Partial removal of the pulmonary artery in video-assisted thoracic surgery for non-small cell lung cancer

Abstract

Lobectomy with partial removal of the pulmonary artery in video-assisted thoracic surgery (VATS) currently remains a challenge for thoracic surgeons. We were interested in introducing pulmonary vessel blocking techniques in open thoracic surgery into video-assisted thoracic surgery (VATS) procedures. In this study, we reported a surgical technique simultaneously blocking the pulmonary artery and the pulmonary vein for partial removal of the pulmonary artery under VATS. Seven patients with non-small-cell lung cancer (NSCLC) received lobectomy with partial removal of the pulmonary artery using the technique between December 2007 and March 2012. Briefly, rather than using a small clamp on the distal pulmonary artery to the area of invading cancer, we replaced a vascular clamp with a ribbon and Hem-o-lock clip to block the preserved pulmonary veins so as to prevent back bleeding and yield a better view for surgeons. The mean occlusion time of the pulmonary artery and pulmonary veins were 44.0±10.0 and 41.3±9.7 minutes, respectively. The mean repair time of the pulmonary artery was 25.3±13.7 minutes. No complications occurred. No patients showed abnormal blood flow through the reconstructed vessel. There were no local recurrences on the pulmonary artery. In conclusion, the technique for blocking the pulmonary artery and veins is feasible and safe in VATS and reduces the risk of abrupt intraoperative bleeding and the chance of converting to open thoracotomy, and extends the indications of VATS lobectomy.

Keywords: lobectomy; non-small-cell lung cancer (NSCLC); pulmonary artery reconstruction; video-assisted thoracic surgery (VATS).

Fig. 1. A patient was put in the lateral decubitus position.

An access incision (12 mm) was added for the center vascular clamp in the third intercostal space on the anterior axillary line. ICS: intercostal space.

Fig. 2. The images of blocking the pulmonary vessels.

A: left upper lobectomy with partial pulmonary artery anterior resection is depicted. The tumor invasion of pulmonary artery branches. B: The pulmonary artery branches (anterior branch and apicoposterior branch) were sutured directly with 4-0 Prolene. The handles of the clamps was placed on the main pulmonary artery and a caval tape secured with a 5 mm hem-o-lock non-absorbable polymer ligating clips to block the reserved pulmonary vein. PA: pulmonary artery; PV: pulmonary vein.

Fig. 3. The biospy and typical CT examination of lung cancer.

A: The specimen of lung cancer. B: Typical CT scan of a patient of a left upper lobe tumor with dense adhesion of tumor around apicoposterior branch. PV: pulmonary vein; PA: pulmonary artery.