Jon Lutz

Single-incision thoracoscopic right pneumonectomy with primary division of the pulmonary artery

In recent years video-assisted thoracoscopic surgery (VATS) techniques have gained popularity also for major lung resections. Furthermore, especially in experienced VATS centers, single-incision thoracoscopic surgery is more and more adapted due to its even lesser invasiveness. Most thoracic surgeons still prefer an open approach to perform pneumonectomy, although reports of VATS and even single-incision VATS pneumonectomy are increasing. Unlike other authors we prefer to divide the pulmonary artery (PA) as one of the first steps of the procedure in order to obtain a clear field of vision on one hand and to obtain optimal control of bleeding and total blood loss on the other hand. Herein we describe our technique for single incision thoracoscopic right pneumonectomy and mediastinal lymphadenectomy without rib-spreading and with division of the PA as a first step. Furthermore we prefer to routinely cover the bronchial stump (BS) with an in situ azygos vein (AV) flap during right pneumonectomy.

Upper lobe anterior segment (S3): technique of fissureless uniportal VATS segmentectomy

There is a growing interest for minimally invasive sublobar anatomic resections. Whereas some segmentectomies like lingulectomy or S6-resection appear trivial for experienced surgeons, other sublobar anatomic resections with large parenchymal surface remain challenging. In our video, we demonstrate our technique to separate a fused interlobar fissure between upper and middle lobe, safely allowing to proceed to S3-segmentectomy.

Dynamic stenosis of the right main bronchus in a 3-month-old child: a tracheobronchial sleeve resection under venovenous extracorporeal membrane oxygenation

We report the case of a boy with congenital dynamic stenosis of the right main bronchus. The operation was postponed to a later date, when the patient was in a better clinical position to tolerate surgery. A tracheobronchial sleeve resection under dual-lumen venovenous extracorporeal membrane oxygenation was performed.

Technical aspects of video-assisted and robotic-assisted thoracoscopic segmentectomy

Li and co-authors very nicely presented their technique of robot-assisted thoracic surgery (RATS) S6-segmentectomy illustrated by high quality figures (1). They presumably base their approach on the excellent book of Nomori and Okada (2), one of the most important references for open segmentectomy of the lung.

Thoracoscopic S 6 segmentectomy: tricks to know

Thoracoscopic S 6 segmentectomy is a relatively easy sublobar resection. However, there are many variations in the anatomy that can make the procedure more difficult than expected. Some technical difficulties can also be faced. This article is based on an experience of 68 S 6 segmentectomies, 40 left and 28 right, out of a series of 272 thoracoscopic sublobar resection. In 2 cases, the S 6 segmentectomy was extended to S 2 and to S 10 . Indication was a proven or suspected cT1aN0 non-small cell lung carcinoma in 48, suspected metastasis in 11 and benign lesion in 9 patients. There were 4 conversions into thoracotomy (5.9%). Mean operative time was 137 mn (range: 50–240 mn) and mean intraoperative blood loss was 82 cc (range: 0–700 cc). Mean drainage duration was 2.6 days (range: 1–8 days) and mean hospital stay was 4.8 days (range: 2–10 days). Based on our experience, the aim of this article is to illustrate variations and suggest technical tips that make the procedure reliable and reproducible.

Thoracoscopic anatomic segmentectomies for lung cancer: technical aspects

Although the interest for thoracoscopic sublobar resections (TSLR) is rising, its use for treating non-small cell lung carcinoma (NSCLC) is still controversial because publications dealing with survival and recurrence rate provide contradictory results. If applied to the resection of lung cancer, thoracoscopic segmentectomies must be performed according to oncological criteria. The aim of this technical paper is to give some technical details on thoracoscopic segmentectomies for the treatment of malignancies. Our experience is based on 235 thoracoscopic anatomical segmentectomies performed in 232 patients for a malignant lesion between January 2007 and July 2016. Indication for segmentectomy was a proven or suspected NSCLC in 184 and suspected metastasis in 51 patients. Intraoperative and postoperative data were recorded in a prospective manner. There were eight conversions into a posterolateral thoracotomy (3.4%) and seven unplanned additional pulmonary resections for an oncological reason (3%). We discuss some technical refinements that could minimize these adverse events and make thoracoscopic segmentectomy a safe and reliable procedure.