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. 2018 Feb 27:4:42.
doi: 10.21037/jovs.2018.02.02. eCollection 2018.

Transcervical uniportal pulmonary lobectomy

Marcin Zieliński  1 , Tomasz Nabialek  2 , Juliusz Pankowski  3
Affiliations

Transcervical uniportal pulmonary lobectomy

Marcin Zieliński et al. J Vis Surg. .

Abstract

Background: The aim of the study is a description of surgical technique of uniportal transcervical video-assisted thoracoscopic surgery (VATS) for pulmonary lobectomy.

Methods: We used a collar neck incision (transcervical) of an average length 5-8 centimeters. The manubrium of the sternum is elevated with a hook connected to the Zakopane II frame (Aesculap-Chifa, B. Braun, Nowy Tomyśl, Poland). The first step is a transcervical extended mediastinal lymphadenectomy (TEMLA), for improved staging and possible improved survival. The nodes removed during TEMLA undergo intraoperative imprint cytology examination. In case of no metastasis a uniportal VATS lobectomy through the neck follows. Ventilation of the operated lung is disconnected and the pleural cavity is entered by opening of the mediastinal pleura. Pleural adhesions, if present are managed with electrocautery. The branches of the pulmonary artery and vein are sequentially dissected and managed with endostaplers or vascular clips. The lobar bronchus and the fissures are divided with endostaplers and the resected lobe is removed in an endobag.

Results: There were 16 patients operated on in the period 1.2.2016-30.7.2016. There were two conversions-in one patient with left lower lobe tumor we had to convert to uniportal VATS left lower lobectomy due to extensive adhesions. In the other patient undergoing right lower lobectomy there was a conversion to right thoracotomy because of the bleeding from the pulmonary artery. There was no mortality and complications occurred in three patients. The mean operative time was 245.6 min (range, 145-385 min) for the whole TEMLA procedure with imprint cytology and lobectomy and 175.6 min (range, 75-295 min) for a lobectomy solely.

Conclusions: A uniportal transcervical VATS approach for pulmonary lobectomy combined with transcervical extended mediastinal lobectomy (TEMLA) provides an opportunity for radical pulmonary resection and superradical extensive mediastinal lymphadenectomy.

Keywords: Thoracoscopy; lobectomy; lymphadenectomy.

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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
Collar incision in the neck and elevation of the sternal manubrium (10). Available online: http://asvidett.amegroups.com/article/view/22994
Figure 2
Figure 2
Performance of transcervical extended mediastinal lymphadenectomy (TEMLA)—part 1 (11). Available online: http://asvidett.amegroups.com/article/view/22995
Figure 3
Figure 3
Performance of transcervical extended mediastinal lymphadenectomy (TEMLA)—part 2 (12). Available online: http://asvidett.amegroups.com/article/view/22996
Figure 4
Figure 4
Transcervical entrance to the right pleural cavity and insertion of the Alexis ring retractor (13). Available online: http://asvidett.amegroups.com/article/view/22997
Figure 5
Figure 5
Dissection and division of the upper right lobe structures, division of the fissure, removal of the resected upper lobe is removed in an endobag, inflation of the right lung (14). Available online: http://asvidett.amegroups.com/article/view/22998
Figure 6
Figure 6
Two chest tubes are inserted to the chest through the transcervical incision (15). Available online: http://asvidett.amegroups.com/article/view/22999
Figure 7
Figure 7
The final view of the sutured operative wound (16). Available online: http://asvidett.amegroups.com/article/view/23001
See this image and copyright information in PMC

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