Video-assisted Major Pulmonary Resection Research Articles

Uniportal thoracoscopic surgery: from medical thoracoscopy to non-intubated uniportal video-assisted major pulmonary resections

Uniportal thoracoscopic surgery: from medical thoracoscopy to non-intubated uniportal video-assisted major pulmonary resections

Uniportal thoracoscopic surgery: from medical thoracoscopy to non-intubated uniportal video-assisted major pulmonary resections.

The development of thoracoscopy has more than one hundred years of history since Jacobaeus described the first procedure in 1910. He used the thoracoscope to lyse adhesions in tuberculosis patients. This technique was adopted throughout Europe in the early decades of the 20(th) century for minor and diagnostic procedures. It is only in the last two decades that interest in minimally invasive thoracic surgery was reintroduced by two key technological improvements: the development of better thoracoscopic cameras and the availability of endoscopic linear mechanical staplers. From these advances the first video-assisted thoracic surgery (VATS) major pulmonary resection was performed in 1992. In the following years, the progress of VATS was slow until studies showing clear benefits of VATS over open surgery started to be published. From that point on, the technique spread throughout the world and variations of the technique started to emerge. The information available on internet, live surgery events and experimental courses has contributed to the rapid learning of minimally invasive surgery during the last decade. While initially slow to catch on, the traditional multi-port approach has evolved into a uniportal approach that mimics open surgical vantage points while utilizing a non-rib-spreading single small incision. The early period of uniportal VATS development was focused on minor procedures until 2010 with the adoption of the technique for major pulmonary resections. Currently, experts in the technique are able to use uniportal VATS to encompass the most complex procedures such as bronchial sleeve, vascular reconstructions or carinal resections. In contrast, non-intubated and awake thoracic surgery techniques, described since the early history of thoracic surgery, peaked in the decades before the invention of the double lumen endotracheal tube and have failed to gain widespread acceptance following their re-emergence over a decade ago thanks to the improvements in VATS techniques.

Totally endoscopic anatomic pulmonary segmentectomies

Although some series of video-assisted major pulmonary resections have been reported, very few series of totally endoscopic lobectomies have been published and - to our knowledge - none of totally endoscopic anatomic segmentectomies. We have recently performed five anatomic segmentectomies using this approach. The video demonstrates the main steps of the procedure, based on the recordings of three different operations: a lingulectomy, a left basilar segmentectomy and a resection of the right lower lobe superior segment.

Sutureless Pneumostasis Using Polyglycolic Acid Mesh as Artificial Pleura During Video-Assisted Major Pulmonary Resection

Postoperative air leaks impede rehabilitation and prolong hospitalization after pulmonary resection. To promote rehabilitation after video-assisted major pulmonary resection, we attempted to control alveolar air leaks without suturing, using polyglycolic acid mesh as artificial pleura. Forty-five patients undergoing video-assisted major pulmonary resection in our institute were enrolled in this study. Pneumostasis was done for intraoperative air leaks, by combining polyglycolic acid mesh with fibrin glue. We removed the chest tube the day after the air leaks stopped. Pneumostasis was done for intraoperative air leaks in 28 patients. The air leaks stopped immediately, allowing chest tube removal on postoperative day 1 in all but one patient whose air leak took 1 day longer to disappear. The time of chest tube drainage and the postoperative stay were similar in the patients with and those without intraoperative air leaks (mean 1.0 days vs 1.2 days and 6.8 days vs 7.1 days, respectively). The percentage of predicted forced expiratory volume in one second was significantly lower in patients with, than in those without, intraoperative air leaks (p < 0.05). We achieved sutureless pneumostasis using bioabsorbable artificial pleura during video-assisted major pulmonary resection. This method may contribute to reducing hospitalization, especially in patients with poor pulmonary function.

Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: Are these carcinomas candidates for video-assisted lobectomy?

To determine the clinicopathologic characteristics of peripheral non-small-cell carcinomas, the cases of 337 patients undergoing major pulmonary resection with complete lymphadenectomy were retrospectively reviewed with regard to lymph node involvement, recurrence, and prognosis. All of the tumors were 3.0 cm or less in diameter and were categorized as T1 (318 patients) or T2 (19). Eighty-eight patients (26.1%) had lymph node involvement: 32 (9.5%) at N1 nodes, 55 (16.3%) at N2 nodes, and 1 (0.3%) at N3 nodes. Although the prevalence of lymph node involvement did not differ significantly with tumor histologic type, it was quite low in squamous cell carcinomas 2.0 cm or less in diameter. Of the 56 N2/3 metastases, 14 (25%) occurred in a “skipping” manner, and all but one had a nonsquamous histologic makeup. Of the 213 patients with a follow-up period of 5 years or more, 59 patients (27.7%) showed cancer recurrence. This occurred at a distant site in 67.8% of the cases. Five-year survival rates based on nodal status were 91.9% (N0), 61.8% (N1), 44.5% (N2), and 0% (N3). Because of the relatively high prevalence of lymph node involvement, complete hilar/mediastinal lymphadenectomy should be routinely done regardless of tumor histologic type and size, as long as patients are at good risk. However, in squamous cell histologic types, mediastinal lymphadenectomy might be dispensable if the tumor is less than 2.0 cm in diameter, or if the hilar node is proved to be tumor-free on pathologic examination of the frozen section during operation. Although video-assisted major pulmonary resection currently has limited application, this new technique may represent a surgical option in resection without complete lymphadenectomy. (J T HORAC C ARDIOVASC S URG 1996;111:1125-34)