Video-assisted thoracoscopic pneumonectomy: the Edinburgh posterior approach.

Twenty years of experience in Video-assisted thoracoscopic lung surgery (VATS), have led to the development of innovative techniques to rival open thoracotomy for major lung resections (1,2). Acceptability of the technique relates to benefits including; reduced length of hospital stay, decreased blood loss, decreased pain, improved cosmesis, earlier return to normal activities and improved tolerance of chemotherapy (3-6). Whilst the technique was initially limited to pulmonary lobectomy, centers are now routinely performing VATS pneumonectomy. Whilst it remains unclear as to whether the technique affects survival, VATS pneumonectomy provides a safe alternative to open resection, which confers many of the benefits outlined above (7,8). An additional plus, is that patients are not subject to postoperative air leaks, which are one of the major complications of VATS lobectomy, often resulting in prolonged hospital stays and increased morbidity and mortality (9,10). The technique of VATS pneumonectomy described here is that which is currently employed in the unit of cardiothoracic surgery at the Royal Infirmary of Edinburgh.