Complete video-assisted thoracoscopic surgery upper left bronchial sleeve lobectomy.

Abstract

This video demonstrates a case undergoing complete video-assisted thoracoscopic surgery (VATS) upper left bronchial sleeve lobectomy. The 18-year-old female patient was admitted for recurrent cough and intermittent hemoptysis for one month. Chest CT scan showed a neoplasm in the left main bronchus and the left upper lobe bronchus. Bronchoscopic biopsy indicated mucinous epithelial cancer. Based on the chest CT findings, the left lower lung was not affected. To preserve normal lung tissue and minimize the loss of lung function, we decided to perform this surgical procedure. A three-port technique was conducted, in which the hypoplastic oblique fissure, the left upper pulmonary vein, and the upper lobe branch of the left pulmonary artery were initially treated under complete VATS. Bronchial sleeve lobectomy of the upper lobe of the left lung was finally carried out. The key to success was the end-to-end anastomosis between the left main bronchus and the lower left bronchus under thoracoscope. The deep location of the operative field partly hidden under the left pulmonary artery trunk during bronchial anastomosis made it even more difficult to operate thoracoscopically. To improve exposure of the operative field, we managed to raise the left main bronchus by passing two 1-0 silk sutures, respectively ligated with both sides of the posterior wall of the left main bronchus, through the anterior and posterior chest walls using a crochet needle. Similarly, a 1-0 silk suture was advanced through the posterior chest wall with a crochet needle to lift the trunk of the left pulmonary artery. In this way, a widely open, exposed field was achieved. Postoperative recovery was smooth. Chest X-ray showed good expansion of the left lung. Bronchoscopy indicated a patent anastomosis. The patient was discharged after two weeks. In conclusion, complete VATS bronchial sleeve lobectomy is a minimally invasive approach for thorough removal of tumor lesions while sparing as most normal lung tissue as possible, which avoids pneumonectomy and satisfies the psychological and physiological needs of patients.