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Standardized steps for robotic right upper lung lobectomy
Video-assisted thoracoscopic surgery has been accepted as a safe and effective technique for the treatment of non-small cell lung cancer. The robot-assisted technologies have been rapidly applied to general thoracic surgery and many studies have proven their efficacy.
This video reports the case of a 64-year-old patient complaining of cough and mild dyspnea secondary to a double nodule localized on the right upper lobe and which showed fixations on PET-scan. There was also a fixation of a hilar lymph node with a clinical T3N1 disease according to the TNM staging system. We report the 4 standardized operative steps and exposure required to make a complete robotic right upper lobectomy, along with trocars positioning, the different techniques for lymph node dissections, and postoperative outcomes.
JM Baste, Z Chaari
Surgical intervention
3 months ago
630 views
12 likes
1 comment
07:57
Standardized steps for robotic right upper lung lobectomy
Video-assisted thoracoscopic surgery has been accepted as a safe and effective technique for the treatment of non-small cell lung cancer. The robot-assisted technologies have been rapidly applied to general thoracic surgery and many studies have proven their efficacy.
This video reports the case of a 64-year-old patient complaining of cough and mild dyspnea secondary to a double nodule localized on the right upper lobe and which showed fixations on PET-scan. There was also a fixation of a hilar lymph node with a clinical T3N1 disease according to the TNM staging system. We report the 4 standardized operative steps and exposure required to make a complete robotic right upper lobectomy, along with trocars positioning, the different techniques for lymph node dissections, and postoperative outcomes.
Incidental finding of a voluminous bronchogenic cyst in a 13-year-old child
This rare case of a giant bronchogenic cyst in the lower right hemithorax allows to provide the following tips: patient positioning and port placement should allow for a 180-degree reversal of the screen and free movement of the surgical team; use of a LigaSure™ vessel-sealing device used as a dissection instrument in lung surgery is helpful but does not guarantee perfect aerostasis, which should be controlled by taking enough time at the end of the procedure when reventilating an excluded lobe intraoperatively; along with low intrathoracic carbon dioxide insufflation, the use of a blocker in pediatric thoracoscopic surgery is an unconditional factor, which contributes to a satisfactory operating field.
F Becmeur, L Donato
Surgical intervention
1 year ago
958 views
0 likes
0 comments
05:31
Incidental finding of a voluminous bronchogenic cyst in a 13-year-old child
This rare case of a giant bronchogenic cyst in the lower right hemithorax allows to provide the following tips: patient positioning and port placement should allow for a 180-degree reversal of the screen and free movement of the surgical team; use of a LigaSure™ vessel-sealing device used as a dissection instrument in lung surgery is helpful but does not guarantee perfect aerostasis, which should be controlled by taking enough time at the end of the procedure when reventilating an excluded lobe intraoperatively; along with low intrathoracic carbon dioxide insufflation, the use of a blocker in pediatric thoracoscopic surgery is an unconditional factor, which contributes to a satisfactory operating field.
Thoracoscopic treatment of pulmonary hydatid cyst in children
Introduction: The hydatid cyst is an anthropozoonosis caused by the development of the Echinococcus granulosus tapeworm larva in humans. It is endemic in the Mediterranean, South America, Middle East, Australia, New Zealand, and India. Lung localization is ranked second in order of frequency for all age groups after liver localization.
Treatment is mainly surgical and consists in the resection of the protruding dome after cyst puncture, suction, and sterilization using a Scolicide solution followed by proligerous membrane extraction and bronchial fistulas obstruction. This surgery can be performed through a thoracotomy or a thoracoscopy.
We report the highlights of a thoracoscopic surgical management of a bilateral pulmonary hydatid cyst in a 6-year-old boy. The cyst was discovered following exploration for chest pain associated with a dry cough, as demonstrated by chest CT-scan findings and confirmed by serum chemistries positive for pulmonary hydatid cyst.
Materials and methods: The patient was first operated on for his two hydatid cysts of the right lung, followed by another left-side intervention a month later. Intubation was selective and was performed with a standard intubation cannula.
The patient was placed in a strict lateral decubitus position.
Four ports (10, 5, 5, and 5mm in size) were used for the right lung and three ports (10, 5, and 5mm) were used for the left lung, making sure to respect the rule of triangulation.
After partial filling of the pleural cavity with a 10% hypertonic saline solution, the surgical principles of the thoracoscopic treatment of pulmonary hydatid cysts are performed as follows: puncture of the cyst at its dome using a Veress needle, suction, and sterilization with a 10% hypertonic saline solution for 15 minutes; resection of the protruding dome; extraction of the proligerous membrane through an Endobag®; closure of bronchial fistulas by means of intracorporeal stitches; no padding necessary; double chest drainage (anterior and posterior).
Results: Immediate postoperative outcomes were uneventful. Paracetamol was sufficient to manage postoperative pain in the first 24 hours. Chest drains were removed on postoperative day 3, and the patient was discharged on postoperative day 4.
After 5 years, late postoperative outcomes were extremely favorable clinically, radiologically, and cosmetically speaking.
Conclusion: The thoracoscopic approach to the management of pulmonary hydatid cysts is feasible. It completely changed the postoperative evolution of thoracotomy, which causes pain and parietal sequelae in children.
AM Benaired
Surgical intervention
2 years ago
1367 views
144 likes
0 comments
04:03
Thoracoscopic treatment of pulmonary hydatid cyst in children
Introduction: The hydatid cyst is an anthropozoonosis caused by the development of the Echinococcus granulosus tapeworm larva in humans. It is endemic in the Mediterranean, South America, Middle East, Australia, New Zealand, and India. Lung localization is ranked second in order of frequency for all age groups after liver localization.
Treatment is mainly surgical and consists in the resection of the protruding dome after cyst puncture, suction, and sterilization using a Scolicide solution followed by proligerous membrane extraction and bronchial fistulas obstruction. This surgery can be performed through a thoracotomy or a thoracoscopy.
We report the highlights of a thoracoscopic surgical management of a bilateral pulmonary hydatid cyst in a 6-year-old boy. The cyst was discovered following exploration for chest pain associated with a dry cough, as demonstrated by chest CT-scan findings and confirmed by serum chemistries positive for pulmonary hydatid cyst.
Materials and methods: The patient was first operated on for his two hydatid cysts of the right lung, followed by another left-side intervention a month later. Intubation was selective and was performed with a standard intubation cannula.
The patient was placed in a strict lateral decubitus position.
Four ports (10, 5, 5, and 5mm in size) were used for the right lung and three ports (10, 5, and 5mm) were used for the left lung, making sure to respect the rule of triangulation.
After partial filling of the pleural cavity with a 10% hypertonic saline solution, the surgical principles of the thoracoscopic treatment of pulmonary hydatid cysts are performed as follows: puncture of the cyst at its dome using a Veress needle, suction, and sterilization with a 10% hypertonic saline solution for 15 minutes; resection of the protruding dome; extraction of the proligerous membrane through an Endobag®; closure of bronchial fistulas by means of intracorporeal stitches; no padding necessary; double chest drainage (anterior and posterior).
Results: Immediate postoperative outcomes were uneventful. Paracetamol was sufficient to manage postoperative pain in the first 24 hours. Chest drains were removed on postoperative day 3, and the patient was discharged on postoperative day 4.
After 5 years, late postoperative outcomes were extremely favorable clinically, radiologically, and cosmetically speaking.
Conclusion: The thoracoscopic approach to the management of pulmonary hydatid cysts is feasible. It completely changed the postoperative evolution of thoracotomy, which causes pain and parietal sequelae in children.
Right upper lobectomy: how I do it?
The anterior approach to right upper lobectomies is the most standard one, although it is not always the easiest one. As stressed by Dr. Baste, anterior dissection of the hilum can be hazardous and requires attention. Based on demonstrative pictures and videos, Dr. Baste outlines the global preoperative and intraoperative approach used routinely at Rouen’s Teaching Hospital. The description of the technique is mainly inspired from the Danish team (Hansen et al., Surgical Endoscopy). Surgical safety is one of the key objectives of this approach with preventative methods and intraoperative management techniques in case of injury. Preoperatively, CT-scan analysis is highlighted and patient set-up is described.
The intraoperative step is also described meticulously, and notably the D-zone, which represents the most dangerous zone during the resection.
JM Baste
Lecture
3 years ago
1461 views
94 likes
0 comments
13:30
Right upper lobectomy: how I do it?
The anterior approach to right upper lobectomies is the most standard one, although it is not always the easiest one. As stressed by Dr. Baste, anterior dissection of the hilum can be hazardous and requires attention. Based on demonstrative pictures and videos, Dr. Baste outlines the global preoperative and intraoperative approach used routinely at Rouen’s Teaching Hospital. The description of the technique is mainly inspired from the Danish team (Hansen et al., Surgical Endoscopy). Surgical safety is one of the key objectives of this approach with preventative methods and intraoperative management techniques in case of injury. Preoperatively, CT-scan analysis is highlighted and patient set-up is described.
The intraoperative step is also described meticulously, and notably the D-zone, which represents the most dangerous zone during the resection.
Alternative fissureless technique: VATS ‘tunnel’ and ‘fissure first’ technique with staplers
Over the last years, the fissureless technique for thoracoscopic major pulmonary resections has become very popular. In this technique, the surgeon does not care about the fissure and its contents and staples it “en bloc” at completion of the lobectomy. The main advantage is its relative ease and rapidity. However, some anatomical variations make this technique hazardous and some surgeons do prefer a “fissure-based” technique with first dissection of vascular elements in the fissure. When the fissure is fused, this technique is difficult and can lead to troublesome oozing and postoperative air leaks. In these cases, the “tunnel technique”, which is presented here by Dr. Decaluwe, is very helpful.
H Decaluwe
Lecture
3 years ago
861 views
43 likes
0 comments
15:00
Alternative fissureless technique: VATS ‘tunnel’ and ‘fissure first’ technique with staplers
Over the last years, the fissureless technique for thoracoscopic major pulmonary resections has become very popular. In this technique, the surgeon does not care about the fissure and its contents and staples it “en bloc” at completion of the lobectomy. The main advantage is its relative ease and rapidity. However, some anatomical variations make this technique hazardous and some surgeons do prefer a “fissure-based” technique with first dissection of vascular elements in the fissure. When the fissure is fused, this technique is difficult and can lead to troublesome oozing and postoperative air leaks. In these cases, the “tunnel technique”, which is presented here by Dr. Decaluwe, is very helpful.
Laparoscopic management of a pediatric bronchogenic cyst in a 6-year-old boy
We report the case of a 6-year-old boy who presented with an infectious bronchopulmonary episode during which a plain anterior chest X-ray was performed. The X-ray showed an opacity at the right apex. A thoracic CT-scan allowed to demonstrate the presence of a right superior and posterior mediastinal cystic structure, which could be either a non-communicating cystic duplication of the esophagus, or a bronchogenic cyst.
The 3D CT-scan image modeling analysis allowed the surgeon to become familiar with a benign superior mediastinal cystic tumor including its surrounding anatomical structures. The tumor was immediately found above the arch of the azygos vein laterally to the superior vena cava and to the right phrenic nerve, and anteriorly to the right vagus nerve.
The resection was performed thoracoscopically, without any difficulty after a small opening of the mediastinal pleura in order to provide direct access to the paramedian cyst.
Pathological findings demonstrated the presence of a bronchogenic cyst without any communication with the airway tree or the esophagus. Postoperative outcomes were uneventful and the patient was rapidly discharged from hospital.
F Becmeur, C Boff
Surgical intervention
4 years ago
907 views
45 likes
0 comments
04:49
Laparoscopic management of a pediatric bronchogenic cyst in a 6-year-old boy
We report the case of a 6-year-old boy who presented with an infectious bronchopulmonary episode during which a plain anterior chest X-ray was performed. The X-ray showed an opacity at the right apex. A thoracic CT-scan allowed to demonstrate the presence of a right superior and posterior mediastinal cystic structure, which could be either a non-communicating cystic duplication of the esophagus, or a bronchogenic cyst.
The 3D CT-scan image modeling analysis allowed the surgeon to become familiar with a benign superior mediastinal cystic tumor including its surrounding anatomical structures. The tumor was immediately found above the arch of the azygos vein laterally to the superior vena cava and to the right phrenic nerve, and anteriorly to the right vagus nerve.
The resection was performed thoracoscopically, without any difficulty after a small opening of the mediastinal pleura in order to provide direct access to the paramedian cyst.
Pathological findings demonstrated the presence of a bronchogenic cyst without any communication with the airway tree or the esophagus. Postoperative outcomes were uneventful and the patient was rapidly discharged from hospital.
Full thoracoscopic left 6 segmentectomy for invasive pulmonary aspergillosis (IPA)
This video summarizes the main steps of a thoracoscopic left S6 segmentectomy whose indication was a high suspicion of invasive pulmonary aspergillosis (IPA) in a female patient presenting with an acute myeloid leukemia. IPA was resistant to antifungal therapy. A resection was rapidly required as an allogenic bone marrow transplantation was pending.
A full thoracoscopic technique, i.e., with access incision, was used. As for all anatomical segmentectomies performed in our department, a tridimensional reconstruction was carried out preoperatively. A high-definition camera system, a deflectable scope, as well as dedicated thoracoscopic instruments were used.
D Gossot, A Seguin-Givelet, E Brian, M Grigoroiu, D Mayeur, J Lutz
Surgical intervention
4 years ago
975 views
43 likes
0 comments
08:39
Full thoracoscopic left 6 segmentectomy for invasive pulmonary aspergillosis (IPA)
This video summarizes the main steps of a thoracoscopic left S6 segmentectomy whose indication was a high suspicion of invasive pulmonary aspergillosis (IPA) in a female patient presenting with an acute myeloid leukemia. IPA was resistant to antifungal therapy. A resection was rapidly required as an allogenic bone marrow transplantation was pending.
A full thoracoscopic technique, i.e., with access incision, was used. As for all anatomical segmentectomies performed in our department, a tridimensional reconstruction was carried out preoperatively. A high-definition camera system, a deflectable scope, as well as dedicated thoracoscopic instruments were used.
VATS right upper lobectomy with en bloc chest wall resection
The optimal treatment of lung cancer invading the chest wall is complete surgical resection via lobectomy and en bloc chest wall resection, which has a 40 to 50% 5-year survival when there is no lymph node involvement.
VATS lobectomy is currently preferred as a standard approach in selected cases for pulmonary resections, especially for early stage non-small cell lung cancer with acceptable safety, successful surgical outcomes, and oncological efficacy. With recent advances in both equipment and technique, VATS is being applied to more complex conditions by some experienced thoracic surgeons.
We present the case of a 68-year-old man with pulmonary squamous cells carcinoma of the right upper lobe invading chest wall on the level of posterolateral part of the 3rd and 4th ribs. Right upper lobectomy with en bloc chest wall resection was finally performed by VATS.
M Gonzalez, JY Perentes, T Krueger
Surgical intervention
4 years ago
1432 views
45 likes
0 comments
12:29
VATS right upper lobectomy with en bloc chest wall resection
The optimal treatment of lung cancer invading the chest wall is complete surgical resection via lobectomy and en bloc chest wall resection, which has a 40 to 50% 5-year survival when there is no lymph node involvement.
VATS lobectomy is currently preferred as a standard approach in selected cases for pulmonary resections, especially for early stage non-small cell lung cancer with acceptable safety, successful surgical outcomes, and oncological efficacy. With recent advances in both equipment and technique, VATS is being applied to more complex conditions by some experienced thoracic surgeons.
We present the case of a 68-year-old man with pulmonary squamous cells carcinoma of the right upper lobe invading chest wall on the level of posterolateral part of the 3rd and 4th ribs. Right upper lobectomy with en bloc chest wall resection was finally performed by VATS.
Robotic assisted thoracoscopic lingulectomy
A 67-year-old otherwise healthy woman presented to her primary care physician with complaints of dyspnea. Her primary care physician obtained a chest X-ray, which revealed a left upper lobe abnormality. A follow-up chest CT revealed a 16mm left upper lobe mass concerning for malignancy in the lingula. A bronchoscopy with brushings was performed and pathology was positive for a well-differentiated adenocarcinoma. As part of a clinical staging, a PET-CT was obtained and demonstrated no FDG avid disease in the thorax or elsewhere. Pulmonary function tests revealed an FEV1 of 2.28 L (122% predicted) and DLCO of 19.05 (112% predicted). The therapeutic objectives were to perform an oncologically sound anatomic lung resection and lymph node dissection for the patients early stage biopsy proven lung cancer. The robotic platform was used in this case and we aimed to demonstrate our approach to a robotic assisted thoracoscopic lingulectomy for lung cancer.
HJ Feldman, M Kent, J Wilson
Surgical intervention
4 years ago
532 views
17 likes
0 comments
10:55
Robotic assisted thoracoscopic lingulectomy
A 67-year-old otherwise healthy woman presented to her primary care physician with complaints of dyspnea. Her primary care physician obtained a chest X-ray, which revealed a left upper lobe abnormality. A follow-up chest CT revealed a 16mm left upper lobe mass concerning for malignancy in the lingula. A bronchoscopy with brushings was performed and pathology was positive for a well-differentiated adenocarcinoma. As part of a clinical staging, a PET-CT was obtained and demonstrated no FDG avid disease in the thorax or elsewhere. Pulmonary function tests revealed an FEV1 of 2.28 L (122% predicted) and DLCO of 19.05 (112% predicted). The therapeutic objectives were to perform an oncologically sound anatomic lung resection and lymph node dissection for the patients early stage biopsy proven lung cancer. The robotic platform was used in this case and we aimed to demonstrate our approach to a robotic assisted thoracoscopic lingulectomy for lung cancer.