Emilio Peña

Two-incision approach for video-assisted thoracoscopic sleeve lobectomy.

The video-assisted thoracoscopic approach for bronchoplasty procedures is not standardized. Although 3 to 4 incisions are usually made, with adequate surgical technique, the operation can be successfully carried out using only 2 incisions. We describe the technique of video-assisted thoracoscopic surgery for a right upper lobe sleeve lobectomy for a carcinoid tumor in the right upper bronchus, using only 2 ports.

Left main bronchus rupture during video-assisted thoracoscopic surgery resection of a bronchogenic cyst

Video-assisted thoracoscopic surgery (VATS) is an approach to resection of bronchogenic cysts (BC) which is effective and viable. There may be complications as a result of pericystic adhesions to neighboring structures during dissection. This report describes an unusual case of an operative complication, the rupture of the main left bronchus. The initial VATS approach was converted into a right thoracotomy to remove the cyst and suture the bronchus once adequate exposure was obtained. Bronchus reconstruction failed and a few hours later, it was necessary to perform a left thoracotomy. A left pneumonectomy was required after the attempt to reconstruct the anastomosis was ruled out. The conclusion is that great care should be taken when using VATS approach for BC with adhesions.

Reconstrucción broncovascular con conducto de pericardio bovino y reintervención quirúrgica por trombosis con revascularización

We present the case of a 57-year-old male with left hilar squamous cell carcinoma infiltrating the pulmonary artery and in whom a sleeve bronchoplasty and angioplasty were performed using a bovine pericardial conduit. Three days post-operatively, graft thrombosis was detected; thrombectomy and graft reconstruction were performed with revascularisation of the graft.

Herniación hepática tras neumonectomía extrapleural por mesotelioma

The patient is a 66-year-old woman who had undergone a right extrapleural pneumonectomy 2 years earlier for pleural mesothelioma (stage II) and had received adjuvant chemoand radiotherapy. During the procedure, a Gore-Tex patch was used to reconstruct the diaphragm. Six months after surgery, a follow-up MRI was ordered due to high transaminase levels, and herniation of the liver into the thorax was observed (Fig. 1a). CT showed the patch situated under the wall (Fig. 1b, arrow). In spite of this complication, the patient presents good quality of life and has required no treatment. Fig. 1 c i r e s p . 2 0 1 3 ; 9 1 ( 6 ) : 3 8 9

Síndrome de vena cava superior y circulación colateral en la pared abdominal por una mediastinitis fibrosante

Paciente varón de 65 años que consultó hace un año por anorexia y pérdida de aproximadamente 10 kg de peso en 6 meses. En la exploración fı́sica destacaba un desarrollo de circulación venosa en pared abdominal (fig. 1B). En la TAC torácica se visualizaba un manto tisular con un grosor aproximado de 2 cm, que englobaba la porción media de la vena cava superior estenosándola prácticamente en su totalidad (fig. 1C, flecha). Se evidenciaba una extensa circulación colateral a través de los sistemas ácigos, hemiácigos y sobre todo a nivel de venas de la pared toracoabdominal anterior (fig. 1A). Se realizó una mediastinoscopia cervical y videotoracoscopia derecha y se tomaron biopsias múltiples con el diagnóstico de tejido fibroso hialinizado sin células malignas. Con dichos datos se hizo el diagnóstico de mediastinitis fibrosante. En los controles de tomografı́a computarizada con un año de seguimiento no se aprecian cambios. Figura 1. ww w.els evier .es /med i c in ac l in i c a

Superior vena cava syndrome and collateral circulation in the abdominal wall by a fibrosing mediastinitis

Paciente varón de 65 años que consultó hace un año por anorexia y pérdida de aproximadamente 10 kg de peso en 6 meses. En la exploración fı́sica destacaba un desarrollo de circulación venosa en pared abdominal (fig. 1B). En la TAC torácica se visualizaba un manto tisular con un grosor aproximado de 2 cm, que englobaba la porción media de la vena cava superior estenosándola prácticamente en su totalidad (fig. 1C, flecha). Se evidenciaba una extensa circulación colateral a través de los sistemas ácigos, hemiácigos y sobre todo a nivel de venas de la pared toracoabdominal anterior (fig. 1A). Se realizó una mediastinoscopia cervical y videotoracoscopia derecha y se tomaron biopsias múltiples con el diagnóstico de tejido fibroso hialinizado sin células malignas. Con dichos datos se hizo el diagnóstico de mediastinitis fibrosante. En los controles de tomografı́a computarizada con un año de seguimiento no se aprecian cambios. Figura 1. ww w.els evier .es /med i c in ac l in i c a