Left upper lobectomy with pulmonary artery reconstruction after neoadjuvant therapy in re-VATS

Video-assisted thoracoscopic surgery (VATS) is considered the gold standard for the treatment of early stage non-small-cell lung cancer. Many studies have demonstrated reduced postoperative pain, hospital stay, and morbidity, while achieving the same oncological results. Indeed, it has become a widespread technique in many countries around the world. VATS can be applied also to challenging surgical procedures, such as plasty of the pulmonary artery, to obtain an oncologically radical resection of the tumor, and in the context of an N2 disease even after a previous operation on the thorax. In this case report, we demonstrate how to carry out this procedure safely to achieve radical resection of the diseased tissue.

A novel guidewire technique for endobronchial silicone plug occlusion for bronchopleural fistula

Successful bronchoscopic bronchopleural fistula closure requires both accurate localization of the fistula and device implantation; placing a silicone plug requires experience and skill because of the limited endobronchial working space. We report a novel bronchoscopic silicone plug placement technique for a bronchopleural fistula that developed after a left upper lobectomy following induction chemoradiation therapy, which was then successfully treated by omentopexy.

Left lower lobar lung transplant

A lung transplant is an effective therapeutic option for selected patients with end-stage lung diseases. The shortage of donors is a major limitation for this life-saving therapy, especially in patients with small body sizes or with reduced thoracic cavities, who usually wait longer for grafts with adequate dimensions. Nonanatomic or sublobar graft resections can be sufficient in cases of a small size discrepancy between the donor and the recipient; however, in cases of a greater size mismatch, lobar reduction is mandatory but, because of the associated technical difficulties, only a few centers have adopted this procedure as part of their routine clinical practice. We describe a left upper lobectomy performed at the back table and the subsequent implantation of the left lower lobe in the recipient’s chest cavity.