Video assisted thoracic surgery with chest wall resection

Chest wall resection is indicated in the management of operable primary chest wall tumors and lung cancers with chest wall invasion. Traditionally, chest wall resection is performed via thoracotomy and is associated with significant postoperative pain and other morbidities. Depending on the size and location of the resulting chest wall defect, chest wall reconstruction is often also required to maintain thoracic structure, preserve respiratory mechanics, and protect the underlying intrathoracic structures. As an alternative to open chest wall resection, video assisted thoracic surgery (VATS) techniques have been proposed for chest wall resection in order to limit overall incision size, avoid rib spreading, and reduce tissue trauma. As a result, VATS chest wall resection may improve postoperative pain and offer better preservation of respiratory mechanics and chest wall structure. Although VATS based chest wall resection has not been widely adopted at present, early reports have demonstrated its feasibility without apparent detriment to safety in selected patient populations. Efforts to refine minimally invasive techniques for chest wall resection are likely to continue with growing surgeon experience and improving technology, although further study is needed to conclusively demonstrate the benefit of these procedures.