VATS with Chest Wall Resection

Robert J. McKenna M.D.Chief, Thoracic Surgery

Cedars Sinai Medical Center

Disclosures• Speaker for Ethicon VATS

Lobectomy Courses• Advisory Board for Ethicon• Speaker for Covidien VATS

Lobectomy Courses

Intercostal Muscle Flap

VATS Chest WallResection

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Intercostal Muscle Flap

•First mobilize through utility incision

•Then with VATS to vertebral body

VATS Chest WallResection

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•VATS for Pancoast Tumors

VATS Chest WallResection

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Traditional Posterior Approach

Anterior Approach

Pancoast: VATS Hybrid

9

Resect ribs 1-4

VATS Lobectomy

Thanks Herbert Decaluwe

tHANKS

TOS

• Complete First Rib Resection:–Entire first rib–Cut by sternum–Disarticulate posteriorly

VATS Chest WallResection

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Venous Symptoms

VATS First RibResection ▓

Subclavian VeinFirst Rib

Costo-clavicular Ligament

TOS Incisions VATS Chest Wall

Resection▓

TOS Instruments VATS Chest Wall

Resection▓

14 “ Dale First Rib Rongeur

Cobb 11” Elevator

VATS TOS Video

Rib Cutter

Rib

Possibilities

Complex Procedures are Possible with

VATS

VATS Chest WallResection

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