Bulectomia bilateral por cirurgia torácica vídeo-assistida uniportal combinada com acesso contralateral ao mediastino anterior

Abstract

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) has been a surgical intervention of choice for the treatment of spontaneous pneumothorax (SP) with lung bulla. Our objective was to introduce a uniportal VATS approach for simultaneous bilateral bullectomy and to evaluate its therapeutic efficacy. METHODS: Between May of 2011 and January of 2012, five patients underwent bilateral bullectomy conducted using this approach. All of the patients presented with bilateral SP. Preoperative HRCT revealed that all of the patients had bilateral apical bullae. We reviewed the surgical indications, surgical procedures, and outcomes. RESULTS: All of the patients were successfully submitted to this approach for bilateral bullectomy, and there were no intraoperative complications. The median time to chest tube removal was 4.2 days, and the median length of the postoperative hospital stay was 5.2 days. The median postoperative follow-up period was 11.2 months. One patient experienced recurrence of left SP three weeks after the surgery and underwent pleural abrasion. CONCLUSIONS: Bilateral bullectomy through uniportal VATS combined with contralateral access to the anterior mediastinum is technically reliable and provides favorable surgical outcomes for patients with bilateral SP who develop bilateral apical bullae. However, among other requirements, this surgical procedure demands that surgeons be experienced in VATS and that the appropriate thoracoscopic instruments are available.

Wedge resection and pleurodesis through single-incision videothoracoscopic transmediastinal approach for bilateral spontaneous pneumothorax

“…However, this procedure has some contraindications such as a history of sternotomy or thoracotomy, intolerance to one-lung ventilation, fatty mediastinum, a remnant large thymus, lung bullae/blebs are located in the hilum and posterior or basal region, cardiac and vascular abnormalities. [ 10 ] Therefore, a meticulous preoperative CT evaluation should be carried out for all patients. The TMA-VATS technique was applied using a multi-port approach for much of the study.…”

Unilateral single-port thoracoscopic surgery for bilateral pneumothorax or pulmonary bullae

“…In 2011, Cho et al [24] introduced a method of bilateral VATS surgery via the posterior mediastinum (between esophagus and vertebrae). In 2013, Song Nan et al [25] introduced the anterior mediastinal video-assisted thoracic treatment of bilateral pneumothorax surgery, which considered that it is better to enter through the right side of the thoracic mediastinum. Postoperative pain was lighter.…”

Single-staged uniportal VATS in the supine position for simultaneous bilateral primary spontaneous pneumothorax

“…The trans-mediastinal thoracoscopic approach using multi-ports already has been demonstrated for simultaneous resection for bilateral bullae lesions with satisfactory results [ 17 – 19 ]. In a single port surgery, it is thought to be difficult to manipulate the thoracoscopic instruments for mediastinal dissection through the minimal single incision..…”