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Case Reports
. 2014 Feb;18(2):237-9.
doi: 10.1093/icvts/ivt441. Epub 2013 Oct 29.

Left lower sleeve lobectomy by uniportal video-assisted thoracoscopic approach

Diego Gonzalez-Rivas  1 , Maria Delgado, Eva Fieira, Oscar Pato
Affiliations
Case Reports

Left lower sleeve lobectomy by uniportal video-assisted thoracoscopic approach

Diego Gonzalez-Rivas et al. Interact Cardiovasc Thorac Surg. 2014 Feb.

Abstract

Endobronchial tumours requiring sleeve resection have been usually considered a contraindication for video-assisted thoracoscopic surgery (VATS). However, with new technical advances and the experience gained in VATS, sleeve lobectomy has been performed by thoracoscopy in experienced VATS centres. Right-sided sleeve anastomoses are easier to perform by VATS than left-sided ones because of the presence of the pulmonary artery and aortic arch on the left side. Most surgeons use a 3 to 4 incision VATS technique for sleeve anastomosis but the surgery can be performed by using only one incision. This is the first report of a left-sided sleeve lobectomy by uniportal approach.

Keywords: Lobectomy; Lung cancer; Minimally invasive surgery; Sleeve lobectomy; Thoracoscopy/video-assisted thoracic surgery.

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Figures

Supplementary Video 1:
Supplementary Video 1:
Sleeve resection.
Supplementary Video 2:
Supplementary Video 2:
Sleeve anastomosis.
Figure 1:
Figure 1:
Sequence of sleeve resection and anastomosis. (A) Exposure of left upper, lower and main bronchi. (B) Transection of left upper lobe bronchus. (C) Transection of main bronchus. (D) Retraction of artery and apposition of main and upper lobe bronchi with a 3–0 interrupted suture. (E) Posterior wall of anastomosis. (F) Interrupted 3–0 absorbable suture at the angle of anterior portion of the bronchial cartilage. (G) Continuous and interrupted sutures tied with the help of a thoracoscopic knot-pusher. (H) Continuous suture for the membranous portion of the bronchial membrane. (I) Use of endoscopic knot-pusher to tie the continuous suture with the last interrupted cranial suture to complete the anastomosis.
Figure 2:
Figure 2:
(A) Surgical image of uniportal instrumentation during sleeve anastomosis. (B) Postoperative result with the chest tube placed in the posterior part of the incision.
See this image and copyright information in PMC

References

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