VATS Biportal Left Pneumonectomy

Pneumonectomy is defined as the removal of the entire lung. This surgical procedure can be performed intrapericardially or extrapericardially and is associated with the radical dissection of the mediastinal lymph node without the resection of the mediastinal chest wall or the diaphragm. Pneumonectomy remains the main surgical choice for managing locally advanced lung cancer that cannot be treated using other anatomic lung resections like lobectomy or parenchyma-sparing procedures such as sleeve resection. The first successful pneumonectomy for cancer was performed by Evarts Graham in 1933 (1). In recent years, pneumonectomy has been performed for 10% of major lung resections. Despite improvements in surgical techniques and perioperative medical care, pneumonectomy is often associated with high perioperative morbidity and mortality (2–5).

The video-assisted thoracoscopic surgery (VATS) approach used to perform lobectomy is widely accepted as a superior alternative to open thoracotomy. This is due to the following benefits: less postoperative pain, lower surgical morbidity, fewer complications, shorter hospital stays, and lower costs (6, 7). Video-assisted thoracoscopic pneumonectomy was first described by Walker in 1994 (8). After that, few reports of thoracoscopic pneumonectomy were published because the VATS approach is associated with technical difficulties (9–11). The purpose of this video is to show the authors’ experience performing a left pneumonectomy using the biportal VATS approach.

References

  1. Fuentes PA. Pneumonectomy: historical perspective and prospective insight. Eur J Cardiothorac Surg. 2003;23:439-445.
  2. Jungraithmayr W, Hasse J, Olschewski M, Stoelben E. Indications and results of completion pneumonectomy. Eur J Cardiothorac Surg. 2004;26(1):189–196.
  3. Owen RM, Force SD, Pickens A, Mansour KA, Miller DL, Fernandez FG. Pneumonectomy for benign disease: analysis of the early and late outcomes. Eur J Cardiothorac Surg. 2013;43(2):312–317.
  4. Thomas PA, Berbis J, Baste JM, Le Pimpec-Bathes F, Tronc F, Falcoz PE, et al; EPITHOR group. Pneumonectomy for lung cancer: contemporary national early morbidity and mortality outcomes. J Thorac Cardiovasc Surg. 2015;149(1): 73–82.
  5. Pagès PB, Mordant P, Renaud S, Brouchet L, Thomas PA, Dahan M, et al. Sleeve lobectomy may provide better outcomes than pneumonectomy for non-small cell lung cancer. A decade in a nationwide study. J Thorac Cardiovasc Surg. 2017;153(1):184–195.
  6. Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity- matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010;139(2):366–378.
  7. Swanson SJ, Meyers BF, Gunnarsson CL, Moore M, Howington JA, Maddaus MA, et al. Video-assisted thoracoscopic lobectomy is less costly and morbid than open lobectomy: a retrospective multiinstitutional database analysis. Ann Thorac Surg. 2012;93(4):1027–1032.
  8. Walker WS, Carnochan FM, Mattar S. Video-assisted thoracoscopic pneumonectomy. Br J Surg. 1994;81(1):81–82.
  9. Liu Y, Gao Y, Zhang H, Cheng Y, Chang R, Zhang W, et al. Video-assisted versus conventional thoracotomy pneumonectomy: a comparison of perioperative outcomes and short-term measures of convalescence. J Thorac Dis. 2016;8(12):3537–3542.
  10. Sahai RK, Nwogu CE, Yendamuri S, Tan W, Wilding GE, Demmy TL. Is thoracoscopic pneumonectomy safe? Ann Thorac Surg. 2009;88 (4):1086–1092.
  11. Nwogu CE, Yendamuri S, Demmy TL. Does thoracoscopic pneumonectomy for lung cancer affect survival? Ann Thorac Surg. 2010;89(6):S2102–S2106.