Pulmonary sequestration (PS) is a rare congenital malformation of the respiratory tract. Two main variants are described, the intralobar and the extralobar PS. Clinical manifestations vary from accidental findings to life threatening complications. Surgical resection is the definitive and indicated treatment of PS. The operation could be performed through an open thoracotomy or video-assisted thoracic surgery approach. We report the management of two patients with diagnosis of extralobar PS in the first case and intralobar PS in the second case. Both patients underwent uniportal video-assisted thoracic surgery resection of PS with success. In our experience, we confirm that uniportal video-assisted thoracic surgery is a safe and feasible approach for extralobar and intralobar PS. both reported cases MRI and angiography were not necessary because the angio-CT scan images were considered optimal for the identification of the aberrant vessels and surgical planning. Patient 1 (Figure 1)A 26-year-old female was admitted to our hospital because of left lower lobe pneumonia. At the clinical history the patient reports recurrent episodes of respiratory infection since childhood, much more frequent in the last 5 years. A computed tomography (CT) scan of the thorax was performed documenting the presence of a lesion in the basal segments of left lower lobe, with a diameter about 8.6 cm × 4.4 cm × 3.2 cm ( Figure 1A). The angio-CT-scan showed the presence of an aberrant arterial branch of the descending thoracic aorta measuring 9 mm in diameter connected to the lesion ( Figure 1B,C). Findings matched with intra-lobar sequestration. Further pre-operative investigations comprising bronchoscopy, pulmonary function test and echocardiography were strictly normal. Patient was recommended for surgery and she was referred to our department. Patient 2 (Figure 2)The patient was a 56-year-old woman with history recurrent respiratory infection and a recent endocarditis of the aortic valve with brain embolisms. After treatment of the endocarditis, the following cardiological, vascular and neurological evaluations were negative. Thus she underwent total body angio-CT-scan which showed an anomalous area of left lower lobe parenchyma separated with the normal one by an accessory fissure (Figure 2A,B) with two separate feeding arteries arising from the descending thoracic aorta suggestive for extralobar lung sequestration ( Figure 2C). Further, pre-operative investigations comprising bronchoscopy, pulmonary function test and echocardiography were strictly normal. The patient was recommended for surgery and she was referred to our department. Pre-operative preparationRoutine laboratory tests, chest X-ray, electrocardiography (EKG).Equipment preference card: all surgical instruments used were exactly the same for both patients. Patients positioningA double-lumen endotracheal tube is inserted, then, the patients are placed in a lateral decubitus on the table next to its anterior edge with the arm in the swimming position. The table ...

No abstract

No abstract

Our study showed that different type of trocars during video assisted thoracic surgery (VATS) produces similar level of acute postoperative pain. In future, further randomized study with a great number of patients enrolled needs to confirm our results.

No abstract