Most studies have shown that thoracic epidural analgesia reduces postoperative pain, but it carries potential risks. Recently, video-assisted thoracoscopic surgery has become an established technique that causes minimal postoperative pain. This report shows that thoracic epidural analgesia is not always necessary after video-assisted thoracoscopic lobectomy. From January to December 2007, 30 consecutive patients who underwent video-assisted thoracoscopic lobectomy were examined retrospectively. We analyzed the necessity for routine thoracic epidural analgesia. The continuous subcutaneous analgesia catheter for morphine (2 mg in 48 h) was removed from 15 patients on postoperative day 1, and from the other 15 on day 2. We administered loxoprofen sodium hydrate, diclofenac sodium suppository, pentazocine hydrochloride, and mexiletine hydrochloride for postoperative analgesia, as needed. The mean pain score was no more than 1.0. The maximum score was 3.0 on day 0, and 2.0 on day 14; subsequently, no pain score exceeded 2.0. The postoperative hospital stay was 8.7 ± 0.8 days. All patients made uneventful postoperative recoveries. There is no need for thoracic epidural analgesia after every video-assisted thoracoscopic lobectomy because our patients recovered with no serious complication. Less invasive surgical approaches should require simpler postoperative pain management.

Cross-clamping the main pulmonary artery (PA) is a risky, stressful procedure for the general thoracic surgeon performing video-assisted thoracic major pulmonary resection (VATS). However, converting VATS to thoracotomy each time PA clamping is planned is a poor tactic. We present a simpler technique for VATS than the traditional method involving a thoracotomy. In VATS, DeBakey vascular clamps with double angle jaws are inserted through 1-cm access incisions. We clamped the main PA so as to maintain the limited visual field through the working port. Thus, we modified the position of these vascular clamps, which we call 'the outside-field vascular clamping technique'. Our technique should be used for VATS lobectomy to prevent conversion to open thoracotomy when one requires scheduled control of the PA during VATS.

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