VATS Clipping of Thoracic Duct After Posterolateral Thoracotomy with Upper Lobectomy and Lymphadenectomy

In this video, the author presents the case of a 78-year-old patient who was admitted for recurrent lung carcinoma in the left lower lobe. Three years prior, the patient was diagnosed with adenocarcinoma in the right upper lobe. The patient underwent a right upper lobectomy, wedge resection of the lower lobe, and mediastinal lymphadenectomy via right posterolateral thoracotomy. A wedge resection via posterolateral thoracotomy and chemotherapy were performed three months afterwards due to a metastatic tumor in the left lower lobe.

The author performed an extended lower lobectomy via left rethoracotomy for the recurrent tumor in the left lower lobe. Chylothorax occurred on the first postoperative day. Conservative management of chylothorax and surgical intervention on the left lobe (re-rethoracotomy for the ligation of the thoracic duct) failed to provide improvement. The author then decided to perform a right-sided VATS clipping of the thoracic duct.