Video-assisted simultaneously stapled segmentectomy for pulmonary arteriovenous malformation located in the pulmonary hilum

Pulmonary arteriovenous malformation (PAVM) consists of abnormal communications between the pulmonary arteries and veins. Because PAVM may cause neurological defects (such as stroke and brain abscess) or hemoptysis and hemothorax, embolization therapy or surgery is required. Resection using video-assisted thoracic surgery (VATS) has recently been performed for small peripheral PAVMs. For large or hilar PAVM, surgical resection with thoracotomy is required. We report herein a case of PAVM (4.0 × 3.5 cm) located in the left S6 segment near the lung hilum that was resected successfully using simultaneously stapled S6 segmentectomy (simultaneous stapling of anomalous vessels of the PAVM and hillar structures of S6) with VATS.     

Anomalous systemic arterial supply to normal basal segment of the left lower lobe; report of a case

A 28-year-old male was referred to our hospital because of hemoptysis. A chest X-ray revealed an increase of vascular marking in the left lower field and a partial defect in the lateral line of the descending thoracic aorta. An aortogram and pulmonary arteriogram showed a large artery arising from the descending thoracic aorta and supplying the left basal segment, which had no normal pulmonary arteries. A bronchoscopy showed no abnormal findings in the bronchial tree. A clinical diagnosis of systemic arterial supply to the basal segment of the left lower lung was made, and a left lower lobectomy and closure of the anomalous systemic artery by video-assisted thoracic surgery (VATS) were successfully performed. Vascular marking of the visceral pleura of left lower basal segment was observed and the anomalous arterial pressure was 84 mmHg, as high as systemic arterial pressure, during the procedure. The histopathological examination revealed normal alveolar structure, and sclerosis and hypertrophy of pulmonary arteries of the lesion (Heath-Edwards V, which means irreversible vascular changes due to pulmonary hypertension). The patient had an uneventful postoperative course and was discharged on postoperative day 8. The VATS procedure is a more useful and less invasive method for cases of systemic arterial supply to the basal segment of the left lower lung than an open thoracotomy.     

Techniques for Treating Aberrant Arteries During Resection of Pulmonary Sequestration by Video-Assisted Thoracic Surgery: Report of Two Cases

We describe the techniques we used for treating aberrant arteries during resection of pulmonary sequestration by video-assisted thoracic surgery (VATS) in two patients. In patient 1, the aberrant artery was transected after securing six rows of staples with a knifeless vascular endostapler. In patient 2, the aberrant artery was cut after ligation with special forceps that designed by one of us (S.K.) to push a knot, tied outside the body, into the thoracic cavity, then ligate the suture. Left lower lobectomy and right basal segmentectomy were both successfully performed by these methods. These two cases are reported to show that VATS lobectomy is a feasible and minimally invasive technique of treating pulmonary sequestration and other diseases of the lung. Received: October 12, 2001 / Accepted: July 2, 2002 Reprint requests to: S. Kaseda     

Partial anomalous pulmonary venous connection in right lung cancer: Report of a case

A partial anomalous pulmonary venous connection (PAPVC) is an uncommon congenital anomaly which is frequently associated with congenital heart disease such as an atrial-level shunt. This report documents the case of an 81-year-old man with PAPVC which was incidentally discovered during a right upper lobectomy for lung cancer. Surgery was performed through a minithoracotomy of an auscultatory triangle using a video-assisted procedure (video-assisted thoracic surgery: VATS). Although the ramus lobi medii was connected normally, the right superior lobe vein was found to drain into the superior vena cava. The surgery was successful, and the patient had an uneventful postoperative course. Asymptomatic PAPVC without an atrial septal defect (ASD) is extremely rare. If the PAPVC is located in a different lobe, a pulmonary resection for lung cancer would precipitate an adverse outcome without a correction of the PAPVC. Surgeons should therefore be cautious regarding the potential existence of a PAPVC when a patient undergoes surgical procedures, especially VATS, for lung cancer.     

Video-assisted thoracic surgery lobectomy for lung cancer in a patient with complete situs inversus

Complete situs inversus is a rare abnormality of autosomal recessive inheritance; it requires particular care during surgery, because the viscus anatomy is a mirror image of the normal anatomy. Reports of surgery for lung cancer in cases of complete situs inversus are very rare. Here, we report a case of lobectomy for lung cancer of the right lower lobe performed using video-assisted thoracic surgery (VATS) in a patient with complete situs inversus. We emphasize the importance of careful examination of the relationship between the bronchus, pulmonary artery, and pulmonary vein in the hilum of the lung in cases of complete situs inversus requiring lung resection for cancer; this is even more necessary when VATS is performed.     

A video-assisted thoracic surgical lobectomy for a lung tumour with a rare anomalous pulmonary artery

A detailed knowledge of anomalies of the anatomical course of the pulmonary vessels is extremely important for video-assisted thoracic surgery (VATS). Inadvertent vascular ligation and dissection are catastrophic for patients undergoing lobectomy. We describe a case with a rare anomaly of the left pulmonary artery and highlight the importance of identifying the courses of pulmonary vessels for VATS lobectomy.     

Complete video-assisted resection of trilobar mucormycosis

A case of trilobar pulmonary mucormycosis in a diabetic patient with severe obstructive pulmonary disease, successfully treated with systemic antifungal therapy and complete video-assisted thoracic surgery (VATS) resection, is presented. The VATS approach permitted accurate diagnosis and definitive therapy using lung-sparing techniques in a minimally invasive manner.     

Limited operation of lung cancer: the role of video-assisted thoracic surgery for lung cancer

Lobectomy with systemic nodal dissection is recognized as a standard operation for lung cancer. Partial resection and segmental resection are classified as limited resections for lung cancer to preserve pulmonary function. Minor complications occur more frequently with limited resection than with lobectomy. Partial resection of the lung and simple lobectomy can be performed as video-assisted thoracic surgery (VATS). Systemic hilar and mediastinal lymph node dissection is not yet standardized using VATS. On the other hand, VATS preserves chest wall muscles. The difference between standard thoracotomy and VATS is a difference of approach to the thoracic cavity. It is most important for lung cancer surgery to be performed in the thoracic cavity with the minimum burden on patients.     

Video-assisted thoracic surgery for the resection of pulmonary metastases

We report the use of video-assisted thoracic surgery (VATS) as a treatment or pulmonary metastases. Between July 1994 and March 2002, 75 patients were treated for metastatic lung tumor by VATS. These patients included 45 males and 30 females with an average age of 60.6 years. Their primary diseases were Colon cancer (38), renal cell carcinoma (12), breast cancer (6), seminoma (3), thyroid carcinoma (3), parotid cancer (2), pharyngeal cancer (2) and the others (9). Tumor size ranged from 6 to 62 mm in diameter. A preoperative high resolution spiral computed tomography (CT) scan was used to locate the nodule in all patients. Ten recurrence cases were performed re-resection by VATS approach with an average period was 22 month. We conclude that VATS is a good candidate for the resection of lung metastases in the selected cases.     

Benefits of video-assisted thoracic surgery for repeated pulmonary metastasectomy

Purpose  

The use of repeated pulmonary resection for metachronous pulmonary metastasis has increased. We assessed whether video-assisted thoracic surgery (VATS) produced greater benefits than classic thoracotomy for repeated pulmonary metastasectomy procedures.     

Intrapulmonary sequestration operated by video-assisted thoracoscopic surgery lobectomy; report of a case

Pulmonary sequestration is a rare malformation of the respiratory tract. We here report an adult case of intralobar pulmonary sequestration with aberrant artery of the right lower lobe. A 20-year-old man admitted to our hospital with a chest discomfort. Chest computed tomography (CT), angiography, and scintigraphy showed abnormal findings of the right lower lobe with an aberrant artery. Under the diagnosis of pulmonary sequestration, video-assisted thoracoscopic surgery (VATS) lobectomy was performed. VATS is useful for the operation of pulmonary sequestration.     

Planned pulmonary resection for metastatic pulmonary tumor with video-assisted thoracoscopic surgery using multidetector row angiography

Purpose  

For video-assisted thoracic surgery (VATS) on metastatic pulmonary tumors, wedge resection using an endo-stapler is the standard procedure in many institutions. However, this procedure can miss lesions or compromise surgical margins, particularly with small, deep lesions. The planned pulmonary resection in this study is a surgical method for pulmonary resection aimed at a previously assigned pulmonary area. We determine the pulmonary area for anatomical or nonanatomical resection before surgery on the basis of tumor location in relation to the anatomical distribution of pulmonary vessels.     

Video-assisted thoracoscopic wedge resection for pulmonary sequestration

A 60-year-old woman underwent a video-assisted thoracoscopic wedge resection of intralobar pulmonary sequestration instead of a lobotomy because the lesion was localized in the right basal segment. Preoperative 3-dimensional computed tomography was useful for identifying an aberrant artery arising from the thoracic aorta and distributing to the lesion. A successful outcome more than 4 years after the surgery indicates that a wedge resection under video-assisted thoracoscopy may prove to be a therapeutic option for localized pulmonary sequestration.     

An extrapleural approach to the anterior mediastinum using video-assisted thoracic surgery (VATS)

A lateral extrapleural approach via video-assisted thoracic surgery (VATS) was used in a patient suspected of having a benign tumor of right lobe of the thymus. The patient previously had undergone lung resection for pulmonary tuberculosis, and the ipsilateral thorax had contracted and dense pleural adhesions were likely to exist. Lateral extrapleural approach by VATS was performed successfully and is an alternative to open surgery in highly selected patients with anterior mediastinal lesions.     

Robot-assisted resection of pulmonary sequestrations

Pulmonary sequestration is a rare congenital malformation and may cause recurrent infections and hemoptysis. Although video-assisted thoracic surgery (VATS) is feasible, some drawbacks remain, mainly dealing the managing of anomalous vessels. We describe the use of a robotic system (da Vinci Robotic System, Surgical Intuitive, Mountain View, CA, USA) in the treatment of four consecutive cases of pulmonary sequestration.     

Pulmonary nodules 10 mm or less in diameter with ground-glass opacity component detected by high-resolution computed tomography have a high possibility of malignancy

OBJECTIVES: For the histological diagnosis of small lung cancers of 10 mm or less in diameter (< or =10), resection by video-assisted thoracic surgery (VATS) with computed tomography (CT)-guided marking is feasible. One problem is that a small number of these pulmonary nodules are malignant. We retrospectively analyzed CT images of pulmonary nodules to find better criteria to select candidates for resection among patients with small pulmonary nodules. METHODS: Ninety-four patients with indeterminate peripheral pulmonary nodules underwent wedge resection by VATS. High-resolution CT using a 1.25 mm slice included the area of lesions. Nodules were classified by size (< or =10, 11 to 20, >20 mm) and whether they had a ground-glass opacity (GGO) component. RESULTS: The histology of all 94 nodules showed 52 primary lung cancers, 6 metastatic tumors, 5 benign tumors, 8 intrapulmonary lymph nodes, and 23 inflammatory nodules. Ninety-three percent of nodules larger than 20 mm, 75% of nodules 10 to 20 mm, and 43% of nodules < or =10 mm were malignant. Introducing a classification according to GGO component to nodules, malignancy was detected in 88% of nodules with a GGO component and in 30% of nodules without a GGO component among nodules < or =10 mm. Nodules < or =10 mm with a GGO component showed a statistically significant (p < 0.01) correlation with malignancy. CONCLUSIONS: Pulmonary nodules < or =10 mm with GGO should be considered to have a high possibility of malignancy and to be candidates for resection by VATS.     

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.     

Minimally invasive thoracic surgery versus standard surgery

Advances in technology, with the availability of optics and minitelevision cameras and improved endoscopic instrumentation (especially endo-stapler devices), have allowed the surgeon to obtain a superior panoramic view of the thoracic cavity and an optimal surgical manuvrability. This has determined the development, besides the traditional thoracotomic approach, of minimally invasive techniques of video-assisted thoracic surgery (VATS). An auxiliary mini-thoracotomic approach and the magnification of the operating theatre, which allows the surgeon to accomplish difficult manoeuvres under diret view, have progressively extended the indications of this procedure: at first used for the treatment of pneumothorax and pleural effusions, it is now employed in biopsy or atypical resection of pulmonary nodules, lung cancer staging and diagnostic-therapeutical procedures of mediastinal diseases, major pulmonary resections (lobectomy and pneumonectomy) and lung volume reduction surgery for emphysema (LVRS). The Authors review minimally invasive techniques of video-assisted thoracic surgery (VATS), compared to the traditional surgical ones, for the treatment of various thoracic diseases.     

Current status of pulmonary metastasectomy from primary epithelial tumors

The resection of pulmonary metastases can prolong the survival of selected patients and its therapeutic value is now accepted. The criteria for eligibility have also evolved. We reviewed the recent literature on pulmonary metastasectomy for various epithelial primary tumors and tried to establish better prognostic indicators for its surgical application. In addition to the welldefined requisites for pulmonary metastasectomy, other requirements include the absence of mediastinal lymph node involvement, a limited number of pulmonary metastatic lesions, a long disease-free interval, small metastasis, and no elevation of tumor markers, although the clinical importance of each factor varies among the primary tumors. On the other hand, with the development of video-assisted thoracoscopic surgery (VATS) and advances in thoracic imaging technology, VATS metastasectomy might become an accepted treatment for metastatic nodules located in the periphery of the lung, which can be easily removed by a wedge resection. Repeat surgery is also possible during follow-up after VATS.     

Extrapleural resection of lung metastasis in a patient with dense pleural adhesions using VATS

We report the case of a 78-year-old man with dense pleural adhesion who underwent a resection of a lung metastasis by video-assisted thoracic surgery (VATS) through an extrapleural approach. The approach for diagnosis and therapeutic wedge resection of a lung tumor by VATS is easier and safer than an intrapleural approach if the patient has dense pleural adhesions.