Unidirectional Thoracoscopic Lobectomy

The team led by Professor Lunxu Liu from the Department of Thoracic Surgery at Huaxi Hospital has been established.

Lobectomy is the primary surgical procedure for treating lung diseases such as lung cancer, bronchiectasis, and pulmonary tuberculosis. Among these conditions, lung cancer remains the malignancy with the highest incidence and mortality rates—each year in China, approximately 300,000 new lung cancer patients require surgery. Traditionally, this procedure involved a large incision through the chest wall. However, in the early 1990s, video-assisted thoracoscopic surgery (VATS) for lobectomy emerged as a less invasive alternative. Unfortunately, early VATS techniques were still immature and carried significant risks, often leaving surgeons unable to manage critical complications like unexpected massive bleeding during the procedure. As a result, minimally invasive lung cancer resection via VATS could not be widely adopted for many years. Professor Lunxu Liu from the Department of Thoracic Surgery at West China Hospital of Sichuan University has tackled these challenges head-on. After more than a decade of intensive research, he developed a groundbreaking one-way VATS lobectomy technique along with a suite of innovative key technologies. Thanks to this advancement, minimally invasive VATS lobectomy has now become a standard procedure, successfully implemented across 32 provinces, municipalities, and autonomous regions throughout China.

1. Pioneering the "unidirectional video-assisted thoracoscopic lobectomy" surgical system, this innovation has provided crucial supporting technology that has facilitated the widespread adoption of minimally invasive lung cancer surgery in China. Key advancements include the "vertical-parallel" incision design concept, the "suction-electrocoagulation bloodless dissection technique," a novel unidirectional approach for lung resection, and an innovative method for en bloc mediastinal lymph node dissection without tissue grasping. These breakthroughs have streamlined and standardized VATS lung cancer procedures, resulting in a 35% reduction in surgical time compared to international counterparts, a 66% decrease in intraoperative blood loss, and a 68% drop in the need for conversion to open thoracotomy. As a result, the 5-year survival rate for stage I lung cancer patients has improved significantly—from the internationally reported 73.5% to 83.8%.

2. Pioneered a comprehensive technique for managing massive bleeding during thoracoscopy—the "Thoracoscopic Suction-and-Lateral Compression Hemostasis Method"—overcoming the global challenge of treating severe vascular injuries that are notoriously difficult to manage under thoracoscopy. This breakthrough has achieved an 88.2% success rate in achieving intraoperative hemostasis via thoracoscopy, significantly enhancing surgical safety. International peers have praised the technique, calling it "excellent."

3. Established a comprehensive group of advanced thoracoscopic lung surgery techniques, expanding the indications for minimally invasive procedures. We developed integrated strategies such as "pre-blocking" of the pulmonary artery, "pre-cutting" of the bronchus, and simultaneous "co-cutting" of the bronchus and pulmonary artery. Additionally, we performed the world’s first complex central-type lung cancer resection using a thoracoscopic bronchopulmonary double-pneumonectomy sleeve technique, breaking through previously insurmountable barriers in thoracic endoscopy surgery.

The introduction of the single-port video-assisted thoracoscopic lobectomy is considered "a milestone marking the maturity of video-assisted thoracoscopic lung cancer resection in China," and it has been incorporated into the national university textbook *Surgery*. The technique has also earned prestigious accolades, including the First-Class Sichuan Provincial Science and Technology Progress Award in 2011 and the First-Class Chinese Medical Science and Technology Award in 2013. By 2015, 93.1% of hospitals in China performing thoracic surgeries had adopted this procedure, with over 160,000 single-port video-assisted thoracoscopic lobectomies conducted annually.