Multimedia article. Entirely thoracoscopic pneumonectomy using the prone position: a new technique

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Oncology

Background:

• Video-assisted thoracoscopic surgery (VATS) for pneumonectomy remains underreported despite its technical feasibility.
• Previous reports utilized a lateral decubitus position for VATS pneumonectomy.
• This video showcases a novel approach using a prone position for totally videothoracoscopic pneumonectomy.

Purpose of the Study:

• To demonstrate the technical details of a totally videothoracoscopic left-side pneumonectomy performed with the patient in the prone position.
• To highlight the advantages of the prone position for accessing the aortopulmonary window and hilar structures.

Main Methods:

• A 49-year-old male patient with bifocal cancer (lung and esophagus) underwent a totally videothoracoscopic left-side pneumonectomy.
• The patient was positioned prone, with trocar placement in the 7th, 5th, 9th, and 11th intercostal spaces.
• Key structures including the left main bronchus, pulmonary veins, and pulmonary artery were dissected and transected using endoscopic staplers.

Main Results:

• The pneumonectomy was completed in 146 minutes with minimal blood loss (30 ml).
• Pathology confirmed invasive adenocarcinoma (staged IIB, pT2N1Mx) with clear bronchial margins.
• The prone position facilitated direct visualization and dissection of the aortopulmonary window and hilar structures.

Conclusions:

• The prone position in thoracoscopic surgery provides superior visualization and ergonomics for accessing the aortopulmonary window.
• This technique simplifies the dissection of hilar vessels and lymph node sampling by utilizing gravity to retract the lung.
• Totally videothoracoscopic pneumonectomy in the prone position is a viable and advantageous approach for selected thoracic malignancies.