CPT® Code 32663

Thoracoscopy, surgical; with lobectomy (single lobe), commonly referred to as video-assisted thoracoscopic surgery (VATS), is a minimally invasive surgical procedure performed to remove a single lobe of the lung. This technique involves the use of a thoracoscope, which is a specialized instrument equipped with a camera that allows the surgeon to visualize the thoracic cavity without the need for a large incision. The procedure begins with the initiation of single lung ventilation, which is crucial for providing optimal working space and visibility during the surgery. The thoracoscope is strategically placed at either the anterior or posterior axillary line, depending on the side of the lung from which the lobe is being excised. Additional trocars, which are small tubes, are inserted to facilitate the introduction of various surgical instruments necessary for the lobectomy. During the procedure, a lung clamp is utilized to retract the lung, enhancing the surgeon's ability to visualize critical structures such as the pulmonary vein and artery. A larger utility incision is then made, either over the superior pulmonary vein for an upper lobe lobectomy or between the third and fourth intercostal spaces for a middle or lower lobe lobectomy. The surgical team meticulously dissects the pulmonary vein from the surrounding pleura and divides it to gain access to the main pulmonary artery. The surgeon identifies the arterial branch corresponding to the lobe being removed, excises any lymph nodes obstructing access, and subsequently clamps and transects the artery using a vascular stapler. The bronchus, which is the airway leading to the lobe, is also exposed and transected. After all vascular and bronchial connections to the lobe have been severed, the fissure between the lobes is exposed, and the lung is divided along both the minor and major fissures. Finally, the excised lobe is placed in a surgical extraction bag and removed through the utility incision, completing the procedure.