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Case Reports
. 2021 May;12(9):1489-1492.
doi: 10.1111/1759-7714.13949. Epub 2021 Apr 3.

Handling benign interlobar lymphadenopathy during thoracoscopic lobectomy

Alfonso Fiorelli  1 , Stefano Forte  2 , Giovanni Natale  1 , Mario Santini  1 , Wentao Fang  3
Affiliations
Case Reports

Handling benign interlobar lymphadenopathy during thoracoscopic lobectomy

Alfonso Fiorelli et al. Thorac Cancer. 2021 May.

Abstract

The presence of calcified or inflammatory lymph nodes between the target bronchus and pulmonary artery is a huge challenge when performing thoracoscopic lobectomy as it may frequently result in tearing of the vessel, and massive bleeding. Herein, we describe a simple strategy in which thoracoscopic lobectomy was safely completed in similar cases. After fissure dissection, the target pulmonary artery was exposed by more than two-thirds of its circumference. A needle was passed across the nodes and the target vessel was closed with a proximal and distal suture. After dissection of lymphadenopathies, the target bronchus was exposed, and stapled. This strategy was applied with success to complete right lower lobectomies for cancer in three patients. No complications occurred during the operation. Only one patient had persistent air leaks that spontaneously ceased 11 days later. Final pathology showed pN0 disease in all cases.

Keywords: lobectomy; lymphadenopathy; thoracoscopy.

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Conflict of interest statement

The authors disclose no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Computed tomography (CT) findings. (a) Axial view, and (b) coronal view showed calcified lymph nodes between lower pulmonary artery and lower bronchus (patient number 3)
FIGURE 2
FIGURE 2
The inferior pulmonary artery and lower bronchus were frozen together by inflammatory lymph nodes. (a) A needle was passed across the nodes and (b) the target vessel closed with a proximal (*) and distal (**) suture. The vessel was then gradually transected with scissors (c). The lower bronchus was completely exposed (d), and stapled
See this image and copyright information in PMC

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