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Uniportal VATS Lobectomy for inflammatory lung disease

By September 3, 2019volume2-issue1
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Ajay Narasimhan: Uniportal VATS Lobectomy for inflammatory lung disease

Case Report

Uniportal VATS Lobectomy for Inflammatory Lung Disease

Ajay Narasimhan

Institute of Cardiothoracic Surgery, Rajiv gandhi Government General Hospital, Madras Medical College, Chennai
Corresponding Author: Dr.Ajay Narasimhan, Institute of Cardiothoracic Surgery, Rajiv gandhi Government General Hospital, Madras Medical College, Chennai

Corresponding Author: Dr. Dhanasekar, Department of Chest, Sri Ramachandra Institute of Higher Education and Research

How to cite this article: Ajay Narasimhan, Uniportal VATS Lobectomy for inflammatory lung disease, JAPT 2019:2(1):34-35

Introduction

The first reports of VATS lobectomy came around 1992 and was published by Lewis et Al. He published around 100 cases and he followed the simultaneous stapling technique without isolating the hilar structures separately. These surgeries were performed using 4 ports without spreading the ribs. (1)Mc Kenna was the first surgeon to start isolating the structures separately before stapling them. (2)The uniportal era of VATS was born when Diego Gonzales Rivas performed the first lobectomy (3)by this approach in 2011. Since that time this technique has started to gain popularity and being accepted all over the world. However most of the reports of VATS lobectomies are for cancer. Inflammaory diseases are generally considered to be poor candidate for VATS because of extensive adhesions and poorly formed fissures.

We report 2 cases of uniportal VATS lobectomy for inflammatory lung disease performed at our hospital.

Case Report

Case 1

A 37 year old male was diagnosed to have Left Lower lobe bronchiectasis and had complaints of recurrent hemoptysis. He was referred to us for left lower lobectomy. He underwent left lower lobectomy by Uniportal VATS. The patient was given general anaesthesia using double lumen endotracheal tube. He was placed in right lateral position. A single incision of size 5 cm was made in the 5th intercostal space.

Figure 1 – Showing single port with the camera and all instruments through it

Figure 2 – The scar with a single intercostal tube through the wound

Figure 3 – The appearance of the scar 2 weeks post operatively

A 30 degree thoracoscope camera was used. All the instruments were passed through the same port. The adhesions were released using electrocautery. After the adhesions were released, the fissure was tackled. The fissure was stapled using endoscopic green stapler. The pulmonary artery was then identified and transected using endovascular white stapler. The lower lobe pulmonary vein was then tackled in the same way. The left lower lobe bronchus was isolated and stapled using a endoscopic green stapler. After the procedure, a 36 Fr intercostal daring tube was placed through the incision and connected to underwater seal.The ICD was removed on the 5th post operative day. Patient was discharged on the 7th post operative day.

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Case 2

A 57 year old male was diagnosed to have right lower lobe bronchiectasis with recurrent hemoptysis. He was referred for right lower lobectomy. He also underwent right lower lobectomy by the Uniportal approach. (The procedure is similar to the one described above)

Discussion

The world is moving towards minimally invasive surgery. Cosmetic outcomes are not the only reasons for this paradigm shift. It has proven to be a safe and feasible technique with good outcomes, less post operative pain and morbidity and fast recovery time. (4)This technique is slightly more advanced than conventional VATS because all instruments are passed through the same port along with the camera giving the surgeon and assistant very less space to operate in.

Most of the reports from all around the world contain reports of uniportal lobectomies for cancer. However the scenario in our country is different. We see more of benign conditions rather than operable malignancies. Inflammatory diseases are generally considered to be difficult for video assisted thoracoscopic surgery because of extensive adhesions and poorly formed fissures.

The reason for presenting this case is that its being done for the first time at our centre and that too for benign inflammatory condition like bronchiectasis. VATS is not without its share of problems. If any difficulties are anticipated during the procedure such as bleeding, adhesions, difficult fissures etc, one must not hesitate to convert to a formal thoracotomy in the best interest of the patient. This should not be considered a failure of the operation.

Declarations

None

REFERENCES

  1. Lewis RJ, Caccavale RJ, Sisler GE, Bocage JP, Mackenzie JW. One hundred video-assisted thoracic surgical simultaneously stapled lobectomies without rib spreading. Ann Thorac Surg. 1997 May;63(5):1415-21; discussion 1421-2. doi: 10.1016/s0003-4975(97)00254-3. PubMed PMID: 9146336.
  2. McKenna RJ Jr, Houck W, Fuller CB. Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2006 Feb;81(2):421-5; discussion 425-6. doi: 10.1016/j.athoracsur.2005.07.078. PubMed PMID: 16427825.
  3. Gonzalez D, Paradela M, Garcia J, Dela Torre M. Single-port video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg. 2011 Mar;12(3):514-5. doi: 10.1510/icvts.2010.256222. Epub 2010 Dec 5. PubMed PMID: 21131682.
  4. Aragón J, Pérez Méndez I. From open surgery to uniportal VATS: asturias experience. J Thorac Dis. 2014 Oct;6(Suppl 6):S644-9. doi: 10.3978/j.issn.2072-1439.2014.08.53. PubMed PMID: 25379204; PubMed Central PMCID: PMC4221342.

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