VATS lobectomy for lung cancer. It's technique and the concept of sequential thoracotomy

VATS lobectomy for lung cancer has not got the consensus among thoracic surgeons(1,2). But usefulness of using thoracoscope is widely accepted e.g. to find out minute pleural effusion and/or miliary dissemination and/or metastatic mediastinal lymph nodes(3,4,5). We try to use thoracoscope almost ail operations for lung cancer prior to lung resection. And if it is thought to be reasonable to resect by ''VATS'', we do ''VATS'', but once it seems difficult to accomplish by ''VATS'' procedure, we elongate the operation scar and use rib spreader and/or scapular retractor. But we rarely convert to standard posterolateral thoracotomy. We propose this procedure as ''sequential thoracotomy''.