Video–assisted thoracoscopic lobectomies in a phthisiatric, nonspecific and oncological pulmonary affection
Objective. To share own experience of performance of video–assisted thoracoscopic (VATS) lobectomies in patients with phthisiatric, nonspecific and oncological pulmonary damage in 2014 – 2019 yrs.
Materials and methods. Through last 5 years we performed 72 VATS resections of the pulmonary lobe, including 30 (41.7%) typical VATS lower lobectomies with separate surgical processing of elements of the lobe. In 1 (1.4%) patient conversion to thoracotomy was performed when a hemorrhage have occurred. Among the patients women prevailed – 46 (63.9%). The patient’s age was between 17 and 85 years, (39.2 ± 6.2) years at average.
Operative intervention was done for pulmonary tuberculosis in 57 (79.2%) patients, for cancer – in 7 (9.7%), inborn pulmonary hypoplasia – in 2 (2.8%), arterio–venous malformation – in 1 (1.4%), hamartochondroma of big dimensions – in 2 (2.8%), bronchoechtatic disease – in 2 (2.8%), intralobar sequestration – in 1 (1.4%) patient.
Results. Intraoperative complications were diagnosed in 3 (4.2%) patients. Total morbidity have occurred in 12 (16.7%) patients. Total efficacy of performance of the VATS lobectomy have constituted 98.6%, median duration of resections – (185.1 ± 72.2) min, average blood loss volume – (154.1 ± 73.8) ml, median duration of treatment in postoperative period – (29.2 ± 14.1) days, rate of conversion to wide thoracotomy – 1,4%.
Conclusion. VATS lobectomy constitutes an effective method of surgical treatment in patients, who need performance of thoracic operations, including phthisiatric and oncological. This kind of operation is perspective, miniinvasive, guarantees anatomic preparation of elements of the pulmonary lobe radix, and it may be regarded as alternative to open lobectomy. Pronounced fibrosis of pulmonary radix due to durable inflammatory process and prolonged medicinal treatment, as well as the cost of endoscopic instruments, preclude wide application of this method.
Augustin F, Maier H, Lucciarini P, Bodner J, Klotzner S, Schmid T. Extended minimally invasive lung resections: VATS bilobectomy, bronchoplasty, and pneumonectomy. Langenbecks Arch Surg. 2016;401(3):341-8. PMID: 26420241. doi: 10.1007/s00423-015-1345-4.
Melfi FM, Fanucchi O, Davini F, Mussi A. VATS-based approach for robotic lobectomy. Thorac Surg Clin. 2014;24(2):143-9, v. PMID: 24780417. doi: 10.1016/j.thorsurg.2014.02.003.
Chung JH, Choi YS, Cho JH, Kim HK, Kim J, Zo JI, Shim YM. Uniportal video-assisted thoracoscopic lobectomy: an alternative to conventional thoracoscopic lobectomy in lung cancer surgery? Interact Cardiovasc Thorac Surg. 2015;20(6):813-9. PMID: 25736285. doi: 10.1093/icvts/ivv034.
DE LA Torre M, González-Rivas D, Fernández R, Delgado M, Fieira E, Méndez L. Uniportal VATS lobectomy. Minerva Chir. 2016;71(1):46-60. PMID: 26606690.
White A, Swanson SJ. Minimally Invasive Surgery for Early-Stage Lung Cancer: From Innovation to Standard of Care. Oncology (Williston Park). 2016;30(11):982-7. PMID: 27854099.
McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2006;81(2):421-5; discussion 425-6. PMID: 16427825.
Ismail NA, Elsaegh M, Dunning J. Novel Techniques in Video-assisted Thoracic Surgery (VATS) Lobectomy. Surg Technol Int. 2015;26:206-9. Review. PubMed PMID: 26055011.
Mollberg NM, Mulligan MS. Video-assisted thoracoscopic (VATS) lobectomy after induction therapy. Thorac Surg Clin. 2014;24(4):465-70. PMID: 25441140. doi: 10.1016/j.thorsurg.2014.07.013.
Kuritzky AM, Ryder BA, Ng T. Long-term survival outcomes of Video-assisted Thoracic Surgery (VATS) lobectomy after transitioning from open lobectomy. Ann Surg Oncol. 2013;20(8):2734-40. PMID: 23463094. doi: 10.1245/s10434-013-2929-2.
McElnay P, Casali G, Batchelor T, West D. Adopting a standardized anterior approach significantly increases video-assisted thoracoscopic surgery lobectomy rates. Eur J Cardiothorac Surg. 2014;46(1):100-5. PMID: 24335265.doi: 10.1093/ejcts/ezt561.
Ngodngamthaweesuk M, Attanawanich S, Kijjanon N. Video-assisted thoracic surgery lobectomy for lung cancer in Ramathibodi Hospital. J Med Assoc Thai. 2013;96(7):819-23. PMID: 24319853.
Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW, et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg. 2010;139(2):366-78. PMID: 20106398. doi: 10.1016/j.jtcvs.2009.08.026.
This work is licensed under a Creative Commons Attribution 4.0 International License.