Video-assisted thoracic surgery involving major pulmonary resection for central tumors

Nakanishi, Ryoichi; Fujino, Yoshihisa; Oka, Soichi; Odate, Seiichi

doi:10.1007/s00464-009-0540-1

Cited by 17 publications

(5 citation statements)

References 31 publications

(39 reference statements)

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“…3,4 The benefits of thoracoscopic surgery over thoracotomy for such a complicated procedure include fewer postoperative complications and an earlier return to full preoperative activities. 5 Thoracoscopic carinal resection and reconstruction was feasible in this patient with good clinical outcomes, including the benefits described above. HFJV using a blocker tube, effective traction using endoscopic devices, and the extensive use of running sutures thus allowed the surgeons to perform thoracoscopic carinal surgery in a patient with mucoepidermoid carcinoma.…”

Section: Discussionmentioning

confidence: 67%

Thoracoscopic carinal resection and reconstruction in a patient with mucoepidermoid carcinoma

Nakanishi

Yamashita

Muranaka

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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Video clip is available online.Resection of any tumor that involves the carina requires a thoracotomy because of technical difficulties in airway management and carinal reconstruction. 1 This report presents the first known case of thoracoscopic carinal resection and reconstruction in a patient with a carinal tumor. CLINICAL SUMMARYA 39-year-old woman rearing 2 children had hemoptysis. Radiologic images showed a carinal tumor without any other associated diseases ( Figure 1). A transbronchial biopsy revealed carcinoma. Thoracoscopic surgery was planned to allow the patient an early return to her normal life.One-lung ventilation was established using an endobronchial blocker tube. Thoracoscopic carinal surgery was begun while viewing only a video monitor, without rib spreading, through an access window measuring 4.0 cm in length that was placed in the third intercostal space on the anterior axillary line and 2 additional 1.2-cm diameter ports placed in the sixth intercostal spaces on the auscultatory triangle and the midaxillary line. Hilar and mediastinal lymph node dissections were performed after division of the pulmonary ligament. The left main bronchus and the trachea were mobilized by blunt dissection. The traction 4-0 monofilament sutures of both the left bronchus and the trachea were extracted to the outside of the body using the Endo Close device (Tyco Healthcare, Norwalk, Conn) through the third and seventh intercostal spaces on the midaxillary line, respectively. The carina measuring 4.0 cm in length with the involved area was then removed with adequate margins that were pathologically negative for malignancy. Anastomosis between the trachea and the left bronchus was primarily performed in an end-to-end fashion with 3-0 absorbable monofilament sutures after reduction of the tension by drawing the traction sutures. The right main bronchus was then implanted below the first anastomosis in an end-to-side fashion. The anastomoses were FIGURE 1. Computed tomographic scans of the chest showing an abnormal mass approximately 2.6 cm in diameter involving the carina. A, Axial view. B, Coronal view. From the Departments of Thoracic Surgery a and Anesthesiology, b Shin-Kokura Hospital, Federation of National Public Service, Personnel Mutual Aid Associations, Kitakyushu, Japan. Disclosures: Authors have nothing to disclose with regard to commercial support.

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Section: Discussionmentioning

confidence: 67%

Thoracoscopic carinal resection and reconstruction in a patient with mucoepidermoid carcinoma

Nakanishi

Yamashita

Muranaka

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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“…The benefits of thoracoscopic surgery versus thoracotomy include fewer postoperative complications and an earlier return to full preoperative activities. [ 2 ] But lung isolation during surgery and a method of ventilation are challenging tasks for anesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

Use of Univent tube for intermittent lung isolation during thoracoscopic mediastinal tracheal resection and reconstruction

Zhang

Xin²,

Ma³

et al. 2017

Medicine

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Rationale:Primary tracheal adenoid cystic carcinoma of the trachea primary is a rare neoplasm and commonly misdiagnosed. Lung isolation during surgery and ventilation pose a tremendous challenge to anesthesiologists.Patient concerns:The authors describe a novel technique of lung isolation and ventilation with a Univent tube during thoracoscopic mediastinal tracheal resection and reconstruction in a female patient.Diagnoses:Primary tracheal adenoid cystic carcinoma, nonsmall cell carcinoma.Interventions:In this case, tracheal resection and reconstruction were performed. A bronchial blocker of the Univent tube was used as a guide to manipulate the depth of endotracheal tube.Outcomes:The intermittent 1-lung ventilation was established successfully. The patient recovered uneventfully and discharged after 10 days.Lessons:The advantages of approach include a stable airway management without occupying the contracted space of thoracoscope and no potential risk of trapping or barotraumas.

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“…However, the intraoperative complication rate does not seem to differ between a primary VATS or thoracotomy approach [ 19 , 20 ]. Moreover, also potential concerns about more extended tumor stages being the reason for higher morbidity rates in thoracotomy can be dismissed as also major pulmonary resections can be safely performed by VATS without an elevated postoperative complication rate [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

External validation of risk prediction scores in patients undergoing anatomic video-assisted thoracoscopic resection

Ponholzer

Chorazy

et al. 2022

Surg Endosc

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Background EuroLung Risk scores were established to predict postoperative morbidity and mortality in patients undergoing anatomic lung resections. We aimed to perform an external validation of the EuroLung scores, which were calculated from data of the European Society of Thoracic Surgeons database, in our video-assisted thoracoscopic surgery cohort. Methods All available EuroLung scores were calculated for 718 patients scheduled for anatomic video-assisted thoracoscopic surgery resections between 2009 and 2019. Morbidity and mortality according to the definitions of the EuroLung scores were analyzed in a prospectively maintained database. Results Overall observed complication rate was 10.45%. Scores showed weak individual correlation (η = 0.155–0.174). The EuroLung1 app score showed the biggest area under the receiver operative characteristic (ROC) curve with 0.660. Binary logistic regression analysis showed that predicted postoperative forced expiratory volume in 1 s was associated with increased complications in both EuroLung1 and parsimonious EuroLung1 scores. Thirty-day mortality was 0.7% (predicted 1.10–1.40%) and was associated with predicted postoperative forced expiratory volume in 1 s for both EuroLung2 and parsimonious EuroLung2 scores. The EuroLung2 (2016) showed the biggest area under the ROC curve with 0.673. Only a very weak eta correlation between predicted and observed mortality was found for both aggregate EuroLung2, EuroLung2 (2016), EuroLung2 (2019), and parsimonious EuroLung2 (2016) (η = 0.025/0.015/0.011/0.009). Conclusion EuroLung scores help to estimate postoperative morbidity. However, even with the highest aggregate EuroLung scores possible only 50% suffer from postoperative morbidity. Although calibration of the scores was acceptable, discrimination between predicted and observed events was poor. Therefore, individual correlation between predicted and observed events is weak. Therefore, EuroLung scores may be best used to compare institutional quality of care to the European Society of Thoracic Surgeons database but should not be used to preclude patients from surgical treatment.

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Video-assisted thoracic surgery involving major pulmonary resection for central tumors

Abstract: The results indicate that VATS involving major pulmonary resection is technically feasible and safe for selected patients with central lung tumors, with an acceptable perioperative outcome compared with open thoracotomy.

Cited by 17 publications

References 31 publications

Thoracoscopic carinal resection and reconstruction in a patient with mucoepidermoid carcinoma

Thoracoscopic carinal resection and reconstruction in a patient with mucoepidermoid carcinoma

Use of Univent tube for intermittent lung isolation during thoracoscopic mediastinal tracheal resection and reconstruction

External validation of risk prediction scores in patients undergoing anatomic video-assisted thoracoscopic resection

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