Uniportal Thoracoscopic Left Lower Lobectomy After Previous Wedge Resection
In the chest CT-scan, you can see an interlobar lymph node, the
pulmonary nodule, and the staple line from previous surgery. A PET scan
was performed and the lymph node and the pulmonary nodule were confirmed
with a standardized uptake value more than 25. The authors also
observed some progression in dimensions of the nodule and lymph node.
left lower lobectomy was performed. As expected, there were some
pleural adhesions at the level of the minithoracotomy from previous
surgery, which the authors dissected with the blunt instruments or with
the hook. The next step was dissecting the pulmonary ligament,
harvesting the station 9 lymph node, and identifying the inferior border
of the inferior pulmonary vein. They continue by sectioning the
anterior and posterior mediastinal pleura, identifying the superior
border of the inferior pulmonary vein, thus preparing the dissection of
the vein. Since the authors expected a laborious dissection in the
fissure. To avoid vascular tension, the stapling of the vein took place
after the completion of the arterial dissection. After that, the authors
released the fissure and identifi the pulmonary artery. To complete the
fissure, they used the hook and the scissors. The interlobar lymph node
was observed “sitting” between the lower lobe bronchus and branches of
the pulmonary artery (A5, A6, A7- 10 truncus). Due to the tight
adhesions of the lymphadenopathy to the bronchial and vascular
structures, its dissection was difficult, being necessary both blunt
dissection and the hook electrocautery dissection.
After making sure the arterial branches were “free of lymph node,” they completed the vascular dissection by applying a 35 mm white EndoStapler reload for each vessel. After arterial stapling, they saw the lymph node and the structures around it. For the inferior pulmonary vein, they also used a curved tip stapler reload to facilitate the passage of the stapler under the vessel.
The next step was releasing the bronchus by completing the interlobar lymphadenectomy and finalizing the dissection of the bronchus by applying a 45 mm green EndoStapler reload. Before “firing” the stapler, the authors usually check the inflation of the upper lobe (marked in the video by a blue arrow). They completed the mediastinal and hilar lymphadenectomy and drained the pleural cavity with one 24CH chest tube taken out through the working incision.The postoperative chest X-ray was nearly normal. The patient was discharged three days after surgery.
- Gonzalez-Rivas D, Fieira E, Delgado M, Mendez L, Fernandez R, de la Torre M. Uniportal video-assisted thoracoscopic lobectomy. J Thorac Dis. 2013 Aug;5 Suppl 3(Suppl 3):S234-245.
- Anile M, Diso D, Mantovani S, Patella M, Russo E, Carillo C, et al. Uniportal video assisted thoracoscopic lobectomy: going directly from open surgery to a single port approach. J Thorac Dis. 2014 Oct;6(Suppl 6):S641-643.