Video-assisted thoracic surgery for pulmonary sequestration: a safe alternative procedure

Abstract

Background: Pulmonary sequestration (PS), a rare congenital anatomic anomaly of the lung, is usually treated through resection by a conventional thoracotomy procedure. The efficacy and safety of video-assisted thoracic surgery (VATS) in PS treatment has seldom been evaluated. To address this research gap, we assessed the efficacy and safety of VATS in the treatment of PS in a large Chinese cohort.

Methods: We retrospectively reviewed 58 patients with PS who had undergone surgical resection in our department between January 2003 and April 2014. Of these patients, 42 (72.4%) underwent thoracotomy, and 16 (27.6%) underwent attempted VATS resection. Clinical and demographic data, including patients' age, sex, complaints, sequestration characteristics, approach and procedures, operative time, resection range, blood loss, drainage volume, chest tube duration, hospital stay, and complications were collected, in addition to short-term follow-up data.

Results: Of the 58 participating patients, 55 accepted anatomic lobectomy, 2 accepted wedge resection, and 1 accepted left lower lobectomy combined with lingular segmentectomy. All lesions were located in the lower lobe, with 1-4 aberrant arteries, except one right upper lobe sequestration. Three cases (18.8%) in the VATS group were converted to thoracotomy because of dense adhesion (n=1), hilar fusion (n=1), or bleeding (n=1). No significant differences in operative time, postoperative hospital stay, or perioperative complications were observed between the VATS and thoracotomy groups, although the VATS patients had less blood loss (P=0.032), a greater drainage volume (P=0.001), and a longer chest tube duration (P=0.001) than their thoracotomy counterparts.

Conclusions: VATS is a viable alternative procedure for PS in some patients. Simple sequestration without a thoracic cavity or hilum adhesion is a good indication for VATS resection, particularly for VATS anatomic lobectomy. Thoracic cavity and hilum adhesion remain a challenge for VATS.

Keywords: Pulmonary sequestration (PS); anatomic lobectomy; video-assisted thoracic surgery (VATS).

Figure 1

The produce of dissection aberrant artery. (A) The aberrant artery (arrow) is separated in the operation; (B) the aberrant artery (arrow) is cut with a stapling device.

Figure 2

The left aberrant blood vessel is detected by tomographic angiography. (A) A mass (arrow) is detected in the left lower lobe in chest CT; (B,C) an aberrant artery (arrow) arises from the descending thoracic aorta.

Figure 3

The right aberrant blood vessel is detected by tomographic angiography. (A) A mass (arrow) is detected in the right lower lobe (RLL) in chest CT; (B) an aberrant artery (arrow) arises from the celiac artery.