Abstract
The resection of chest wall tumors, including superior sulcus tumors, has traditionally been performed via an open approach given the extent of structures to be removed. Recently, more advanced experience with minimally invasive techniques (both VATS and robotic) have allowed thoracic surgeons to perform these operations through smaller incisions and avoid the trauma to the overlying major muscles of the chest wall. One of the earliest reports of VATS-assisted chest wall resection by Widmann et al. described performance of wedge resection of lung with VATS followed by en bloc removal of ribs 3 and 4 along with the wedge of lung, which was accomplished without the use of rib spreading [1]. More recently, Hennon et al. reported a series of 17 patients who underwent VATS chest wall resection, which comprised 36 % of overall chest wall resections done at their institution from 2007 to 2013 [2]. The utilization of minimally invasive techniques for chest wall resection has become a more common phenomenon, as surgeons explore the ways in which it may benefit patients in terms of postoperative pain and morbidity. The phrase “minimally invasive chest wall resection” (MICWR) is a bit misleading, as any chest wall resection by definition requires the resection of the same amount of bone and intercostal muscle as in an “open” operation; however the method by which this is accomplished can take advantage of some of the same tools and techniques by which VATS surgery is performed, and hence we will use the term since it reduces the morbidity of cutting muscle.