and safety in most cases of thoracic
surgery.
The technical and oncological safety of thora-
coscopic surgery for early-stage lung cancer is
considered acceptable worldwide [2, 3]. It has
recently been reported that the majority of tho-
racic surgical procedures can be performed with
J. H. Cho (*) minimal invasive surgery due to advances in the
Department of Thoracic and Cardiovascular Surgery, development of surgical techniques, even in com-
Samsung Medical Center, Sungkyunkwan University plex cases of patients with lung cancer [4].
School of Medicine, Seoul, Republic of Korea
However, even with minimally invasive surgery,
e-mail: [email protected]
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 3
K. Kim et al. (eds.), Techniques in Minimally Invasive Thoracic Surgery,
https://doi.org/10.1007/978-981-19-2472-9_1
4 J. H. Cho
there are risks of complications involving anes- Creating a Learning Team
thesia, major bleeding, and infection [5]. The surgeon as a team leader should follow the
Therefore, it is important to prepare for serious up-to-date knowledge in secondary medical text-
complications, such as massive bleeding from the books, quickly acquire new medical skills, share
pulmonary artery during VATS, with a backup them with fellow doctors, and build a system
plan always in mind [6]. while maintaining the 4 components of team
works [7]. The new paradigm of health care
focuses increasingly on interdisciplinary teams
1.2 H ow to Set Up an Excellent as its core unit. The increasing complexity of the
Surgical Team for Minimally surgical environment has changed the delivery of
Invasive Surgery surgical care and has increasingly led to the for-
mation of multidisciplinary provider teams
Team Approach replacing the more traditional individualistic sur-
geon–assistant–nurse relationship. The chal-
It is unusual for patients to receive more attention lenges are considerable, even if we are already
from the medical team than during surgery. faced with tight competition, especially in the
Patients are prepared by 1 surgeon, 1 or 2 assis- 80-h working-week environment of surgical resi-
tants, anesthesiologists, and nursing staff. Each dent programs. It may be a good strategy for sur-
member of the surgical team has his or her own gical educators to collaborate with other
function, but the surgical team is like playing a colleagues who have conducted training for a
symphony, so each team member must collabo- certain period.
rate with his or her colleagues to achieve good
results. The patient’s life is in the hands of the Framing the Challenge
operating team, so there can be no such thing as Properly framing the challenge is critical to our
properness for its own sake in the operating success in the field of surgery. A frame challenge
room. To bring the best results for the patient, is where someone answers a question in a wholly
everyone must work quickly and effectively, different way that the asker never expected, but in
often in desperate situations. They need to be a way that he or she feels will solve the problem.
familiar with surgical procedures, how to operate The difficulty of introducing new surgical proce-
machines (e.g., surgical robot systems), instru- dures places more stress on team members than
ments, and surgical items, understand each other, usual for minimally invasive surgery. Surgeons
trust each other, cooperate, and be considerate. A must help their team embrace and internalize the
person who does not devote his or her whole legitimacy of this important new challenge
heart to working as a good member of the team, regarding new surgical techniques. Even so,
and who instead tries to work at his own level, identifying the right challenge for innovation is
creates dissonance in teamwork, making it diffi- particularly crucial for the surgical team.
cult to work together in the operating room.
A surgical team includes an array of special- Creating an Environment
ists who need to work in close cooperation for the of Psychological Safety That Fosters
operation to succeed. A single error, miscommu- Communication and Innovation
nication, or slow response can have disastrous It is important to have an environment where the
consequences. To develop the best surgical team, leader’s innovation and creativity are properly
we have to be the best possible leader. An excel- accepted, and team members can exchange feed-
lent article on the approach to building a surgical back with each other. A belief that one will not be
team approach was published in the Harvard punished or humiliated for speaking up with
Business Review [7]. They presented several fac- ideas, questions, or mistakes is important for both
tors for the development of a successful team, as a leader and team members. This relates to assis-
described below. tants feeling empowered to express an idea or
