RATS Left Lower Lobectomy for T4 NSCLC After Immunotherapy

This video demonstrates a left lower lobectomy in a sixty-seven-year-old man with a history of smoking, COPD, and ischemic cardiopathy. which was discovered After a first episode of hemoptysis, a pulmonary epidermoid carcinoma was discovered and staged T4N0. The patient was first addressed and treated by chemo-immunotherapy before being restaffed and led to surgery.

In this video, the authors describe the French lobectomy, a five-area plan of dissection used for several years for every carcinologic procedure and applied to a challenging RATS lobectomy. The authors describe how they managed the dissection in post-immunotherapy tissues.

The dissection was performed counterclockwise, after an adhesiolysis time, by first liberating the pulmonary ligament and then following the scheme of dissection as described. This allowed the release of most of the anatomical structures and simplified the gesture. The main difficulty was the exclusion of the left lower lobe artery, as it was sheathed in the neighboring tissues.

The patient was discharged after only 48 hours of surveillance, and the anatomopathological results showed a resection with R0 margins, no tumor cells left in the carcinoma bedside, and no lymph node invasion. It was therefore categorized as ypT0N0.

The one-month consultation showed no pneumothorax and no liquid effusion. The patient was, at the time, only complaining about remaining neuropathic pain, which common after RATS due to the position of our anterior arm. This was treated with LAROXYL and VERSATIS patches.

References

1. Minimally invasive (robotic assisted thoracic surgery and video-assisted thoracic surgery) lobectomy for the treatment of locally advanced non-small cell lung cancer. Bernard J. Park, Hao-Xian Yang, Kaitlin M. Woo, and Camelia S. Sima doi: 10.21037/jtd.2016.04.56
2. Robotic assisted lobectomy for locally advanced lung cancer. Giulia Veronesi, Pierluigi Novellis, Orazio Difrancesco and Mark Dylewski doi: 10.21037/jovs.2017.04.03

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