Modified bronchial anastomosis in video-assisted thoracoscopic sleeve lobectomy: a report of 32 cases

Abstract

Background: Bronchial anastomosis is a key technical challenge in sleeve lobectomy, especially when using the video-assisted thoracoscopic surgery (VATS) approach. A retrospective study was conducted to evaluate the feasibility and safety of a modified bronchial anastomosis technique developed by the authors at Fujian Union Hospital.Methods: From October 2010 to October 2015, we performed 32 cases of VATS sleeve lobectomy through a three-port or single-port approach. All bronchial anastomoses were performed using modified bronchial anastomosis technique: the bronchial anastomosis was begun with an initial stitch on the posterior wall, and the bilateral quarters of the circumference were continuously sutured. The other two bilateral quarters were then similarly sutured, and the last knot was made outside the bronchial lumen.Results: All cases were completed uneventfully. No perioperative deaths or serious complications occurred.The mean operative time, bronchial anastomosis time, and blood loss volume were 271.8±67.5, 37.6±12.0 min, and 177.5±102.9 mL, respectively. The mean follow-up time was 21.0±11.7 months, and the follow-up rate was 96.9% (31/32). An electronic bronchoscope scan was performed 6 months after surgery, and a fine healing stoma was detected in all cases. No anastomotic fistula, anastomotic stenosis, or other serious postoperative anastomotic complications occurred until the end of follow-up.Conclusions: Modified bronchial anastomosis technique applied in bronchial anastomosis was safe and feasible in three-port and single-port VATS sleeve lobectomy with good short-term and long-term therapeutic results. Adequate management of the operative process and implementation of a skilled bronchial anastomosis technique could help to reduce the difficulty of VATS sleeve lobectomy.

Robotic sleeve resection for pulmonary disease

“…The first study describing video-assisted thoracoscopic (VATS) sleeve lobectomy was reported in 2002 [ 13 ]; after more than 10 years, there have been only a small number of case series reports [ 14 – 18 ], although the morbidity, mortality, and survival were comparable between VATS sleeve lobectomy and thoracotomy. The slow adoption of the thoracoscopic technique for sleeve resection is mainly due to the technical challenges involved in the bronchial anastomosis in VATS and its steep learning curve [ 19 ].…”

“…Nakamura and associates [ 27 ] reported an anastomosis with 16 stitches of interrupted sutures that required a long time because the thread was loosened or cut while ligating. In VATS sleeve lobectomy, Chen and colleagues reported a mean anastomosis time of 37.6 ± 12.0 min [ 18 ], and Wang and associates reported a median time of 44 (37–48) minutes for bronchial anastomosis [ 15 ]. The main features of our experience are the suture mode and segment bronchial sleeve resection without pulmonary resection.…”

Video-assisted thoracoscopic surgery bronchial sleeve lobectomy

“…Chen et al (19) proposed an interesting modified anastomotic technique for VATS SL; in particular, we focused on a RM and right lower (RL) VATS SL performed by a uniportal approach.…”

“…The Authors put one chest drainage through the operating port and a posterior venous catheter in the seventh or the eighth intercostal space. They documented a successful series of 32 VATS SL carried out by a threeportal (19) or a uniportal (5) approach without intraoperative deaths nor major complications due to surgery.…”

“…Regardless of the number of ports, most of the minimally invasive approaches are anterior: both the operative surgeon than the assistant who holds the camera, are positioned in front of the patient. However, some authors (19) describe the assistant opposite to the first surgeon in uniportal procedures, with a central monitor at the head of the patient.…”