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Chirurgie 30. April 2013

Minimally invasive right pneumonectomy: case report

Background: Minimally invasive video-assisted thoracoscopic surgery (VATS) is considered as an alternative to thoracotomy for early-stage lung cancer (Scott et al. Chest 132:234–42, 2007). Since 2009, we have used a VATS approach for all early-stage lung tumors as well as benign indications for lung lobectomy. (Bodner et al. Eur Surg 43:224–8, 2011) As experience with the technique is growing, indications are expanded. Here, we report our first right-sided minimally invasive pneumonectomy.

Patient and methods: A 60-year-old man was diagnosed with a centrally located tumor in the right lung invading all three lobes without any obvious lymph node metastasis in the preoperative work-up. The patient was scheduled for a right-sided VATS pneumonectomy. Written informed consent was given.

Results: The operation was completed using three incisions. A complete mediastinal lymph node dissection was performed. The azygos vein was used for securing of the bronchial stump. For specimen removal, the inferior incision was enlarged to 8 cm. Total operative time was 199 min. Estimated blood loss was less than 100 ml. The patient was extubated in the operating room. The postoperative course was uneventful: chest drain was removed on postoperative day 3; the patient was off pain medication on postoperative day 5, and was discharged on postoperative day 7. Pathologic work-up showed a squamous cell lung cancer invading all lobes with invasion of the right main bronchus. No infiltration was found in the lymph nodes removed (39 lymph nodes in total).

Conclusion: Parenchyma sparing procedures are the preferred type of procedure whenever possible. However, VATS pneumonectomy is feasible in highly selected cases. It offers all advantages known from minimally invasive lung lobectomy with less pain and fast rehabilitation. To facilitate specimen retrieval, the inferior incision should be enlarged because of larger intercostal spaces in this area.

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