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Laura HADDAD

Hôpital Charles Nicolle
Rouen, France
MD
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Right upper lobectomy for large apical tuberculosis cavity using videothoracoscopy: focus on the use of curved endoscopic instruments
A 36-year-old patient was treated for tuberculosis for two years in Georgia. However, treatment failed. After a 3-month treatment in France, CT-scan showed a persistent tuberculous cavity in the right upper lobe, which seemed totally destroyed, associated with bilateral opacities. The patient was still multi-bacillary. A right upper lobectomy by videothoracoscopy was performed. Dissection of the right upper lobe, fully retracted on the apex, was facilitated by the use of an ENSEAL® G2 articulating tissue sealer (Ethicon Endosurgery), a curved vacuum, and the ENDOEYE FLEX 3D (Olympus) articulated camera. The ENSEAL® articulated bipolar forceps facilitated the perpendicular approach to the superior lobar vessels, which were all sheathed by inflamed tissues, and improved dissection of retractile adhesions to the pulmonary apex and mediastinum. It made the handling of hemorrhagic tissue easier. The 3D camera allowed an accurate visualization of these complex anatomical relationships. Drains were removed on postoperative day 6. The BK sputum was negative postoperatively and at 5 months. CT-scan at 2 months is satisfactory with a regression of bilateral opacities. Videothoracoscopy using articulated endoscopic instruments is a relevant technique for the resection of tuberculous lesions, even when lesions are large and retractile.
Surgical intervention
4 years ago
978 views
36 likes
0 comments
07:35
Right upper lobectomy for large apical tuberculosis cavity using videothoracoscopy: focus on the use of curved endoscopic instruments
A 36-year-old patient was treated for tuberculosis for two years in Georgia. However, treatment failed. After a 3-month treatment in France, CT-scan showed a persistent tuberculous cavity in the right upper lobe, which seemed totally destroyed, associated with bilateral opacities. The patient was still multi-bacillary. A right upper lobectomy by videothoracoscopy was performed. Dissection of the right upper lobe, fully retracted on the apex, was facilitated by the use of an ENSEAL® G2 articulating tissue sealer (Ethicon Endosurgery), a curved vacuum, and the ENDOEYE FLEX 3D (Olympus) articulated camera. The ENSEAL® articulated bipolar forceps facilitated the perpendicular approach to the superior lobar vessels, which were all sheathed by inflamed tissues, and improved dissection of retractile adhesions to the pulmonary apex and mediastinum. It made the handling of hemorrhagic tissue easier. The 3D camera allowed an accurate visualization of these complex anatomical relationships. Drains were removed on postoperative day 6. The BK sputum was negative postoperatively and at 5 months. CT-scan at 2 months is satisfactory with a regression of bilateral opacities. Videothoracoscopy using articulated endoscopic instruments is a relevant technique for the resection of tuberculous lesions, even when lesions are large and retractile.
Robotic assisted resection of a complex thymoma
Our objective is to demonstrate the management of a very complex mediastinal tumor. To do so, a minimally invasive resection is used, highlighting the benefit of a robotic approach.
The present case is that of a 64-year-old patient diagnosed with an anterior mediastinal mass discovered during myasthenia assessment with positive antibodies.
The tumor was in contact with the aorta, pulmonary artery, and the innominate vein with probable pericardial invasion.
Given such a complex localization, the challenge was to propose a radical resection using minimally invasive surgery with robotic assistance.
As compared to a VATS approach, a robotic approach provides a better view and instruments to achieve complete resection in complex mediastinal tumor. What is important to first control on the CT-scan is the size of the tumor as compared to the thoracic cavity’s size which will allow robotic surgery with a good operative field.
Pericardial resection associated with a lateral plasty of the innominate vein were required to achieved complete R0 resection. The entire resection was performed using a bipolar forceps.
The postoperative course was uneventful. The patient is discharged on postopeartive day 3. The phrenic nerve was preserved.
Pathological analysis of the operative specimen is evocative of a B1 thymoma classified IIb on the Masaoka staging system with complete R0 resection (margins were clear).
The entire file was discussed at the Rhythmic meeting, which is the national meeting for thymoma tumor management held every two weeks. A simple survey was put forward without any adjuvant radiotherapy.
Surgical intervention
4 years ago
1167 views
26 likes
0 comments
07:19
Robotic assisted resection of a complex thymoma
Our objective is to demonstrate the management of a very complex mediastinal tumor. To do so, a minimally invasive resection is used, highlighting the benefit of a robotic approach.
The present case is that of a 64-year-old patient diagnosed with an anterior mediastinal mass discovered during myasthenia assessment with positive antibodies.
The tumor was in contact with the aorta, pulmonary artery, and the innominate vein with probable pericardial invasion.
Given such a complex localization, the challenge was to propose a radical resection using minimally invasive surgery with robotic assistance.
As compared to a VATS approach, a robotic approach provides a better view and instruments to achieve complete resection in complex mediastinal tumor. What is important to first control on the CT-scan is the size of the tumor as compared to the thoracic cavity’s size which will allow robotic surgery with a good operative field.
Pericardial resection associated with a lateral plasty of the innominate vein were required to achieved complete R0 resection. The entire resection was performed using a bipolar forceps.
The postoperative course was uneventful. The patient is discharged on postopeartive day 3. The phrenic nerve was preserved.
Pathological analysis of the operative specimen is evocative of a B1 thymoma classified IIb on the Masaoka staging system with complete R0 resection (margins were clear).
The entire file was discussed at the Rhythmic meeting, which is the national meeting for thymoma tumor management held every two weeks. A simple survey was put forward without any adjuvant radiotherapy.