Efficacy of complete video-assisted thoracoscopic surgery lobectomy using the three-dimensional endoscopic system for lung cancer

Objective We aimed to investigate the efficacy of complete video-assisted thoracoscopic surgery (cVATS) lobectomy using the three-dimensional (3D) endoscopic system in patients with lung cancer and compare it with that of cVATS lobectomy using the conventional two-dimensional (2D) endoscopic system in former consecutive cases. Methods We retrospectively analyzed the prospectively collected database of patients with clinical stage I lung cancer who underwent cVATS lobectomy using the 3D endoscopic system; the patients who underwent surgery using the 2D endoscopic system were considered the historical control group. The operative and perioperative data were compared, and propensity-score matched comparisons were used to assess the potential impact of selection bias. Results We performed 189 cVATS lobectomies. Of these, 105 were performed using the 3D endoscopic system, while 84 were performed using the 2D endoscopic system. After matching, there was no significant difference in the preoperative factors between the two groups. The operation time was significantly shortened (P = 0.003), and the intraoperative blood loss was significantly reduced in the 3D group (P < 0.001). In particular, there was only one case of intraoperative hemorrhage of 201 mL or more in the 3D group, compared to 12 cases in the 2D group (P < 0.001). After matching, the intraoperative blood loss and operation time were significantly reduced in the 3D group. Conclusions Our results showed that the 3D endoscopic system for cVATS lobectomy may be a useful surgical tool and switching to it from the 2D endoscopic system can be performed safely.