Video-assisted thoracic surgery pneumonectomy: the first case report in Poland

Abstract

Minimally invasive video-assisted thoracic surgery (VATS) lobectomy has proved to be equal and in some aspects superior to open lobectomy in T1 and T2 lung cancers. Indications for VATS pneumonectomy however are still not clearly defined and strictly limited. The minimally invasive VATS pneumonectomy can be undertaken in patients with centrally located tumors without extended invasion of the large pulmonary vessels, chest wall, pericardium, mediastinal structures or proximal part of the main bronchus and when sleeve resection is not feasible (T2). We present a case of a patient who underwent left VATS pneumonectomy due to left lung cancer. Based on the preoperative examinations any kind of less extensive resection than pneumonectomy was excluded. Our VATS technique consisted of three incisions: two ports and a 5-6 cm long utility incision without any kind of rib spreading. The whole of the procedure was controlled on the monitor via a thoracoscope and the technique of resection was described in detail. Total surgery time was 130 min and blood loss was 150 ml. The chest tube was removed on the 2(nd) post-operative day and the patient was discharged home on the 8(th) postoperative day. The final histopathological examination confirmed squamous cell lung cancer (T2aN0M0 stage IB). In the authors' opinion VATS pneumonectomy should be performed only in centers with extensive experience in minimally invasive VATS lobectomy. Despite limited indications for VATS pneumonectomy, if the patients fulfill the VATS pneumonectomy inclusion criteria they may gain from all the advantages of minimally invasive techniques.

Keywords: lung cancer; pneumonectomy; video-assisted thoracic surgery.

Figure 1

The left lung hilum LPA – left pulmonary artery, UPV – upper pulmonary vein, LPV – lower pulmonary vein, LMB – left main bronchus

Figure 2

Endostapler on the left upper pulmonary vein

Figure 3

Left main pulmonary artery prepared for dissection LPA – left pulmonary artery, UPVd – distal stump of the upper pulmonary vein, UPVp – proximal stump of the upper pulmonary vein, LMB – left main bronchus

Figure 4

Endostapler on the left main pulmonary artery

Figure 5

Endostapler on the left main bronchus

Figure 6

Left hilum after pneumonectomy and lymphadenectomy LPA – stump of left main pulmonary artery, UPV – stump of the upper pulmonary vein, LPV – lower pulmonary vein, LMB – stump of the left main bronchus, RMB – right main bronchus