Is posterıor ascendıng artery dıssectıon necessary In rıght upper lobectomy vıa video-assısted thoracoscopıc surgery?

Objective: During lobectomy with Video-Assisted Thoracoscopic Surgery (VATS); vascular dissection is one of the stages that should be performed carefully and meticulously. Especially bleeding during dissection of pulmonary artery branches may cause life-threatening complications. In this study, different techniques developed by two surgeons depending on whether the posterior ascending artery (PAA) was dissected during right upper lobectomy operation; operation, drainage, discharge time and complication rates were investigated. Methods: This study included 180 patients who underwent right upper lobectomy with VATS for non-small cell lung cancer (NSCLC) over a 10-year period. Patients were divided into two groups: Group A (n = 90, patients without PAA dissection) and Group B (n = 90, patients with PAA dissection). Demographic characteristics, tumor histology and stage, operation, drainage and discharge times of the patients were compared. Results: The mean age of all patients was 63.5 (38.0-85.0), tumor size was 2.5 (0.5-8.0) cm, and surgery duration was 235.0 (45.0-420.0) minutes. In terms of operative techniques of two different surgeons, operative time was statistically significantly shorter in patients without PAA dissection (213.9±64.5 minutes) compared to patients with PAA dissection (269.3±61.2 minutes) (p <0.001). In addition, patients in stages 2B and 3A were significantly higher in the group without PAA dissection (p <0.015). Adenocarcinoma cases were significantly higher in patients without PAA dissection (n = 80, 88.9% vs. n = 66, 77.3%; p = 0.019), while squamous carcinomas were significantly higher in the PAA dissection group (n = 22, 24.4% vs. n = 8, 8.9%; p = 0.019). When the complication rates were compared, it was seen that they were lower in the PAA dissection group than in the PAA dissection group and were statistically significant (p = 0.011). When the drainage times were compared, no significant difference was observed between the two groups. Conclusion: This study is the first study to date to compare different surgical approaches to the posterior segment artery in upper lobectomy with VATS. PAA division without dissection with a parenchymal stapler in right upper lobectomies may be a recommended surgical method because it shortens the operation time, reduces the risk of bleeding during dissection, and reduces complication rates.