Figure 1: Preoperative CT scan
In this case, the preoperative CT demonstrated a 6 cm central tumor crossing the oblique fissure between the upper and lower lobes. The case was discussed at the authors’ tumor board, and a right pneumonectomy was recommended. Mediastinal nodes, sampled by EBUS/EUS, were negative.
The patient had severe adhesions between the lower lobe and the diaphragm. To avoid lung congestion, the veins and the truncus anterior were isolated first and then eventually divided. To avoid injury of the main pulmonary artery during dissection, particular care was taken to run the dissector on top of the right main bronchus. Eventually, the specimen was extracted in an endobag. All the steps of the procedure were completed without rib spreading, although the utility incision was slightly larger to allow extraction of the specimen.
The patient had minimal postoperative pain that was managed with a combination of Codeine and Paracetamol. The patient was discharged on the fourth postoperative day.
9 Comments
Nice Video and technique!
Thank you Marco et al.
nice one. well done. very neat job
Nicely done but LOS with muscle sparing thoracotomy same or even less in many cases. What is the benefit?
Nice way to go for a difficult case Marco……..
Great. Are the ports are conventional three or different?
Dr Soberman, thanks for your comments. LOS is only a crude measure of surgery. The patient could have gone home on day one as he was so well. I kept him as sometime pneumonectomies run into Af on day 4-5.
The main reason for a vats procedure is that patients recover sooner and can get adjuvant chemo, if necessary, in few weeks after surgery.
Dr Kibria, we use the same three ports for every vats case. Recently we started the single port approach for vats lobes only.
For to bet , this pneumonectomy would have been avoidable in open technique by a skilled thoracic surgeon
Great job. Congratulations.
Would you mind telling me if a representer related to SILS and MicroCutter is available for Istanbul/Turkey?
Thanks a lot in advance.
Erkan YILDIRIM, MD, FETCS
Thoracic & Lung Transplant Surgeon
Istanbul / TURKEY