Thoracoscopic resection of pulmonary sequestration with carbon dioxide insufflation and indocyanine green

We encountered a rare case of pulmonary sequestration supplied from the right renal artery, which was resected by video-assisted thoracic surgery with carbon dioxide insufflation and indocyanine green-guided technique. A 41-year-old woman with intralobar pulmonary sequestration supplied from the right renal artery was referred to our department. At the time of surgery, we used carbon dioxide insufflation to improve the manoeuvrable workspace for shutting off aberrant arteries and indocyanine green fluorescence guidance to differentiate the boundary of the sequestered lung from the normal lung. These procedures helped in the efficient resection of the lesion.     

Video-assisted thoracic resection for intralobar pulmonary sequestration

We present a case in which video-assisted thoracic resection for intralobar pulmonary sequestration (ILPS) was successfully performed. A 36-year-old woman had repeated pneumonia. Chest computed tomography (CT) showed a round mass in the right lower lobe of the lung. Subsequent three-dimensional CT revealed that a large anomalous artery arising from the descending thoracic aorta was distributing to the posterior basal segment containing the lesion and was draining into the inferior pulmonary vein. The patient was diagnosed with ILPS and underwent surgery. The anomalous artery was divided, and the sequestered segment was completely resected by video-assisted thoracic surgery (VATS). We think that VATS resection for ILPS is feasible and is a major therapeutic option as noninvasive surgery.     

Intralobar sequestration presenting as a coin lesion in an adult

A 4l-year-old male presented with an asymptomatic coin lesion in the left lower lobe. The computerised tomogram was suggestive of pulmonary arteriovenous fistula. At surgery it was found to be an intralobar sequestration for which wedge resection was done. The pathogenesis, presentation and management are discussed.     

Coccidioidomycosis of the lung contracted abroad

Coccidioides immitis is endemic in the southwestern United States. Coccidioidomycosis is rare in Japan, but the number of coccidioidomycosis cases from overseas is expected to increase markedly in the near future. A 33-year-old Japanese man with coccidioidomycosis who had lived in Arizona presented to our hospital. We performed wedge resection of the lung by video-assisted thoracoscopic surgery (VATS), and were able to completely remove the lesion. VATS wedge resection of the lung is effective in treating localized coccidioidomycosis. Before the operation, we could not confirm the existence of satellite lesions, but microscopically the main lesion was accompanied by several daughter lesions. It is very important that the surgical margin be sufficient to achieve complete resection.     

Organizing pneumonia with an enlarging tumor-like lesion: immunohistochemical study

An 86-year-old woman was transferred to our department for investigation of an abnormal enlarging pulmonary shadow with vascular convergence. She had no respiratory symptoms or laboratory data suggesting inflammatory disease. A pulmonary wedge resection was performed under video-assisted thoracic surgery. Pathology examination revealed that the tumor was organizing pneumonia and was composed of fibroblast-like spindle cells, macrophages, lymphoplasma cells, and collagen fibers. Immunohistochemical study revealed that the lesion was in the proliferative state with the relatively more Ki-67-positive fibroblast-like spindle cells. When a surgical resection is necessary for an enlarging abnormal pulmonary mass without any systemic inflammatory reaction or respiratory symptoms, a less invasive approach should be selected.     

A case of localized nodular pulmonary amyloidosis diagnosed by video-assisted thoracoscopic surgery

Pulmonary amyloidosis is a rare pulmonary lesion. We report a 42-year-old male admitted for further evaluation of abnormal chest shadow. A chest CT demonstrated a nodular shadow in right S3. We tried transbronchial and percutaneous lung biopsy, but could not diagnose. We performed partial lung resection by video-assisted thoracoscopic surgery. Pathological diagnosis of the lesion was pulmonary amyloidosis. Immunohistochemical examination revealed this amyloid composed of AL kappa protein. No clinical evidence of amyloid deposits were found in other organs. We finally diagnosed this case as a localized nodular pulmonary amyloidosis.     

Video-assisted thoracic surgery for pure ground-glass opacities 2 cm or less in diameter

BACKGROUND: Small, well-circumscribed pure ground-glass opacities on high-resolution computed tomography can represent either localized bronchioloalveolar carcinoma without foci of active fibroblastic proliferation, or atypical adenomatous hyperplasia. Since neither lesion displays lymph node metastasis, excellent prognosis can be expected even with limited surgical resection. In this study, video-assisted thoracic surgery was performed for patients with pure ground-glass-opacity to evaluate efficacy for both diagnostic and therapeutic purposes. METHODS: Thirty-nine patients with pure ground-glass opacity less than or equal to 2 cm in diameter (62 lesions) underwent video-assisted thoracic surgery with wedge resection as primary therapy. Histologic diagnoses were made according to Noguchi classifications. RESULTS: Single lesions were observed in 30 patients, with multiple lesions (mean, 4 lesions) in 9 patients. Twenty-eight patients underwent wedge resection. Seven patients underwent lobectomy or segmentectomy for technical reasons. Four patients underwent conversion of wedge resection to lobectomy (due to active fibroblastic proliferation in 2 patients, and other reasons in 2 patients). All procedures were performed under videoscopic observation. Histologic diagnoses comprised localized bronchioloalveolar carcinoma without active fibroblastic proliferation either alone or in combination with atypical adenomatous hyperplasia in 29 patients, atypical adenomatous hyperplasia in 8 patients, and localized bronchioloalveolar carcinoma with active fibroblastic proliferation in 2 patients. All patients with localized bronchioloalveolar carcinoma underwent follow-up for a median period of 29.3 months, and have survived without sign of recurrence. CONCLUSIONS: Video-assisted thoracic surgery may be appropriate for management of small pure ground-glass opacities.     

单孔胸腔镜治疗胸部良性病变18例

目的探讨单孔胸腔镜手术在胸部良性病变治疗中的可行性及安全性。方法2012年10月～2013年8月,施行全麻双腔气管插管下单孔胸腔镜手术18例。于腋前线与腋中线间第4或第5肋间做切口长2～3cm,置入5mm 30°胸腔镜和器械,行肺大疱切除、胸膜固定术12例,胸腔止血、肺大疱切除、胸膜固定术1例,肺楔形切除术3例,胸腺囊肿切除术1例,纵隔肿瘤切除术1例。结果无中转开胸或增加辅助切口。自发性气胸12例,自发性血气胸1例,肺结核球3例,胸腺囊肿1例,纵隔神经鞘瘤1例。手术时间30～82min,平均55min,出血量10～100ml,平均50ml。胸腔闭式引流时间2～5d,平均3．5d。术后随访2～12个月,平均5．2月,无复发及其他并发症。结论单孔胸腔镜手术治疗胸部良性病变简单易行,安全可靠。     

Intrapulmonary hematoma surrounding the stapled line after video-assisted thoracoscopic bullectomy for spontaneous pneumothorax]

A 52-year-old man presented at our hospital with hemoptysis three months after undergoing a video-assisted thoracoscopic bullectomy for spontaneous pneumothorax. A chest X-ray showed a localized infiltrative shadow in the right upper lobe of the lung. The chest CT findings revealed a mass-like lesion surrounding the staple which had been used during the bullectomy. He therefore underwent a pulmonary resection including the lesion due to the continued hemoptysis that did not improve even after treatment by hemostatic agents and bronchial arterial embolization. The resected specimen revealed an intrapulmonary hematoma with severe inflammation. The late onset hematoma which was induced by the stapler may thus be a rare complication in video-assisted thoracoscopic surgery.     

Treatment of pulmonary sequestration by video-assisted thoracic surgery (VATS)

Pulmonary sequestration is a rare malformation of the respiratory tract that accounts for 0.15–6.4% of all congenital lung anomalies. Treatment requires resection of the lesion, provided that there is no technical contraindication. The lession should first be evaluated using video thoracoscopy and then resected whenever possible by video-assisted thoracic surgery (VATS). We report a case of extralobar pulmonary sequestration in a 48-year-old woman. She underwent lobectomy by VATS and achieved an excellent outcome.     

Uniportal VATS wedge pulmonary resections

Since 2000, 15 patients have undergone single port (uniportal) video-assisted thoracic surgery for wedge pulmonary resection either for diagnosis of interstitial lung diseases (10 patients) or for treatment of primary spontaneous pneumothoraces (5 patients). Diagnosis was obtained in all patients and no recurrences of pneumothorax were seen at follow-up. This initial experience shows that, for specific indications, uniportal video-assisted thoracic surgery for wedge pulmonary resections can be safe and effective.     

Thoracoscopic resection of pulmonary nodules after computed tomographic-guided coil labeling

BACKGROUND: A limiting factor in performing video-assisted thoracic surgery for resection of peripheral solitary pulmonary nodules has been the recognition of the lesion visually. This study reports our clinical experience of injecting a small metallic marker under computed tomographic scan guidance before the operation, allowing localization of the lesion. METHODS: A series of 14 patients underwent video-assisted thoracic surgery for removal of 15 pulmonary nodules situated in the outer third of the lung. Before operation, a radiopaque microcoil was injected just behind the lesion and then used to locate, under fluoroscopy, the area to be resected during thoracoscopy. The technique was evaluated for accuracy, reliability, and ease of use. RESULTS: Microcoil labeling of peripheral pulmonary nodules allowed in every case a complete resection and a histologic identification of the lesion. It is more stable and accurate than methylene blue dye marking, and it is as easy to perform as computed tomographic scan-guided biopsy. The incidence of complication was small in spite of our inexperience with the technique. CONCLUSIONS: Our experience with microcoil injection shows that it provides consistent and highly accurate marking of pulmonary nodules for video-assisted thoracic surgery, allowing secure resection with a safe margin.     

Pulmonary dirofilariasis resected by video-assisted thoracoscopy; report of a case

A 35-year-old female was admitted for biopsy of abnormal shadow on chest X-ray. She was operated on for partial wedge resection of the right lower lobe by video-assisted thoracoscopy without complication. Pathological findings in operation showed inflammatory benign tissues and suggested pulmonary dirofilariasis. Serologic examination was negative after operation, however histological diagnosis supported pulmonary dirofilariasis because a pulmonary artery embolism of calcified tissues consisted of non-human cells. There may be many cases due to old infections like this one, so it is important to consider it for diagnosis and perform more positive surgical procedures. We review a case of pulmonary dirofilariasis safely resected by video-assisted thoracoscopy for diagnosis by exclusion.     

Successful Video-Assisted Thoracic Surgery for Pulmonary Endometriosis: Report of a Case

Pulmonary endometriosis is a disease in which uterine endometrial cells with stromal components grow in the pulmonary parenchymal tissues or pleura. Surgical resection is considered an effective and radical treatment for pulmonary endometriosis to avoid the adverse effects of long-term hormone therapy in young women of childbearing years with a localized abnormal lesion. We report a case of pulmonary endometriosis with catamenial hemoptysis, an uncommon result of this disease, which was diagnosed histologically and treated successfully by video-assisted thoracic surgery.     

Extralobar pulmonary sequestration with aberrant lobulation of the lower lobe; report of a case

An adult case of extralobar pulmonary sequestration with aberrant lobulation of the right lower lobe is reported. A 32-year-old woman admitted to our hospital with a right intrathoracic tumor in the chest computed tomography (CT). Chest CT showed a mass lesion on the right diaphragm of a diameter 5 cm and abnormal fissure of the right lower lobe. Under the diagnosis of pulmonary sequestration without clearly thick vessels, video-assisted thoracoscopic surgery was performed. The mass existed between the right diaphragm and posterior lower lobe with a thin stalk, and the lower lobe had aberrant lobulation. The resected mass was histopathologically diagnosed as extralobar pulmonary sequestration.     

Thoracoscopic localization techniques for patients with solitary pulmonary nodule: hookwire versus radio-guided surgery

Objective: Our aim was to evaluate the best intrathoracoscopic localization technique between hookwire and radio-guided surgery, in patients with pulmonary nodule. Methods: From January 2000 to January 2005 we enrolled in this study 50 patients with a solitary pulmonary nodule, prospective randomized in two groups, well matched for diameter and depth of the pulmonary lesion. In 25 patients we performed the hookwire technique (Group A), whereas in the other 25 patients radio-guided localization was adopted (Group B). In both groups the localization technique was compared with finger palpation. In Group A, 9 lesions were in the left and 16 in the right lung; in Group B, 14 nodules were in the left lung and 11 in the right one. In both groups, the distance of the nodule from the pleural surface with lung inflated was 2.5 cm (1.5–2.5 cm in 12 patients, and >2.5 cm for the remaining 13). The mean size of the nodules in both groups was 1.1, range 0.6–1.9 (≤1 cm n = 18 patients, and >1 cm n = 7 patients). Results: All patients underwent thoracoscopic wedge resection, and 23 patients with a primary pulmonary lesion underwent thoracotomy for lobectomy and radical mediastinal lymphadenectomy. In Group A the hookwire technique localized the nodule in 21 of 25 patients (84%) whereas finger palpation localized it in 7 of 25 patients (28%). In Group B, radio-guided surgery localized the nodule in 24 of 25 patients (96%) whereas finger palpation localized it in 6 of 25 (24%). In Group A we registered 6 cases of pneumothorax compared to 1 case observed in the radio-guided group. Postoperative hospital stay required an average of 4 days in both groups. Conclusions: In our experience radio-guided surgery has therefore been proven efficacious in the diagnosis of solitary pulmonary nodule and video-assisted thoracoscopic surgery allows the removal of pulmonary nodules without complications. Hookwire was also shown to be efficacious but demonstrated complications linked primarily to external technical factors.     

肺段切除与肺楔形切除对肺小气道功能影响的对比研究

目的比较分析胸腔镜解剖性肺段切除及肺楔形切除术对肺小气道功能的影响。 方法收集2021年1~6月期间,在民航总医院行胸腔镜肺段切除及肺楔形切除124例患者资料,其中行解剖性肺段切除64例、肺楔形切除60例。通过比较两组患者术前、术后1周,以及术后1、3、6个月的MEF25%、MEF50%、MEF75%/25%变化,明确肺段切除与肺楔形切除对肺小气道功能的影响。 结果MEF50%、MEF75%/25%、MEF25%两组指标术后1周均降低,两者之间差异无统计学意义;术后1个月较术后1周升高,且肺楔形切除组较肺段切除组结果升高;术后3个月两组指标均较前升高,且肺楔形切除组仍较肺段切除组结果高;MEF50%、MEF75%/25%术后6个月恢复至术前水平,MEF25%肺楔形切除组恢复至术前水平,较肺段切除组指标高,肺段切除组尚未恢复至术前水平。 结论小气道肺功能指标更能反映出机体肺功能情况;对于<1 cm且实性成分<5 mm的肺小结节,肺楔形切除术后肺功能指标比肺段切除恢复较快;提示切除肺部组织越小,保留的肺功能越多,越具有长期的功能优势。     

电视胸腔镜手术在肺部孤立性结节诊治中的应用

目的评价电视胸腔镜手术（VATS）在肺部孤立性结节（SPN）诊治中的应用。方法回顾性分析55例SPN患者行VATS手术的临床资料,术中对SPN进行探查定位,然后行肺叶楔形切除并送快速冰冻病理检查。若为良性,则缝闭结束手术,若为恶性,则VATS辅助小切口行肺叶切除加纵隔淋巴结清扫术。结果全组55例SPN患者中31例为良性病变,24例为恶性病变;30例行VATS下肺楔形切除,25例行VATS辅助小切口肺叶切除加纵隔淋巴结清扫。全组患者无围手术期死亡,无严重手术并发症发生。结论 VATS对SPN患者具有诊断准确和治疗规范的突出优势,应做为SPN主要或标准的诊治手段加以明确。     

纤维支气管镜、胸腔镜诊治肺错构瘤43例报告

目的总结肺错构瘤的诊断和治疗经验。方法1例腔内型错构瘤在纤维支气管镜下行肿物摘除术，余42例行胸腔镜或胸腔镜辅助小切口手术，其中肺楔形切除40例，肺叶切除1例，双侧病灶活检1例。结果43例病理均为错构瘤，其中1例为多发性肺错构瘤，1例肺癌合并肺错构瘤。术后病理诊断与术前诊断符合率11．6％（5／43）。37例随访4个月～11年，平均41．2月，无复发与恶变。结论肺错构瘤术前难以确诊，腔镜手术可以提供明确的诊断并能彻底切除病灶，创伤小，恢复快。     

肺隔离症4例诊治体会及文献复习

目的 探讨肺隔离症的诊断和治疗策略。方法 2017年7月至2019年6月收治的4例肺隔离症患者,3例患者行胸腔镜手术治疗,1例行介入下血管塞封堵迷走供血动脉,对其诊治过程和临床资料进行回顾性分析,总结诊治过程中的体会。结果 4例肺隔离症患者均接受治疗,1例患者接受介入下血管塞封堵迷走供血动脉后恢复顺利;1例患者胸腔镜下肺叶切除术后恢复顺利;2例患者接受胸腔镜下隔离肺叶切除术,其中1例恢复顺利,1例因胸腔进行性出血行胸腔镜下开胸止血术,后恢复顺利。术后3月复查胸部螺旋计算机体层摄影血管造影显示,3例行胸腔镜下隔离肺叶或肺叶切除手术患者的异常肺叶及供血动脉消失,行介入下血管塞封堵异常血管的1例患者的迷走供血动脉被栓塞,栓塞血管远端已无血流供应,隔离肺组织充血表现较前明显好转,4例患者随访7~31个月,未见复发。在手术时间、术中出血量、术后疼痛、术后胸腔闭式引流量、术后并发症、住院时间及住院费用等方面,介入栓塞治疗均优于胸腔镜手术治疗。结论 胸腔镜手术是目前处理肺隔离症的主要方式,介入栓塞治疗肺隔离症同样是一种安全、有效、微创的治疗方法,尤其对以咯血为主要症状,凝血功能异常且病情较重者效果佳。