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

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.

Download Full-text

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

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01505-y ◽

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.

Download Full-text

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

10.21203/rs.3.rs-88153/v1 ◽

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.

Download Full-text

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

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1633 ◽

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.

Download Full-text

Communicating Bronchopulmonary Foregut Malformation Type IB: Diagnostic and Surgical Challenges

European Journal of Pediatric Surgery Reports ◽

10.1055/s-0041-1740321 ◽

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.

Download Full-text

Esophagopleural fistula after the right lower lobectomy

The Journal of the Japanese Association for Chest Surgery ◽

10.2995/jacsurg.18.5_660 ◽

2004 ◽

Vol 18 (5) ◽

pp. 660-665

Author(s):

Masaya Takizawa ◽

Shigeki Tabata ◽

Hiroshi Saito

Keyword(s):

Lower Lobectomy ◽

The Right ◽

Right Lower Lobectomy

Download Full-text

Uniportal VATS Lobectomy and Decortication: Not an Everyday Occurrence

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984520972370 ◽

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.

Download Full-text

An aberrant mediastinal mediobasal segmental pulmonary artery in a patient with lung cancer undergoing right lower lobectomy: a case report

10.21203/rs.3.rs-922468/v1 ◽

2021 ◽

Author(s):

Kazuyuki Komori ◽

Hiroshi Hashimoto ◽

Kotaro Yoshikawa ◽

Koji Kameda ◽

Shinichi Taguchi ◽

...

Keyword(s):

Lung Cancer ◽

Pulmonary Artery ◽

Ct Angiography ◽

Multidetector Ct ◽

Mediastinal Lymph Node ◽

Pulmonary Veins ◽

Main Pulmonary Artery ◽

Lower Lobectomy ◽

The Right ◽

Right Lower Lobectomy

Abstract Background A mediastinal mediobasal segmental pulmonary artery (A7) from the right main pulmonary artery is extremely rare. Case presentation: We have reported a case of a 71-year-old woman with aberrant A7 who underwent right lower lobectomy for lung cancer (cT1bN0M0, stage IA2). Preoperative three-dimensional computed tomography (CT) angiography revealed an aberrant mediastinal A7 from the right main pulmonary artery. Right lower lobectomy and mediastinal lymph node dissection were performed. Intraoperatively, A7 was observed between the superior and inferior pulmonary veins, and at the front of the lower bronchus near the anterior hilum. The artery was carefully dissected from the caudal side after dissection of the inferior pulmonary vein. Then, the lung parenchyma, which was within the fissure due to poor lobulation between the middle and lower lobes, was safely divided. Conclusions Thoracic surgeons need to evaluate CT angiography or enhanced multidetector CT carefully at preoperative conferences and always keep this anomaly in mind.

Download Full-text