Video-assisted thoracoscopic bronchoplasty/pulmonary arterial angioplasty

Abstract

Thoracoscopic bronchoplasty combined with pulmonary arterial angioplasty can be particularly challenging. In the past, it was often done by using a conventional incision or hybrid video-assisted small incision. In recent years, anecdotal articles have described the application of thoracoscopic bronchoplasty/pulmonary arterial angioplasty. This chapter will describe the details associated with thoracoscopic bronchoplasty/pulmonary arterial angioplasty.

Keywords: Non-small lung cell cancer (NSCLC); pulmonary arterial angioplasty; sleeve lobectomy; video-assisted thoracic surgery (VATS).

Figure 1

Body position.

Figure 2

Under general anesthesia with double lumen tube, video-assisted thoracoscopic bronchoplasty/pulmonary arterial angioplasty (3). Available online: http://www.asvide.com/articles/905

Figure 3

Transection of the left upper pulmonary vein. (A) Dissect to expose the left upper pulmonary vein; (B) dissociate to expose the gap behind the left upper pulmonary vein; (C–E) the endoscopic cutter/stapler is guided by a urinary catheter; (F) transect the left upper pulmonary vein.

Figure 4

Transection of the pulmonary arterial branch in lingular segment of the left upper lobe (LUL). (A) Dissociate the pulmonary arterial branch in lingular segment of the LUL; (B,C) ligate the pulmonary arterial branch in lingular segment of the LUL with a silk suture; (D) transect the distal end of the pulmonary arterial branch in lingular segment of the LUL using HIFU. HIFU, high intensity focused ultrasound; LLL, left lower lobe.

Figure 5

Transection of the pulmonary arterial branch in posterior segment of the left upper lobe (LUL). (A) Dissociate the pulmonary arterial branch in posterior segment of the LUL; (B) ligate the pulmonary arterial branch in posterior segment of the LUL with a silk suture; (C) transect the distal end of the pulmonary arterial branch in posterior segment of the LUL using HIFU. HIFU, high intensity focused ultrasound.

Figure 6

Transection of the left upper lobe (LUL) bronchus. (A,B) Dissociate the LUL bronchus; (C–F) transect the main left bronchus using knives and scissors. LLL, left lower lobe.

Figure 7

Transection of the left lower lobe (LLL) bronchus. (A) Dissect the LLL bronchus using a knife; (B,C) transect the LLL bronchus using scissors; (D) complete the transection of the left main bronchus and LLL bronchus. LUL, left upper lobe.

Figure 8

Block off the proximal/distal ends of pulmonary trunk. (A–C) An additional small incision is made for the placement of blocking clamp to block off the proximal end of pulmonary trunk; (D,E) block off the proximal end of the pulmonary trunk; (F) block off the distal end of the pulmonary trunk; (G) distribution and appearances of incisions.

Figure 9

Transection of the posterior segment of left upper lobe (LUL) artery following the blockage of pulmonary trunk. (A) Dissociation continues using the scissors; (B) dissociate the pulmonary artery branches in LUL; (C) ligate with a silk suture; and (D) transect the distal end of the pulmonary artery branches using HIFU. HIFU, high intensity focused ultrasound.

Figure 10

Resection of left upper pulmonary lobe. (A,B) Remove parts of the pulmonary artery wall with scissors; (C) resect the left upper pulmonary lobe, which can be temporarily remained inside the pleural space. LUL, left upper lobe; LLL, left lower lobe.

Figure 11

Shearing of the resection margin of the pulmonary artery. (A–C) Shear the resection margin with scissors; (D) the sheared resection margin of the pulmonary artery. LUL, left upper lobe; LLL, left lower lobe.

Figure 12

Pulmonary angioplasty performed using a continuous simple suture. (A,B) The first stitch; (C) close the resection margin of pulmonary artery; (D) complete the pulmonary angioplasty.

Figure 13

Bronchial anastomosis performed using a continuous simple suture. (A) Appearance of bronchial stump before anastomosis; (B) the first stitch; (C) the second stitch; (D) closure of the bronchial membranes using the continuous simple suture; (E) appearance of bronchial cartilage before anastomosis; (F) anastomosis of the bronchial cartilages using knit and purl stitch combinations; (G) the anastomosis is to be finished; (H) bronchial stump leak test shows negative result.