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Right VATS Pneumonectomy

Monday, December 1, 2014

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.


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.
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

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