A different approach in thoracic surgery: Guillotine lobectomy

Background: In this study, we aimed to compare the surgical results of video-assisted thoracoscopic lobectomy with the guillotine technique to the results of conventional video-assisted thoracoscopic lobectomy. Methods: Between January 2013 and December 2019, a total of 49 patients (20 males, 29 females; median age: 45 years; range, 11 to 73 years) who underwent video-assisted thoracoscopic lobectomy for benign lung pathologies were retrospectively analyzed. The patients were divided into two groups: the guillotine technique group (n=31) who had simultaneous cutting of the lobar artery and lobar bronchus with a single stapler, and the control group (n=18) who received conventional video-assisted thoracoscopic lobectomy. Demographic features of the patients, type of surgery, type of pulmonary resection, duration of the operation, postoperative length of hospital stay, postoperative pathological examination result, complications, and follow-up data were recorded. Results: The median operation time was 142.5 (range, 60 to 237) min and 90 (range, 55 to 180) min in the control and the guillotine technique groups, respectively, indicating a statistically significant difference (p<0.05). Bronchiectasis was the most common histopathological diagnosis in both groups. No intraoperative complication, long-term complications or mortality were observed in any of the patients. Conclusion: The guillotine lobectomy technique significantly reduces the duration of the operation. The adventitia and connective tissue around the lobar artery and lobar bronchus enable the closure of these structures with the supporting tissue and, therefore, reinforces the staples. The guillotine technique in video-assisted thoracoscopic lobectomy seems to be a cost-effective, reliable, and practical method that provides intraoperative convenience and shortens the operation time.