VATS can be used for a variety of thoracic procedures. Here the author demonstrates the technique for first rib resection. The procedure starts with three 5mm ports, with the inferior port converted at the end for rib extraction. A single lumen endotracheal tube is used with CO2 insufflation to create intrathoracic space. An angled 5 mm camera is used to see both underneath and over the first rib.
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I published this technique many years ago. The idea came to me while performing VATS procedures, as the first rib is well visualized. On the very first case I asked a neurosurgeon to assist us, as neurosurgeons are very familiar with small drills. After that I switched to an endoscopic rib cutter, which works great. The other techniques I was taught to use for first rib resection lacked good visualization of the structures involved. I was looking for something better. The VATS technique of first rib resection is a beautiful dissection where all is seen. The results are far superior compared to the transaxillary approach. Years later after the first cases, Rob McKenna asked me to prepare a VATS first rib resection chapter for his VATS book, which I completed. If you perform the first rib resection procedure-do it by VATS-you will then only do VATS!
Randall Wolf MD
University of Texas
Texas Medical Center
Houston, Texas
An excellent technique Dr. Marshall. Having performed VATS lobectomies/ segmentectomies and sympathectomies for many years there is no better visualisation of the first rib and neurovssculsr structures than by VAT. I have just one question. Why did you elect to use a single lumen ETT? Regards.
Thank you for your comments.
In our institution, a single lumen can be easily placed by any anesthesiologist but a double lumen requires additional expertise. Routine use of a single lumen tube in cases such as these, allows us to save time in patient preparation and induces less trauma to the patient’s airway.