10.25373/ctsnet.6965561.v1
Andrea Dell'Amore
Andrea
Dell'Amore
Alessio Campisi
Alessio
Campisi
Stefano Congiu
Stefano
Congiu
Giampiero Dolci
Giampiero
Dolci
Biportal VATS Right Pneumonectomy
CTSNet
2018
Thoracic
Lung Cancer
VATS
Surgery
2018-08-22 17:40:12
Media
https://ctsnet.figshare.com/articles/media/Biportal_VATS_Right_Pneumonectomy/6965561
<p>A 53-year-old man with no comorbidity was referred to the
authors’ unit because of a multifocal wild-type adenocarcinoma of the right
lung. A positron emission tomography scan was negative for metastasis and an endobronchial
ultrasound-guided transbronchial needle aspiration staging of the mediastinum
showed no lymph node involvement. After a multidisciplinary meeting, a right
pneumonectomy indication was given. Preoperative evaluation showed no major
contraindications. The video-assisted thoracoscopic approach was biportal, using
a 6 to 7 cm utility port at the fifth intercostal space, mandatory for the size
of the lung and its extraction, and a 2 cm port for the camera at the eighth
intercostal space. The lung parenchyma was completely altered because of the
multiple foci of adenocarcinoma. First, the authors resected the pulmonary
ligament and opened the mediastinal pleura to isolate the inferior and superior
veins. The veins were transected with a mechanical stapler in the sequence
shown in the video. Once transected, the authors noticed a small vein draining
the S6 segment and had to divide this separately. Then they carefully cleared
the pulmonary artery just over the pericardium and transected it using a
mechanical stapler inserted from the inferior access. Again, the authors
cleaned the bronchus and decided to close it with a TA™ stapler. The utility
incision was sufficient to introduce that stapler, and they were able to obtain
a bronchial stump as short as possible. A systematic lymphadenectomy was then
performed and the bronchial stump was covered with a surgical glue.</p>
<p>The length of surgery was 190 minutes. The patient was transferred
to the intensive care unit and extubated after four hours. The postoperative
period was uneventful. The chest drainage was removed in the first
postoperative day and the patient was discharged from the hospital on the fifth
postoperative day in optimal medical condition. The final pathology result was T3(5)N0M0,
according to the AJCC 8<sup>th</sup> edition. The patient is now under
evaluation for adjuvant chemotherapy.</p>