Uniportal video-assisted thoracic surgery right upper lobectomy with systemic lymphadenectomy

Abstract

IntroductionAs one of the minimal invasive surgery approach for thoracic surgery, uniportal video-assisted thoracic surgery (VATS) has been made great progress with the development of surgical technic and instruments. Now growing evidences show the feasibility and safety of uniportal VATS lobectomy for lung cancer (1), although the long-term outcomes are need to be tested in the future. Here we demonstrate a right upper lobectomy with systemic lymphadenectomy for lung cancer by using uniportal VATS approach. Clinical dataA 51-year-old man had a 3-month history of right lung shadow in X-ray. After 2 months of anti-infective therapy, X-ray showed no significant changes, then a nodule (2.5 cm in diameter) in right upper lobe was detected by CT. PET-CT revealed that the nodule was hypermetabolic with no other metastasis. The result of fine needle aspiration (FNA) verified the nodule was adenocarcinoma. After preoperative preparation, the patient was underwent uniportal VATS lobectomy with systemic lymphadenectomy. Postoperative pathological report suggested the stage of the tumor was T1bN0M0 (stage IA). Operative techniquesAfter being anesthetized with double-lumen endotracheal intubation, the patient was positioned in left lateral decubitus position. The uniportal incision located in the 5th intercostal space, anterior to latissimus dorsi and posterior to pectoralis major. We used a lap-protector to avoid contamination. Both the operator and the camera holder stand on the ventral side. In this video, the procedures were as followed (Figure 1):• Exploration of chest revealed no pleural adhesions, no pleural effusion and no pleural nodules; • After cutting open the mediastinal pleura form horizontal fissure to right hilus pulmonis, the operator performed the dissection of level 10 and level 11 lymph nodes, which would facilitate subsequent dissection of vasa publicas; • After remove of level 10 lymph nodes, we could identify the borders of level 10 lymph nodes: superior vena cava, arch of azygos vein, upper lobe pulmonary artery and upper lobe pulmonary vein; • Dissection of level 11 lymph nodes and oblique fissure from ventral to dorsal would facilitate the exposure of the posterior ascending artery; • The posterior ascending artery was well exposed by dorsal to cranial in order to expose the upper lobe bronchus. After this step, the mediastinal pleura around the upper lobe was entirely cut open; • After dissection of the lymph nodes around it, the upper lobe bronchus was well dissociated by forceps and then transected by a stapler; • It is easy for operator to expose and cut off the apical segment artery after transection of the upper lobe bronchus; • After dissection of the lymph nodes between pulmonary artery truck and bronchus, operator transected the remanent upper lobe pulmonary veins and anterior segment artery by one stapler; • Next to use a bag to take the specimen out, operator began to dissect mediastinal lymph nodes by using hook electrode and harmonic scalpel to minimize blood; • After performing an ent...