Clinical research on the incision line selection of video-assisted thoracoscopic wedge resection of the lung

Objective: To compare the clinical efficacy of video-assisted thoracoscopic direct lung wedge resection (banana peel method) with that of the opposite resection line (traditional method). Methods: Review and analysis of 83 cases of video-assisted thoracoscopic wedge resections of lung operations from February 2007 to September 2011. All of the patients were divided into two groups, as follows: Group A: wedge resection of the lung by the opposite resection line (traditional method), 41 cases; Group B: direct lung wedge resection (banana peel method), 42 cases. Both of the groups received video-assisted thoracic surgery. The postoperative follow-up period was 1-6 months, with an average of 3.6 months. The operating conditions (including operation time, transoperative bleeding volume, number of transoperative sutures added, postoperative time to extubation, surgery cost, number of suturing instruments used for incising with the endoscope and the cost of hospitalisation), atelectasis conditions 1 month after the operation and the decreasing lung function conditions were compared between groups. Results: Group B's operative time was (62 +/- 10) min, significantly less than Group A's (81 +/- 16) min (P < 0.05). The amount of bleeding in Group B was (52 +/- 17) ml, which was also significantly less than that of Group A, at (74 +/- 21) ml (P < 0.05). Compared to Group A, Group B had significantly (P < 0.05) fewer manual sutures and shorter postoperative extubation times. The cost of surgery and number of endoscopic staplers used during the operation in Group B were significantly larger than in Group A; however, the total hospital costs did not differ between the two groups (P > 0.05). Neither group had any cases of atelectasis based on chest X-ray films taken 1 month after the operation, and no difference was found in the groups' decreased lung functions. Conclusions: The video-assisted thoracoscopic direct lung wedge resection (banana peel method) can shorten the operative time, lessen the surgical trauma, reduce the number of additional manual sutures required, and make for an overall more convenient operation, compared to wedge resection of lung by opposite resection line (traditional method). Although operation costs have increased, the total hospital costs have not. Thus, the better choice for video-assisted thoracoscopic lung wedge resections involves the use of direct lung wedge resection. (C) 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.