How to avoid "en masse" lobectomy using VATS technique in presence of hilar fibrosis

https://doi.org/10.4081/monaldi.2021.1633

Authors

  • Dario Amore | darioamoremd@gmail.com Department of Thoracic Surgery, Monaldi Hospital, Naples, Italy. https://orcid.org/0000-0001-9667-8315
  • Dino Casazza Department of Thoracic Surgery, Monaldi Hospital, Naples, Italy.
  • Alessandro Saglia Department of Respiratory Diseases, Monaldi Hospital, Naples, Italy.
  • Pasquale Imitazione Department of Respiratory Diseases, Monaldi Hospital, Naples, Italy.
  • Umberto Caterino Department of Respiratory Diseases, Monaldi Hospital, Naples, Italy.
  • Carlo Curcio Department of Thoracic Surgery, Monaldi Hospital, Naples, Italy.

Abstract

Perivascular fibrosis is technically one of the most challenging issue to manage during thoracoscopic lobectomy and it is associated with increased risk of hemorrhagic injury. Here we report a case of thoracoscopic right lower lobectomy performed with individual dissection of segmental arteries due to dense adventitial fibrosis around the right lower lobe pulmonary artery. This approach may be considered as an alternative to the so-called “en masse” lobectomy and a way to avoid conversion to thoracotomy.

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References

Pischik VG. Technical difficulties and extending the indications for VATS lobectomy. J Thorac Dis 2004;6:S623-30.

Murakami J, Ueda K, Hayashi M, et al. Simultaneous stapling of the lobar bronchus and pulmonary artery: is it actually dangerous? Interact Cardiovasc Thorac Surg 2016;22:671-3.

Qiang G, Nakajima J. Simultaneous stapling of pulmonary vein and bronchus in video-assisted thoracic surgery lobectomy. Ann Thorac Cardiovasc Surg 2015;21:78-80.

Kamiyoshihara M, Igai H, Ibe T, et al. Pulmonary lobar root clamping and stapling technique: return of the “en masse lobectomy”. Gen Thorac Cardiovasc Surg 2013;61:280-91.

Marjanski T, Sternau A, Dziedzic R. Arteriobronchial fistula complicating right upper lobectomy. Ann Thorac Surg 2013;96:e95-6.

Abe J, Hasumi T, Takahashi S, et al. Fatal broncho-pulmonary artery fistula after lobectomy for lung cancer. J Surg Case Rep 2015;9:1-2.

Matsuoka K, Imanishi N, Yamada T, et al. Clinical results of bronchial stump coverage using free pericardial fat pad. Interact Cardiovasc Thorac Surg 2016;23:553-9.

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Published
2021-03-19
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Issue
Section
Pneumology - Case Reports
Keywords:
Lung cancer, VATS lobectomy, vascular fibrosis
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How to Cite
Amore, Dario, Dino Casazza, Alessandro Saglia, Pasquale Imitazione, Umberto Caterino, and Carlo Curcio. 2021. “How to Avoid ‘en Masse’ Lobectomy Using VATS Technique in Presence of Hilar Fibrosis”. Monaldi Archives for Chest Disease 91 (2). https://doi.org/10.4081/monaldi.2021.1633.