The Initial Experience on Thoracoscopic Sleeve Lobectomy: Continuous Suturing Technique of the Bronchial Anastomosis in 12 Cases

Abstract

Background: Sleeve resection is a widely performed type of operation in the surgical treatment of non–small cell lung cancer. Video-assisted thoracoscopic surgery (VATS) is now used even in central tumor surgeries of the lung with the increasing technology and experience. Sleeve resection cases performed through VATS in our clinic in recent years were presented with demographic, surgical, pathologic, and survey characteristics. Materials and Methods: Twelve patients who underwent sleeve resection with VATS in our clinic between November 2015 and August 2019 were included in the study. Operative, pathologic, and postoperative characteristics of the patients were examined. Results: A total of 12 patients, 3 female and 9 male individuals, were included in the study. The mean age of the patients was 61.7±12.9 years. According to the localization of the tumors, left upper lobectomy was performed in 4 patients and 8 patients underwent right upper lobectomy. During the sleeve anastomosis of the patients, 3/0 prolene sutures were used in 5 patients (36%) and 4/0 prolene sutures in 4 patients (36%), whereas 3/0 polydioxanone suture (PDS) was used in 3 patients (28%). The mean operation time was 288.2±77.1 (205 to 460) minutes and the mean anastomosis time was 70±18.5 (55 to 110) minutes. In the postoperative period, 1 patient who had acute myocardial infarction died on the fourth postoperative day. The mean postoperative drainage duration of the patients was 5.5±1.9 (3 to 10) days and the mean length of hospital stay was 6.4±1.9 (4 to 11) days. When the pathologic features were examined, the mean tumor diameter was found to be 2.5±1.2 (1 to 5.5) cm. The mean follow-up period was calculated as 26.1±15.6 months (2 to 47). Other than 1 patient who died, the follow-up of 11 patients still proceeds. Conclusions: VATS approach of sleeve resections, which is performed cautiously even by thoracotomy, is becoming more common. These operations, which could be performed in experienced centers, offer a postoperative period of less morbidity to the patients with the advantage of reduced postoperative pain, drainage time, and hospital stay.

Short‐ and medium‐term outcomes of video‐assisted thoracoscopic surgery versus thoracotomy for carinal lung resection combined with carina reconstruction in locally advanced non–small cell lung cancer patients

“…Our findings revealed that despite patients who underwent open surgeries generally requiring slightly more additional i.v. analgesics than those who received VATS, VATS was able to effectively alleviate the surgical‐related pain compared to thoracotomy, which was in line with previous studies analyzing other surgical modalities, including lobectomy, bronchial sleeve resection, and pneumonectomy 12,19,20 . This benefit of VATS was likely because of the smaller incisions created, which led to less tissue trauma, reduced inflammation, and fewer nerve injuries 21 .…”

Videothoracoscopic Bronchial Sleeve Resection for Non-Small Cell Lung Cancer

“…Zhou et al and Wang et al reported mean durations of anastomosis between 55 and 39 minutes, respectively [3,6]. In Ceylan et al the reported range of anastomosis time was 55-110 minutes [5]. In our study, the anastomosis times were 82 minutes in the first case and 65 minutes in the second.…”

“…It has been reported that the incidence of these complications ranges from 4.8% to 31% [3,7]. Ceylan et al reported that, in their series of 12 cases, there was one case of myocardial infarction and one case of prolonged air leak [5]. Wang et al reported that there were no complications in their series [6].…”

“…In the following years, more complicated surgeries, such as uniportal VATS sleeve lobectomy and bronchovascular VATS sleeve lobectomy, were reported as case series [3]. In VATS sleeve lobectomies, the length of the incision is small, and an intercostal retractor is not used; thus, wound site problems, bleeding, pain, lung damage, hospital stay lengths, and air leakages are lessened in comparison to thoracotomies [1,4,5]. The disadvantage of VATS sleeve lobectomy is that the duration of the anastomosis is longer than thoracotomy.…”

“…Zhou et al compared sleeve lobectomy performed via VATS to thoracotomy and found no significant difference in terms of median survival between the groups [3]. Ceylan et al reported a mean disease-free survival of 36.1 months and mean survival of 42.7 months in their short-term study [5]. Wang et al did not give any information about survival in their study [6].…”