Total thoracoscopic sleeve lobectomy of the middle and lower lobes of the right lung

Abstract

: This is a video recording of total thoracoscopic sleeve lobectomy performed on a patient with central lung cancer in the lower lobe of the right lung involving the orifice of the bronchus intermedius. The patient, a 50-year-old male, was admitted to the hospital due to cough lasting more than 2 months. The patient had no history of underlying diseases. On admission, the patient had decreased breath sounds in the right lower lobe without significant rales. Chest computed tomography showed a space-occupying lesion in the lower part of the right hilum, atelectasis of the middle and lower lobes of the right lung, and right hilar lymph node enlargement; however, the lymph nodes in the mediastinum were not significantly enlarged. Bronchoscopic examination revealed a neoplasm completely obstructing the orifice of the right bronchus intermedius, which pathological biopsy confirmed to be squamous cell carcinoma. A complete examination showed no evidence of distant metastasis; therefore, total thoracoscopic sleeve lobectomy of the right middle and lower lobes was performed. The 3-port approach was used for the surgery, which was performed through the anterior main operating port. Systematic lymph node dissection was performed first, followed by anatomical resection of the middle and lower lobes of the right lung. The arterial and venous branches of the middle and lower lobes of the right lung were cut, after which the right bronchus intermedius was skeletonized, and the orifice of the right bronchus intermedius was cut. Then, sleeve lobectomy of the orifice of the bronchus intermedius was performed, and finally, 3-0 Prolene sutures were used for continuous suture (from right principle bronchus to right upper lobe bronchus). The operation went smoothly. The patient’s postoperative pathological stage was pT2aN0M0 (stage Ib).