Video-assisted thoracic surgery double sleeve bilobectomy of right upper and middle lobes.

Abstract

The evidence on the advantages of minimally invasive approach, represented by video-assisted thoracic surgery (VATS), in surgical treatment of both benign and malignant pulmonary diseases is mountain. Currently, VATS major pulmonary resection is routinely performed in many centers worldwide for patients with non-small cell lung cancer. However, hilar tumor invasion requiring bronchial sleeve or bronchovascular double sleeve lobectomy is generally considered as a contraindication of VATS (1). Even though the VATS bronchial sleeve lobectomy was reported more than one decade ago (2), VATS bronchovascular double sleeve lobectomy remained blank until our first report in 2014 (3). In recent years, a few high-volume centers have tried to perform such operations through the VATS approach (4-7). The results of VATS double sleeve lobectomy in our center were summarized recently (7). Most of the previous reported cases were the operations on the left side. Here we focused on the description of technical aspects of this challenging operation with a more detailed video which depicted a case of VATS bronchovascular double sleeve right upper and middle bilobectomy (Figure 1). Open in a separate window Figure 1 The video depicts a three-portal VATS bronchovascular double sleeve right upper and middle bilobectomy (8). The operation was carried out with the “Hollow-out” process. Lymph nodes and nearby soft tissues of the right hilum and mediastinum were firstly removed to hollow out the main structures of the hilum. The superior pulmonary vein and truncus anterior were transected one by one, followed by clamping the proximal PA using a releasable Bulldog clamp. The anterior part of the oblique fissure was incised, followed by transecting the middle lobe vein and bronchus. The common basal artery was mobilized and clamped with another Bulldog. Bronchial and arterial reconstruction was accomplished using running stiches after removing the diseased lobes. VATS, video-assisted thoracic surgery. Available online: http://www.asvide.com/article/view/26249