Thoracoscopic Wedge Resection of the Lung Using High-Frequency Jet Ventilation in a Postpneumonectomy Patient

Lohser, Jens; McLean, Sean R.

doi:10.1097/acc.0b013e31829459d0

Cited by 9 publications

(3 citation statements)

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“…Thoracoscopic surgery is increasingly used with the purported benefits of less postoperative pain and respiratory dysfunction, leading to faster recovery and hospital discharge [6], but requires the maintenance of the operative field so that the lungs are allowed to collapse during the procedure to maintain cardiopulmonary function under intraoperative anesthesia. Although few in number, previous reports after a contralateral pneumonectomy have included thoracoscopic surgery with high-frequency jet ventilation as a treatment option for pulmonary tumors [7] and with selective double ventilation using an intrabronchial blocker as a treatment option for the bulla in close proximity to the lung tumor [8]. However, there have been few cases reporting thoracoscopic partial lung resection according to the tumor localization.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic partial lung resection following pneumonectomy: a report of three cases

Goto

Mun

Mori

et al. 2019

J Cardiothorac Surg

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BackgroundThe prognosis of patients who undergo unilateral pneumonectomy and subsequently develop a contralateral pulmonary tumor can be improved by tumor resection. Thus, surgery is a treatment option if the patient’s pulmonary function and performance status are satisfactory. To date, there have been only few cases reporting thoracoscopic lung resection for pulmonary tumor after contralateral pneumonectomy because of the difficulty in respiratory management during surgery. Thoracoscopic surgery requires the maintenance of the operative field to allow the lung to collapse, and in partial lung resection we need to identify tumor localization. The identification of a tumor lesion just inferior to the pleura is easy; however, the identification of a tumor lesion in the deep parts is difficult. The tumor in the deep part of the lung segments can be easily located if the tumor-affected lobe is allowed to completely collapse. Therefore, ventilation technique should be modified according to the tumor localization.Case presentationHere, we report three cases of thoracoscopic partial lung resections for pulmonary tumors that developed after contralateral pneumonectomy. Intermittent manual ventilation using a tracheal tube was performed in two cases with a lesion just inferior of the pleura. The tumors in both patients were resected using automatic suturing devices while arresting manual ventilation. The affected lobe was allowed to collapse using a bronchial blocker in one of the cases with a lesion in the deep part. Furthermore, she had contralateral pneumothorax with bullae on the right upper and lower lobes of the lung. The tumor in the deep part of the lung segment and ruptured bullae were easily located and resected using automatic suturing devices. The hemodynamic status of the patients was stable, and the intra- and postoperative courses were uneventful.ConclusionsOur cases demonstrate that thoracoscopic lung resection after contralateral pneumonectomy can be performed if intermittent manual ventilation is utilized when the tumor is located just inferior to the pleura and if selective double ventilation using an intrabronchial blocker is utilized when the tumor is located in the deep part.

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Section: Discussionmentioning

confidence: 99%

Thoracoscopic partial lung resection following pneumonectomy: a report of three cases

Goto

Mun

Mori

et al. 2019

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…Strategies that were reported included highfrequency jet ventilation and selective lobar bronchial blockade. High-frequency jet ventilation is a continuous positive airway pressure applied to a bronchopulmonary segment during VATS (13,14). Selective lobar bronchial blockade is achieved with a bronchial blocker (15,16), or double-lumen tube (10,17).…”

Section: Anaesthesiologic Techniquementioning

confidence: 99%

“…With modified ventilation strategies of these singlelung patients, single up to three-port VATS thoracoscopic additional lung resection is feasible and safe (13,(15)(16)(17)22,23).…”

Section: Surgical Techniquementioning

confidence: 99%