1. VATS with Chest Wall Resection
Robert J. McKenna M.D.
Chief, Thoracic Surgery
Cedars Sinai Medical Center

2. Disclosures Speaker for Ethicon VATS Lobectomy Courses
Advisory Board for Ethicon
Speaker for Covidien VATS Lobectomy Courses

3. Intercostal Muscle Flap
VATS Chest Wall
Resection ▓
Intercostal Muscle Flap

4. Intercostal Muscle Flap
VATS Chest Wall
Resection
Intercostal Muscle Flap ▓
First mobilize through utility incision
Then with VATS to vertebral body

6. VATS for Pancoast Tumors
VATS Chest Wall
Resection ▓
VATS for Pancoast Tumors

7. Traditional Posterior Approach
In my opinion, this approach probably IS ideal for slightly lower tumors that don’t actually invade the structures behind and above the first rib (the ones that are probably not really appropriately called Pancoasts.
Here’s an example of one of those I did recently with one of our neurosurgeons . She had back and shoulder pain, but not arm pain or the other Pancoast-Tobias syndrome symptoms. She received neoadj chemorads, a negative mediastinoscopy, and then came to surgery
Here, we resected ribs 2-4 including the transverse processes, and actually did a total vertebrectomy with reconstructions at T3.

8. Anterior Approach
So here, we’re on the left side. We did resect the clavicle (which we generally did early on in our experience. You can see . . .
This case required resection and reconstruction of the artery.

9. Pancoast: VATS Hybrid
Resect ribs 1-4
VATS Lobectomy

10. Thanks Herbert Decaluwe

11. tHANKS

12. Complete First Rib Resection:
VATS Chest Wall
Resection
TOS ▓
Complete First Rib Resection:
Entire first rib
Cut by sternum
Disarticulate posteriorly

13. Venous Symptoms Subclavian Vein ▓ VATS First Rib Resection
Costo-clavicular
Ligament
First Rib
Subclavian Vein

14. VATS Chest Wall
Resection
TOS Incisions ▓

15. TOS Instruments 14 “ Dale First Rib Rongeur Cobb 11” Elevator ▓
VATS Chest Wall
Resection
TOS Instruments ▓
14 “ Dale First Rib Rongeur
Cobb 11” Elevator

16. VATS TOS Video
Rib Cutter
Rib

18. Complex Procedures are Possible with VATS
VATS Chest Wall
Resection
Possibilities ▓
Complex Procedures are Possible with VATS