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. 2018 Dec;10(12):6653-6659.
doi: 10.21037/jtd.2018.10.97.

Outcomes of minimally invasive sleeve resection

Raul Caso  1 , Thomas J Watson  1   2 , Puja G Khaitan  2 , M Blair Marshall  1
Affiliations

Outcomes of minimally invasive sleeve resection

Raul Caso et al. J Thorac Dis. 2018 Dec.

Abstract

Background: Sleeve resection allows for preservation of lung parenchyma and improved long-term outcomes when compared with pneumonectomy. Little is known about minimally invasive sleeve resection, especially indications, feasibility, technical aspects, complications, and outcomes. We reviewed our institutional experience with sleeve resections via a minimally invasive approach.

Methods: We performed a retrospective review of a prospectively maintained database from 01/01/2010 to 11/01/2017. Indications, operative details, pathology, postoperative complications were reviewed and longer-term follow-up was reviewed.

Results: Fifteen patients were identified (5 males, 10 females). Details are presented in Table 1. Patients ranged in age from 7 to 82 years (median, 57 years). Approaches included video-assisted thoracoscopic surgery (VATS) and robotic. Airway sleeve resection was performed in all patients with an additional arterioplasty in 4, one patient having a double sleeve. Length of stay ranged from 3 to 10 days (median, 5 days). Indication for surgery included carcinoid in 5 (1 atypical), NSCLC in 6, and 4 additional pathologies. Complications occurred in 6 patients: air leak [2], pericardial effusion [1], transient brachial plexopathy [1], and atrial fibrillation [2]. There were no anastomotic complications. Median follow-up was 4.2 years. There were no anastomotic strictures.

Conclusions: In experienced centers, sleeve resection via a minimally invasive approach is feasible with acceptable morbidity and mortality. Results in this small series appear comparable with the open approach.

Keywords: Sleeve resection; bronchoplasty; robotic surgery; sleeve lobectomy; video-assisted thoracoscopic 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
Port placement for a VATS approach. VATS, video-assisted thoracoscopic surgery.
Figure 2
Figure 2
Port placement for a robotic approach. Numbers indicate robotic arm placement: 3, camera port; AP, 5 mm assistant port.
Figure 3
Figure 3
Intraoperative image of airway anastomosis following robotic bronchus intermedius sleeve resection (case 15).
Figure 4
Figure 4
Intraoperative images of a VATS double sleeve resection (case 4) with divided pulmonary artery (A) and completed bronchial and pulmonary artery anastomoses (B). PA, pulmonary artery; SPV, superior pulmonary vein.
See this image and copyright information in PMC

Comment in

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