VATS pneumonectomy and sleeve carinal resections—full thoracoscopic and uniportal approach

Abstract

Advantages of thoracoscopic pulmonary resections can’t be doubted and are confirmed by numerous studies. These procedures allow significantly reducing surgical trauma and blood loss, decreasing the length of hospital staying and less the need for anesthetics. Other benefits include early recovery, rapid rehabilitation and improvement of quality of life. Moreover, if needed, adjuvant chemotherapy might be provided earlier. Despite the high incidence rates of lung cancer in the world and the fact, which most patients present with stage II or, predominantly, stage III of the disease, there has been a decrease in the number of pneumonectomies over the past years. It is attributed to novel neoadjuvant schemes of treatment, which has recently come into play, as well as to the emphasis on organ sparing surgeries with angioplasty and bronchoplasty. However, for some patients with centrally located lung tumors or with tumor infiltrating of hilar structures or interlobar fissure, the only possible surgical procedure is radical pneumonectomy. One of the major problems in selecting patients for thoracoscopic pneumonectomy is unavailability of palpation and lack of full intraoperative revision in order to evaluate tumor spreading. Nevertheless, there is a small group of patients for whom broncho-angioplasty is not possible and who require radical lung removal often with the resection of the surrounding structures and sleeve carinal resections.