MUSC Health thoracic surgeon Chadrick E. Denlinger, M.D. discusses video-assisted thoracoscopic surgery for the treatment of stage 1 nonsmall cell lung cancer (NSCLC). Lobectomy is the preferred treatment with optimal oncological outcomes for most patients with stage 1 NSCLC. Traditionally, lobectomy has been performed with a thoracotomy — in which a large incision is made in the chest and a rib spreader used to gain visual and physical access to the chest cavity. The use of a rib spreader can result in rib fractures, which are very painful and require several weeks to heal, delaying recovery. 

Video-assisted thoracoscopic surgery (VATS) uses an endoscopic camera inserted through a 2-cm “port” to visualize the surgical field and special instruments to perform the lobectomy through one or two additional 5-8-cm ports. Surgeons watch a monitor displaying the endoscopic images to guide them as they perform surgery through the small ports. Because a rib spreader is not required and incision sizes are much smaller, patients experience less pain and can resume normal activities much sooner than after a thoracotomy.

When performed by an appropriately trained surgeon in a high-volume center, VATS achieves oncologic outcomes as good as those obtained with thoracotomy in patients with stage 1 NSCLC, with decreased pain, reduced hospital length of stay, more rapid return to function and fewer complications. VATS is now considered standard of care for patients with stage 1 NSCLC. More than 95 percent of surgical cases for stage 1 NSCLC at MUSC Health are performed with VATS.