Video-Assisted Thoracic Surgery After Median Sternotomy for Cardiac Surgery

: Video-assisted thoracic surgery (VATS) lobectomy has become a standard approach for early stage 1 lung cancer. However, concerns still remain regarding certain clinical situations, such as potential damage to the heart or bypass grafts when VATS is performed after median sternotomy for cardiac surgery. In this article, techniques are described to minimize risk to an internal mammary artery graft during a VATS anatomic pulmonary resection in this group of patients. The article reviews data on VATS after median sternotomy for cardiac surgery and describes techniques to prevent, treat, and mitigate problems in this group of patients. Management of intraoperative crises is also discussed.