Technical tricks to facilitate totally endoscopic major pulmonary resections.

Lobectomies using video-assisted thoracoscopic surgery (VATS) are becoming more and more accepted since several recent studies have demonstrated their safety and efficacy for stage I lung cancer. However, "video-assisted thoracoscopic surgery lobectomy" usually means that a utility incision or a mini-thoracotomy is used for insertion of conventional instruments. We use a totally endoscopic approach in which only endoscopic instruments and video display are used. On the basis of our preliminary experience of 81 cases with this approach, we present some technical details that are important for a successful endoscopic procedure.