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Review
. 2017 Mar 31:3:41.
doi: 10.21037/jovs.2017.03.03. eCollection 2017.

Video-assisted thoracoscopic surgery bronchial sleeve lobectomy

Fabio Davoli  1 , Luca Bertolaccini  1 , Alessandro Pardolesi  2 , Piergiorgio Solli  1   2
Affiliations
Review

Video-assisted thoracoscopic surgery bronchial sleeve lobectomy

Fabio Davoli et al. J Vis Surg. .

Abstract

A sleeve lobectomy (SL) is considered a valid option instead of a pneumonectomy in patients affected by central non-small cell lung cancer (NSCLC). In the last few years, the improvement of video-assisted thoracoscopic surgery (VATS) has allowed experienced surgeons to carry out this challenging operation by a minimally invasive approach. A full pre-operative assessment enclosing a flexible fiber-optic bronchoscopy evaluation and a multidisciplinary team discussion of the clinical case must be accomplished. There is no strictly an indication for the number of thoracoscopic ports: VATS SL is reported from 1 to 3-4 incisions. A significant variability in the technique of the anastomosis is documented and depends on the personal use and ability of the surgeon. However the operational principles are the same of an open SL: free bronchial margins at the frozen section examination, tension-free anastomosis, avoid luminal disparity and en-bloc resection. Due to the extent of the tumour, VATS SL can be associated to other complex resections like arterioplasty, or double sleeve (bronchial and artery) mainly on the left side. A patient underwent a VATS SL must be enrolled in an enhanced recovery pathway (ERP): physiological rehabilitation is a key point to achieve good outcomes and avoid complications.

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

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
VATS right upper lobe bronchial sleeve resection [Reprinted with permission (18)].
Figure 2
Figure 2
Modified bronchial anastomosis technique in singleport video-assisted thoracoscopic surgery (VATS) right middle and lower sleeve lobectomy [Reprinted with permission (20)].
Figure 3
Figure 3
VATS left upper sleeve lobectomy with partial pulmonary artery resection [Reprinted with permission (22)].
Figure 4
Figure 4
Under general anesthesia with double lumen tube, video-assisted thoracoscopic left lower lobe sleeve lobectomy [Reprinted with permission (24)].
See this image and copyright information in PMC

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