Lung cancer is associated with the highest mortality among all cancers in humans and is the 2nd most common malignancy in both leaves, after prostate cancer in men and breast cancer in women.

Surgical treatment of lung cancer

Surgical treatment of lung cancer includes operations such as lobectomy (removal of a lobe, i.e. half of the lung) and pneumonectomy (removal of the entire lung). Both of these operations are always accompanied by a lymphadenectomy, i.e. removal of the lymph nodes that are the local defense-holding stations for cancer cells in the area. Surgical treatment is applied either alone as monotherapy, or in the context of multifactorial treatment, where oncologists administer perioperative or drugs such as:

• Chemotherapy (Chemotherapy)
• Immunotherapy (ANTH)
• Targeted therapy (TTP)
• either Radiation Therapy (RT)

The modern treatment of lung cancer requires the individualized treatment of the patient by an Oncology Board, which consists of a Pulmonologist, the doctor who initially assessed the patient and diagnosed the disease by assessing its stage, the Thoracic Surgeon, who will judge the case is operable (if the tumor is technically removed and if the patient tolerates the resection operation) and the Oncologist, who will say if it is necessary to give drugs (HMTH), (ANTH), (STH) alongside the surgical treatment, or (ACS) before and after surgery to improve the overall survival that would result if the patient had surgery alone.

All the aforementioned operations are performed under general anesthesia with selective lung ventilation. Specifically, the anesthesiologist ventilates the non-operated lung so that it remains deflated and deflated, allowing the surgeon to complete the operation faster and safer.

VATS Thoracoscopic Surgery

VATS Thoracoscopic Surgery (Video Assisted Thoracic Surgery) is one of the most modern techniques used internationally for the diagnosis and treatment of diseases of the chest and lungs.

These techniques are operations with little burden for the patients, avoiding the classic large thoracotomy, and offer a better aesthetic result in the postoperative scars, faster recovery and immediate return of the patients to their daily activities. For their implementation, special technological equipment is required, as well as special training and similar experience of the medical team.

A basic tool of VATS, is the thoracoscope, which is a thin cylindrical metal tube with lens systems and a camera on its back, which enters the chest cavity through a port and renders the image of the chest organs on the television screen. In this way, the surgeon indirectly sees, for example, the lung without having it in front of him in an open field and by inserting his tools through other windows (or one in the case of uniportal Vats) he performs the necessary operations.

It is worth noting that it is not possible to perform techniques with VATS in all thoracic surgeries, e.g. tumors over 4cm or centrally located must be removed open for safety reasons, while in any case of problem with VATS, the surgeon must convert the method to open, so as to ensure both time and, above all, safety for the patient. The most sophisticated and technically difficult form of video thoracoscopy is the VATS lobectomy for lung cancers, which is applied for small to moderate-sized tumors in the initial stages of the disease.

In general, VATS operations have been widely applied in our country since 2000, while the latest development in thoracoscopic surgery is robotic techniques or RATS (Robotic Assisted Thoracic Surgery), as they are commonly called, with the operation being performed through four ports, not insertion of instruments by the surgeon as in VATS, but with the insertion of instrumented arms of the ROBOT, the movements of which the surgeon controls from console controls located outside the field and at a distance from the patient.

A recent development of RATS is the UNIRATS (Uniportal Robotic Assisted Thoracic Surgery) technique, in which the operation is performed through a single enlarged port, as in uniportal Vats. With the robotic system, absolute precision of surgical manipulations is ensured, which makes it superior to Vats and open techniques.

Mr. Evangelos Sepsas has been performing operations with the VATS technique in Greece since 1994.