[Video-assisted thoracoscopic lobectomy for lung cancer patients with severe incomplete fissures or emphysema; intralobar no-touch access technique (INTACT)].

Abstract Severe air leak after lobectomy is one of well-known complications in lung cancer patients with severe emphysema or incomplete fissure. A developing air leak or persistent air leak in those patients may occur postoperative pneumonia or empyema. For those patients, we have operated with intralobar no-touch access technique (INTACT) assisted with thoracoscopy. INTACT is a surgical procedure of lobectomy without interlobar access, a procedure of prior dissection of lobar bronchus and stapling all the fissure. From January 2004 to December 2005, we performed surgery in 227 patients with primary lung cancer, and 12 patients were performed with lobectmy with INTACT among them. Mean age was 68 +/- 7 years. Distribution of lobectomies was as follows: right upper lobe, 7 patients; right upper lobe and S6 segment, 1; right middle lobe and right lower lobe, 1; left upper lobe, 2; left lower lobe, 1. The length of major skin incision was 5-15 (average 9.2 +/- 3.0) cm. Pathological stage were IA in 3 patients, IB in 7, IIIA in 1 and IIIB in 1. The backgrounds of those patients were severely emphysema in 7 patients, incomplete fissure in 2, both emphysema and incomplete fissure in 2 and emphysema and huge sized tumor in 1. The postoperative air leak stopped 1.8 +/- 0.8 days. For carefully selected patients video-assisted thoracoscopic lobectomy by INTACT for lung cancer patients with emphysema or incomplete fissure could be a safe and valuable procedure.