“Circular clamp” excision: A new technique for lung metastasectomy

Abstract

Lung metastasectomy is an accepted procedure in selected patients and demonstrates good survival, depending on the primary tumor histology, disease-free interval, and number and location of the metastases. 1 The aim of metastasectomy is radical tumor resection, saving as much healthy lung tissue as possible: Wedge resection, segmentectomy, and nodule excision are the most common surgical techniques for this procedure. 2 Pulmonary nodule excision, the most parenchyma-sparing procedure, is indicated for small and central nodules not suitable for wedge resections because of their central location and theoretically requiring an anatomic segmentectomy or lobectomy. Lung nodule excision is usually performed by exposing the nodule with a pair of lung forceps, trying to further improve nodule exposure by a tampon mounted on another forceps and pushing behind the nodule.This procedure can be difficult because the nodule is slippery and deeply embedded within the parenchyma, and lung tissue incision results in profuse bleeding even at a high coagulation level using an electric scalpel or laser devices. In addition, there is a risk of tumor cell seeding in case of accidental nodule opening or incision.We have devised a new technique of lung nodule excision using custom-built forceps (Figure 1) designed to block and expose the nodule, and to clamp the lung tissue containing the nodule, thereby avoiding bleeding during the incision and allowing accurate suturing after the excision. CLINICAL SUMMARY Surgical TechniqueAfter gently palpating the whole deflated lung parenchyma and locating the nodules to be resected, the forceps are placed on the parenchyma so that the target nodule is in the center of the empty upper ring (Figure 2, A).

Pulmonary metastasectomy: an overview

“…Both video-assisted thoracic surgical (VATS) techniques and open thoracotomy are accepted as appropriate incisions for performing pulmonary metastasectomy (16); on one side, open techniques have been shown to lead to the detection and hence, resection of more metastases than VATS techniques, in particular in case of nodule deeply embedded within the parenchyma (16)(17)(18). On the contrary VATS has been considered a preferable approach due to superior functional outcome, offering a shorter hospital stay, a shorter duration of chest tube drainage and epidural analgesia (19) (Figures 1,2).…”

Role of subxiphoid uniportal video-assisted thoracoscopic surgery in pulmonary metastasectomy

“…Both VATS and open thoracotomy (OT) are widely accepted as appropriate approaches for carrying out PM [14]. On one hand, OT has demonstrated enhanced detection and hence, resection of more metastases than VATS techniques, especially for nodules deeply seated within lung parenchyma [14][15][16]. On the other hand, VATS has been considered a preferable approach due to superior functional outcomes, offering less pain, decreased analgesic demands, enhanced recovery, shorter hospital stay, shorter duration of chest tube drainage, decreased blood loss and transfusion requirements, decreased post-operative morbidity, less impact on pulmonary functional reserve and early recommence of systemic therapy [17].…”