How minimal could a minimally invasive surgery be?

Two weeks ago,  a lady with a peripheral  lung nodule located at right lower lobe came to me. The maximum diameter of the nodule was about 2cm. CT scan showed that the lesion was well defined and with no spicule or lobular. The lady was just 32 years old and with no smoking history. Obviously the lesion was benign. The patient was very demanding and she cared about the incision. After careful evaluation, video assistied thoracoscopic surgery(VATS) was conduted for the patient. Two 1.0-cm skin incisions were made for the surgery. The histology was solitary fiberous tumor. The patient was discharged on the 2nd post-operative day.上海交通大学医学院附属瑞金医院胸外科李鹤成

I conducted minimally invasive surgery for lung and esophgeal disease 5 years ago. VATS has been maturely conduted for thoracic tumors. The problem now is how minimal  a mininally invasive surgery could be? For the case I mentioned above, regularly three incisions would be necessary. Since the lady was demanding and the lesion was benign, I made two small incisions.  The cosmetic result was excellent and the patient was very satisfied with the procedure. Surely for malignant disease, two small 1-cm incisions were not enough for VATS procedure. But now, we have made the operation more minimal than before. Two 1-cm incisions together wih 1 sample-take out incision will be required for lobectomy. The sample-take out incision is usually about 3cm and longer for bigger tumor. Not all patients is applicable for minimally invasive surgery. Currently the common indication for minimally invasive surgery should be early malignant disease. It is quite controversial to conduct VATS for T2-T3 lung cancer patients. To perform minimally invasive surgery for the treatment of cancer, you must make sure the procedure itself should be the same as an open surgery in terms of radical cure. Minimally invasive surgery could also be conducted for bengin disease or for the biopsy of advanced disease. Based on appropriate selection of patients, the same survival result as open surgery could be achieved by minimally invasive surgery. One of the advantages for minimally invasive surgery is quickly recovering of the patients. Also there are some other advantages for minimally invasive surgery such as good cost-effective result.

To sum up, minimally invasive surgery is a mature procedure here in our department. It should be widely conducted for appropriate patients.