Feasibility of video-assisted thoracoscopic surgery as a redo chest approach for lung resection in patients with a history of surgical procedures on the same side

Background: Thoracic surgeons are increasingly facing situations for which patients are eligible for iterative thoracic surgery. With growing experience in minimally invasive thoracic surgery, the question of the safety and feasibility of minimally invasive redo procedure is rising. Our study aims to report the results of video-assisted thoracoscopic surgery (VATS) as surgical approach for reintervention after a previous ipsilateral intrathoracic surgery.

Methods: This retrospective monocentric observational study required review of medical files of patients undergoing minimally invasive ipsilateral redo surgery between 2018 and 2023. Operative data, morbidity, and mortality were studied.

Results: Thirty-eight patients underwent redo-VATS for pulmonary resection. Of these, 22 (57.9%) were males, with a mean age of 66±12.2 years. Primary procedures included lung cancer resection (n=32, 84%) [lobectomy (n=8, 21.1%), segmentectomy (n=4, 10.5%), wedge resection (n=20, 52.6%)], lung transplantation (n=2, 5.3%), esophagectomy (n=1, 2.6%), thoracic aortic bypass (n=1, 2.6%), empyema (n=1, 2.6%), and chemical pleurodesis (n=1, 2.6%). The median duration between surgeries was 30 (range, 2-99) months. Redo-VATS resection included lobectomy (n=21, 55.3%), segmentectomy (n=3, 7.9%), and wedge resection (n=14, 36.8%). The median operating time was 153 (range, 30-287) min. Intraoperative blood loss was less than 200 mL in 34 (89.5%) cases. The conversion rate was 13.2% secondary to pulmonary artery injuries (n=2) and difficulties in dissection and exposure (n=3). Thirty-day mortality was 0%. Median chest drainage time was 3 (range, 1-37) days, median hospital stay was 5 (range, 3-24) days.

Conclusions: redo-VATS lung tumor resection has been demonstrated as a safe and feasible approach with an acceptable conversion risk and morbidity. These encouraging results should question the indication for a systematic open surgical approach in this situation.