| Division of the ribs/bone |
Thoracoscopic bone shears (Sofamor-DanekTM) exist to facilitate rib division. Standard bone cutting tools can be used for division near utility incision |
| Chest wall soft tissues |
Standard thoracoscopic cutting energy devices allow for division of muscle and the neurovascular bundle |
| Location of tumor invasion related to standard VATS incisions |
Utility port location may need to be altered in some cases. Moving it towards the anterior thorax may aid in dissection as well as extraction of the specimen (due to the wider intercostal space) |
| Pancoast Tumors/Spine Invasion |
Combined approach with surgical spine team utilizing posterior spine approach, followed by VATS approach to lung resection is feasible |
| Extraction of the specimen |
Sturdy 8 by 10 in Nylon extraction sac. Orientation of the rib block perpendicular to the extraction site while delivering the ribs through the port first. An alternative site for extraction may be necessary |
