A new approach for video-assisted thoracoscopic lobectomy "the caudal position"

Background: Despite a general agreement about effectiveness of video-assisted thoracic surgery (VATS) lobectomy the surgical technique is still not standardized, and many technical variations have been described until now. We describe our technique to perform thoracoscopic lobectomy by a caudal approach. Methods: We studied a position in which the operator stays from the inferior side of the thorax, positioning the patients in a lateral sitting position. This position ensures the operator to enjoy all the benefits of the anterior and posterior approach limiting the disadvantages of both. The surgeon maneuvers are further assisted and simplified by the movement of the surgical bed. Results: We perform 23 "caudal video assisted-lobectomy" for non-small cell lung cancer. The conversion rate was 0% and we had no complications related with the new approach. Conclusions: We think that our new position could be considered a further effective technical variation to perform VATS-lobectomy.