Surgical techniques and outcome analysis of uniportal video-assisted thoracic surgery complex sleeve lung resection: a 20 case-series study

Abstract

Background: Our study aims to explore the feasibility of uniportal video-assisted complex sleeve lung resection and summarize the surgical techniques and clinical outcomes.

Methods: From June 2016 to April 2020, a total of 20 complex sleeve pulmonary and distal tracheal resections were performed by the single surgical team at the Thoracic Surgery Department of the Shanghai Pulmonary Hospital. We defined cases as complex sleeve pulmonary resections if they required pulmonary segment sleeve resection, extended sleeve resection (lobectomy plus segmentectomy of the remaining lobe), sleeve pneumonectomy, lobectomy plus carinoplasty or neo-carina construction, pulmonary-sparing main bronchus resection plus carina reconstruction, and distal trachea resection with end to end anastomosis.

Results: The 20 cases comprised lung squamous cell carcinoma (n=11), lung adenocarcinoma (n=2), hamartoma (n=3), adenoid cystic carcinoma (n=2), carcinoid tumor (n=1), and pleomorphic carcinoma (n=1). The average blood loss during the operation was 250±126.17 mL (50-800 mL). The average operation time was 192.0±61.1 minutes. The average number of lymph node stations removed was 5.82±1.33, including station seven in all cases, and the median number of lymph nodes removed was 4.18±5.89. On the day of surgery, the drainage volume was 266±192.01 mL. The mean postoperative hospital stay was 5.37±1.86 days. Twelve of the 16 patients diagnosed with malignancy received postoperative chemotherapy. Granuloma formation at the anastomosis level led to stenosis in one case, and tumor recurrence occurred in one case. Broncho-esophageal fistula occurred in one patient after radiochemotherapy. The postoperative follow-up time was 15.6±10.7 months. The 30-day mortality was zero, and at one-year follow-up, only one patient had died of metastatic disease after the operation.

Conclusions: Uniportal video-assisted complex sleeve pulmonary resections are feasible when conducted by experienced teams.

Keywords: Uniportal video-assisted thoracic surgery (uniportal VATS); carinal reconstruction; sleeve lobectomy.

Figure 1

VATS sleeve resection of the left upper lobe inherent segment: the left upper lobe inherent segment is removed, and then the bronchus of the lingual segment of the upper lobe is anastomosed end to end with the bronchus of the upper lobe. (← is the bronchus of the upper lobe). VATS, video-assisted thoracic surgery.

Figure 2

VATS right upper lobe and carina resection: remove the right upper lobes and remove all the carinas. The left main bronchus is anastomosed with the trache at the first two-thirds of the pipe diameter, and the right middle bronchus is anastomosed to the left main bronchus and trachea after anastomosis. ↑ (↓ is the trachea, ←is the left main bronchus, ↑ is the right middle bronchus). VATS, video-assisted thoracic surgery.

Figure 3

CT manifestations of carinal tumors. (↑ are the carinal tumors).

Figure 4

Uniportal VATS intercostal, right main bronchial segment resection, and double carina angioplasty: the right middle bronchus and the right upper bronchus are completely severed 1 cm from the lower margin of the tumor, and the lateral walls of the right main bronchus and the lower trachea are cut in a wedge shape 1 cm from the upper margin of the tumor. The second carina is reconstructed by continuous side to side anastomosis of the right middle bronchus with the residual branch of the medial wall of the right upper lobe bronchus, and the second carina is anastomosed end to end with the lower end of the trachea to reconstruct a new carina. (→ is the right middle bronchus, ← is the right upper bronchus, ↓ is the trachea). VATS, video-assisted thoracic surgery.

Figure 5

VATS right lung sleeve resection and carina resection: remove the right lung and carina, the left bronchial sleeve suture to the lower segment of the trachea. (→ is the left bronchial, ← is the trachea). VATS, video-assisted thoracic surgery.

Figure 6

VATS left upper lobe and carina plastic resection: remove the left upper lobe and the left half carina, left lower lobe bronchial sleeve suture to the lateral wall of the lower trachea. (→ is the left lower bronchial, ← is the trachea). VATS, video-assisted thoracic surgery.

Figure 7

The survival curve of 20 patients with uniportal VATS complex sleeve lung resection. VATS, video-assisted thoracic surgery.