Microlobectomy—where do we stand?
Video-assisted thoracoscopic surgery (VATS) have been shown to be superior to open procedures, particularly with regards to pain and post-operative recovery, though high-levels of pain may still be reported due to large intercostal port sizes. Microlobectomy is a novel endoscopic lobectomy technique building on VATS lobectomies, with the principle that there are no intercostal ports larger than 5 mm. CO2 insufflation is used to improve access to the chest and a 12 mm subxiphoid port is created to function as a utility port and can be extended further to facilitate specimen removal. All instruments utilized are 5 mm in size, including a 5 mm camera. However, a standard 12 mm stapler can be used through the subxiphoid incision, which provides excellent access to all the hilar structures bilaterally. Additionally, newer instruments are being developed to facilitate easier improved dissection of vascular structures and lymph nodes, such as the FlexDex needle holder, which is an articulated endoscopic needle holder facilitating movements in all directions, similar to a robotic instrument. The main advantage of a microlobectomy is reduced post-operative pain and shorter time to mobilisation, enabling a faster recovery. In our experience of microlobectomies, we have had patients successfully discharged on the first post-operative day. The development of a greater variety of 5 mm instruments that are similar to conventional VATS instruments may enable more surgeons globally to adopt the microlobectomy approach.