Right upper lobectomy for large apical tuberculosis cavity using videothoracoscopy: focus on the use of curved endoscopic instruments
Epublication WebSurg.com, Jun 2015;15(06). URL: http://websurg.com/doi/vd01en4524
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.