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This approach has been practiced for the past 15 years. Like gallbladder surgery or knee surgery, small incisions (ports) are made for access between the ribs and surgery is performed with the guidance of a camera. Ribs are not spread during the surgery.
The advantage with this approach is less pain after surgery. Most patients are ready for discharge from the hospital in five days and do not require pain medication after approximately two weeks.
Unfortunately, difficult cases cannot be done with this approach, especially for patients with possible lymph node spread. Although you can sample the lymph nodes well, complete lymph node dissection is not as easy as with the open (thoracotomy) approach. Therefore this surgery is usually limited to patients with early lung cancer without any lymph node spread on PET scan.