Video-assisted lung lobe resections

Abstract

Video-assisted thoracoscopic (VATS) lobectomy is performed using endoscopic instruments based on stapler technique and general surgical elements. Priority is given to performing typical resections with separate treatment of elements of the root of the lobe (arteries, veins, bronchus).

Materials and methods. Over the past 5 years (from 2014 to 2018), in the department of thoracic surgery and invasive diagnostic methods at the State Institution «National Institute of phthisiology and pulmonology named after F.G. Yanovsky NAMS of Ukraine» 36 VATS-resections of the lung lobe were performed. All 36 (100.0%) VATS resections were performed using bronchial intubation of the contralateral lung, with minithoracotomic incision of no more than 8 cm. The treatment of the elements of the root of the lobe was performed using endoscopic stapling device based on stapler technique, and mechanical phrenicotripsy was performed intraoperatively.

Results. Intraoperative complications were diagnosed in 2 (5.6%) patients. In 1 (2.8%) patient a conversion was made to open thoracotomy with stopping the bleeding. The overall ratio of postoperative complications was 5 (13.9%) observations. The average duration of resection surgeries was 188.4±73.6 minutes; and the average intraoperative blood loss was 86.1±154.1 ml. The average duration of treatment in the postoperative period was 29.2±14.1 days.

Conclusions. VATS resection of the lung lobe is a non-traumatic and promising treatment method that provides anatomical dissection of elements of the lung lobe root. It can be considered as an alternative to open lobectomy. The widespread use of this method is impeded by the pronounced fibrosis of the lung root and adhesion processes due to the prolonged inflammatory process and medications treatment, as well as the cost of endoscopic instruments.