scholarly journals Stapling of an endobronchial suction tube with the bronchus during robot-assisted right lower lobectomy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hiroto Tanaka ◽  
Teruhiro Aoki ◽  
Makoto Oda ◽  
Yoshimasa Inoue
Keyword(s):  
Thoracic Surgery ◽  
Intraoperative Complications ◽  
Clinical Stage ◽  
Lower Lobe ◽  
Robot Assisted ◽  
Bronchial Stump ◽  
Suction Tube ◽  
Lower Lobectomy ◽  
The Right ◽  
Right Lower Lobectomy

Abstract Background Troubleshooting intraoperative complications requires careful management, and the safest technique should be chosen. We recently experienced a unique intraoperative bronchial complication during pulmonary lobectomy in robot-assisted thoracic surgery (RATS). There is no consensus on whether to continue RATS or convert to a more familiar technique, such as video-assisted thoracic surgery (VATS) or thoracotomy, for intraoperative complications that occur during RATS, and the decision should be determined individually. Case presentation A 74-year-old woman with primary lung adenocarcinoma (clinical stage IA2) underwent robot-assisted right lower lobectomy under one-lung ventilation and CO2 insufflation. Intraoperatively, the anesthesiologist placed the endobronchial suction tube in the right bronchus with intention of maintaining the right lung collapse, which was simultaneously stapled with the right lower bronchus during the right lower lobe bronchial closure using a robotic stapler. During robot-assisted manipulation, we removed the staples involved with the suction tube, one by one, using robotic-arm forceps and sutured the partially opened stump. Subsequently, the bronchial stump was covered with a pedicled pericardial fat pad. The postoperative course was uneventful, and the patient developed no complications when followed up 8 months after discharge. Hence, we could rectify this intraoperative bronchial complication using a robot-assisted technique and avoid conversion to VATS or thoracotomy. Conclusion The precise manipulation techniques in RATS contributed to facilitate the successful execution of surgical procedures, such as staple removal and re-suturing of the bronchial stump and may be a useful as a method for such troubleshooting such intraoperative complications.

Right Lower Lobectomy With Middle Lobe Preservation After Right Upper Lobectomy in Lung Cancer of the Right Lower Lobe

2013 ◽  
Vol 96 (6) ◽  
pp. 2227-2230 ◽  
Author(s):  
Naohiro Taira ◽  
Tsutomu Kawabata ◽  
Atsushi Gabe ◽  
Takaharu Ichi ◽  
Kazuaki Kushi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lower Lobe ◽  
Middle Lobe ◽  
Lower Lobectomy ◽  
The Right ◽  
Middle Lobe Preservation ◽  
Right Lower Lobectomy

Four arms robotic right lower lobectomy for giant bullous emphysema localised in the right lower lobe, complicated by chronic inflammatory status

ASVIDE ◽  
2018 ◽  
Vol 5 ◽  
pp. 053-053
Author(s):  
Alessandro Pardolesi ◽  
Luca Bertolaccini ◽  
Jury Brandolini ◽  
Filippo Tommaso Gallina ◽  
Pierluigi Novellis ◽  
...  
Keyword(s):  
Lower Lobe ◽  
Lower Lobectomy ◽  
Inflammatory Status ◽  
The Right ◽  
Right Lower Lobectomy

Uniportal VATS Lobectomy and Decortication: Not an Everyday Occurrence

2020 ◽  
pp. 155698452097237
Author(s):  
Joshua S. Newman ◽  
Alexandra S. Renzi ◽  
Lawrence Glassman ◽  
Paul C. Lee ◽  
Julissa Jurado ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Thoracic Surgery ◽  
Young Patient ◽  
Lower Lobe ◽  
Lung Lesion ◽  
Vats Lobectomy ◽  
Postoperative Course ◽  
Lower Lobectomy ◽  
Trapped Lung ◽  
Right Lower Lobectomy

Management of trapped lung with an underlying lung lesion and hydropneumothorax remains controversial. Furthermore, Aspergillus empyema and aspergilloma are rare pathologies for which uniportal video-assisted thoracoscopic (VATS) surgical management remains controversial. We present a young patient referred to our service after recent hospitalization for pneumonia. The patient was found to have a chronic effusion with a right lower lobe cystic parenchymal lesion and was taken to the operating room. The patient underwent right uniportal VATS surgery with evacuation of empyema, total pulmonary decortication, and right lower lobectomy. His postoperative course was unremarkable, and he was discharged home. Postoperative workup demonstrated lymphocyte variant hypereosinophilia. He continues to follow with thoracic surgery at the time of this report and remains asymptomatic. We conclude that uniportal VATS is a most minimally invasive, safe, and efficient approach for management of complex intrathoracic pathology including total pulmonary decortication and lobectomy.

scholarly journals Lung cancer with partial anomalous pulmonary venous connection in a different lobe: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hikaru Watanabe ◽  
Naoki Kanauchi ◽  
Kouhei Abe ◽  
Soumei Matsuo
Keyword(s):  
Lung Cancer ◽  
Pulmonary Veins ◽  
Lower Lobe ◽  
Right Heart ◽  
Lower Lobectomy ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection ◽  
Right Lower Lobectomy ◽  
Circulatory Dynamics

Abstract Background Anomalous pulmonary venous connection (APVC) is a congenital malformation in which the pulmonary veins connect to the systemic venous system but not to the left atrium. APVC can be classified as total or partial (PAPVC). PAPVC is rare among surgical patients with lung cancer, and most cases are detected incidentally during surgery. We herein report a patient with lung cancer in whom PAPVC was diagnosed before surgery, which made it difficult to determine the surgical procedure. Case presentation A 71-year-old man was followed-up as an outpatient after surgery for renal cell carcinoma. Chest computed tomography showed a 22-mm nodule in the right lower lobe and PAPVC in the right upper lobe. He was diagnosed with lung adenocarcinoma (cT1cN0M0 stage IA3) and scheduled for surgery. Preoperative catheterization showed a pulmonary to systemic flow ratio (Qp/Qs) of 1.64 and mean pulmonary artery pressure (MPAP) of 16 mmHg. Surgical repair of PAPVC is indicated when a patient is symptomatic and has a Qp/Qs ≥1.5–2.0. The patient was scheduled for right lower lobectomy, but postoperative worsening of right heart strain was considered. Concomitant PAPVC repair was therefore considered, but he had no atrial septal defect and was asymptomatic; therefore, PAPVC treatment was considered unnecessary. However, we planned to perform concomitant PAPVC repair if his circulatory dynamics worsened during surgery or if his MPAP exceeded 25 mmHg. His MPAP was 20 mmHg and his circulatory dynamics remained stable, and right lower lobectomy was therefore completed. His postoperative course was favorable. Follow-up catheterization at 6 months showed a Qp/Qs of 1.19 and MPAP of 18 mmHg, with no evidence of increased right heart strain. There was no evidence of right heart failure or recurrence of lung cancer at last follow-up at 18 months after surgery. Conclusions We present a case of right lower lung cancer complicated by PAPVC in the right upper lobe. This case suggests that concomitant repair of PAPVC in the right upper lobe may not be necessary when performing right lower lobectomy, although the patient’s Qp/Qs and MPAP should be considered.

Lung cancer with partial anomalous pulmonary venous connection in a different lobe: A case report

2020 ◽  
Author(s):  
Hikaru Watanabe ◽  
Naoki Kanauchi
Keyword(s):  
Lung Cancer ◽  
Pulmonary Veins ◽  
Lower Lobe ◽  
Right Heart ◽  
Lower Lobectomy ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection ◽  
Right Lower Lobectomy ◽  
Circulatory Dynamics

Abstract Background: Anomalous pulmonary venous connection (APVC) is a congenital malformation in which the pulmonary veins connect to the systemic venous system but not to the left atrium. APVC can be classified as total or partial (PAPVC). PAPVC is rare among surgical patients with lung cancer, and most cases are detected incidentally during surgery. We herein report a patient with lung cancer in whom PAPVC was diagnosed before surgery, which made it difficult to determine the surgical procedure.Case presentation: A 71-year-old man was followed-up as an outpatient after surgery for renal cell carcinoma. Chest computed tomography showed a 22-mm nodule in the right lower lobe and PAPVC in the right upper lobe. He was diagnosed with lung adenocarcinoma (cT1cN0M0 stage IA3) and scheduled for surgery. Preoperative catheterization showed a pulmonary to systemic flow ratio (Qp/Qs) of 1.64 and mean pulmonary artery pressure (MPAP) of 16 mmHg. Surgical repair of PAPVC is indicated when a patient is symptomatic and has a Qp/Qs ≥1.5–2.0. The patient was scheduled for right lower lobectomy, but postoperative worsening of right heart strain was considered. Concomitant PAPVC repair was therefore considered, but he had no atrial septal defect and was asymptomatic; therefore, PAPVC treatment was considered unnecessary. However, we planned to perform concomitant PAPVC repair if his circulatory dynamics worsened during surgery or if his MPAP exceeded 25 mmHg. His MPAP was 20 mmHg and his circulatory dynamics remained stable, and right lower lobectomy was therefore completed. His postoperative course was favorable. Follow-up catheterization at 6 months showed a Qp/Qs of 1.19 and MPAP of 18 mmHg, with no evidence of increased right heart strain. There was no evidence of right heart failure or recurrence of lung cancer at last follow-up at 18 months after surgery.Conclusions: We present a case of right lower lung cancer complicated by PAPVC in the right upper lobe. This case suggests that concomitant repair of PAPVC in the right upper lobe may not be necessary when performing right lower lobectomy, although the patient’s Qp/Qs and MPAP should be considered.

scholarly journals How to avoid en masse lobectomy using VATS technique in presence of hilar fibrosis

2021 ◽  
Author(s):  
Dario Amore ◽  
Dino Casazza ◽  
Alessandro Saglia ◽  
Pasquale Imitazione ◽  
Umberto Caterino ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Lower Lobe ◽  
Lower Lobectomy ◽  
Challenging Issue ◽  
Thoracoscopic Lobectomy ◽  
Increased Risk ◽  
The Right ◽  
Segmental Arteries ◽  
Right Lower Lobectomy

Perivascular fibrosis is technically one of the most challenging issue to manage during thoracoscopic lobectomy and it is associated with increased risk of hemorrhagic injury. Here we report a case of thoracoscopic right lower lobectomy performed with individual dissection of segmental arteries due to dense adventitial fibrosis around the right lower lobe pulmonary artery. This approach may be considered as an alternative to the so-called “en masse” lobectomy and a way to avoid conversion to thoracotomy.

Transcervical Wedge Resection after Transcervical Extended Mediastinal Lymphadenectomy

2014 ◽  
Vol 9 (4) ◽  
pp. 327-329 ◽  
Author(s):  
Anthony W. Kim ◽  
David R. Kull ◽  
Marcin Zieliński ◽  
Daniel J. Boffa ◽  
Frank C. Detterbeck
Keyword(s):  
Wedge Resection ◽  
Clinical Stage ◽  
Lower Lobe ◽  
Lymph Node Involvement ◽  
Adenomatous Hyperplasia ◽  
Mediastinal Lymphadenectomy ◽  
Cervical Approach ◽  
Node Involvement ◽  
Right Lower Lobectomy ◽  
Lung Resections

Transcervical extended mediastinal lymphadenectomy (TEMLA) has been shown to be feasible and safe. This approach may be underrecognized for providing excellent access to the pleural space. We present a 60-year-old woman who had a clinical stage T2b N0 M0 adenocarcinoma of her right lower lobe and several ground glass opacities throughout her upper lobes bilaterally. She underwent a TEMLA to confirm absence of lymph node involvement in her mediastinum. During the same anesthetic setting, a transpleural right upper lobe wedge resection via the cervical approach was performed as an extension of her TEMLA. The pathology from this wedge resection demonstrated atypical adenomatous hyperplasia. Ultimately, she underwent a thoracoscopic right lower lobectomy that confirmed that she had a pathologic T2b N0 M0 (5.0 × 4.0 × 3.0 cm) adenocarcinoma. There were no perioperative adverse events with either operation. Transcervical extended mediastinal lymphadenectomy and transcervical lung resections may be performed safely during the same anesthetic setting.

scholarly journals Communicating Bronchopulmonary Foregut Malformation Type IB: Diagnostic and Surgical Challenges

2021 ◽  
Vol 09 (01) ◽  
pp. e80-e83
Author(s):  
Bhushanrao Jadhav ◽  
Ranjithatharsini Vaseeharan ◽  
Prabhu Sekaran ◽  
Semiu Eniola Folaranmi ◽  
Karim Awad
Keyword(s):  
Primary Repair ◽  
Lower Lobe ◽  
Duodenal Atresia ◽  
Complex Case ◽  
Foregut Malformation ◽  
The Right ◽  
High Index Of Suspicion ◽  
Contrast Swallow ◽  
Right Lower Lobectomy ◽  
Upper Gastrointestinal

AbstractCommunicating bronchopulmonary foregut malformations (CBPFM) are extremely rare. We present a complex case of type IB CBPFM with esophageal atresia and distal tracheoesophageal fistula (EA/TOF), duodenal atresia/annular pancreas (DA/AP), and intestinal malrotation who underwent primary repair for EA/TOF on day 3. Bilious aspirates on day 8 prompted an upper gastrointestinal (GI) contrast revealing a duodenal obstruction and communication between the right lung lower lobe and the esophagus (T8-T9 level). DA/AP and malrotation were repaired by a gastrojejunostomy and Ladd's procedure. A repeat contrast swallow identified a 2nd communication from the esophagus into the right lower lobe (T5-T6 level) raising the suspicion of a recurrent TOF. Computed tomography (CT) thorax confirmed above findings with an anomalous blood supply to right lung. An exploratory thoracotomy identified a three-lobed lung. However, the lower lobe was enlarged and connected in two separate locations to the esophagus. The child recovered after the disconnection of the esophageal connections and partial right lower lobectomy. CBPFM are extremely rare anomalies requiring a high index of suspicion, use of an upper GI contrast series, and CT scans for diagnosis. The treatment of choice is resection of the affected lung and disconnection of the esophageal communications.

scholarly journals Pathological Complete Response After Immune-Checkpoint Inhibitor Followed by Salvage Surgery for Clinical Stage IV Pulmonary Adenocarcinoma with Continuous Low Neutrophil-to-Lymphocyte Ratio: A Case Report

2020 ◽  
Author(s):  
Mitsunori Higuchi ◽  
Takahiro Kawamata ◽  
Ikuro Oshibe ◽  
Nobutoshi Soeta ◽  
Takuro Saito ◽  
...  
Keyword(s):  
T Cells ◽  
Partial Response ◽  
Lymph Nodes ◽  
Pathological Complete Response ◽  
Clinical Stage ◽  
Lower Lobe ◽  
Stage Iv ◽  
Complete Response ◽  
Mediastinal Lymph Nodes ◽  
The Right

Abstract Background: Immune-checkpoint inhibitors (ICIs) play a crucial role in the treatment of advanced non-small cell lung cancer (NSCLC), however, most patients fail this treatment after a limited period. We here report a patient with a pathological complete response (CR) after treatment with ICI for stage IV pulmonary adenocarcinoma.Case presentation: A 73-year-old man was referred to our hospital because of hoarseness. A roentgenogram and chest CT scan revealed a huge (78-mm diameter) pulmonary tumor in the right upper lobe and a tumor with cavitation in the left lower lobe. A CT scan also showed enlarged upper mediastinal lymph nodes. Transbronchial lung biopsy (TBLB) of the tumors showed adenocarcinomas in both. The tumor in the right upper lobe was considered to be the primary with mediastinal lymph nodes metastasis and that in the left lower lobe a pulmonary metastasis. The disease was determined to be cT4N2M1a stage IVA after whole body evaluation . He was treated with first line chemotherapy comprising cisplatin, pemetrexed, and bevacizumab for six cycles, achieving a partial response. However, 6 months after initial treatment, the primary and metastatic tumors enlarged and he was treated with second line anti-PD-1 therapy for 7 months with a partial response. 18-fluorodeoxyglucose positron emission tomography (FDG-PET) revealed weak accumulation of FDG in the primary tumor only with no accumulation in the left pulmonary metastasis or mediastinal lymph nodes, despite the lymph nodes still being enlarged. He was diagnosed as having ycT1bN0M0 stage IA2 disease and underwent right upper lobectomy. Postoperative pathological findings revealed that cancer tissues had been replaced by scar tissue and that CD4 positive T cells, rather than CD8 positive T cells, were predominant. It was also noted that he had a lower neutrophil-to-lymphocyte ratio (NLR) during immunotherapy than before immunotherapy and after surgery. He was diagnosed to be ypT0N0M0 stage 0 (Ef.3). His postoperative course was uneventful and he remained well for twelve months after surgery with no further treatment.Conclusions: Neoadjuvant chemotherapy with ICIs for advanced NSCLC may be a promising modality, even for clinical stage IV disease, in the near future. Furthermore, NLR during immunotherapy may be a promising biomarker of ICIs treatment.

Sign in / Sign up

Export Citation Format

Share Document