A uniportal video assisted thoracic surgery approach for lung cancer with silicosis and highly inflammatory lymph nodes

Abstract

While uniportal video-assisted thoracic surgery (U-VATS) is a viable minimally invasive surgical approach, it may restrict the control of surgical instruments. Furthermore, whether or not U-VATS is well-indicated for lung cancer with silicosis and inflammatory lymph nodes is unclear. We herein report a case of resection performed by U-VATS for lung cancer with silicosis and highly inflammatory lymph nodes and describe the procedures and techniques used. The vessels and bronchus cannot be dissected easily in the hilum due to the presence of several extremely inflamed lymph nodes, and these structures had to be exposed while avoiding inflammatory lymph nodes #10 and #12u in this case. Curved instruments and hooked electrocautery proved useful for these procedures. In addition, the grasping technique using the curved forceps was useful for achieving sufficient tension to expose the vessels. Bulk dissection of the pulmonary artery and bronchus with a stapler may be useful when these structures cannot be isolated, such as with B1 and A2a in the present case. The postoperative course was good, and the patient was discharged on postoperative day 6. Substantial experience and knowledge as well as proficiency with the associated techniques will make difficult surgeries such as this case possible by U-VATS.