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Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
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Video-Assisted Thoracic Surgery After Median Sternotomy for Cardiac Surgery
Derek Serna-Gallegos1, Heather Merry1, Robert J McKenna1
1Division of Thoracic Surgery, Department of Surgery, Cedars-Sinai Medical Center, 8631 West Third, Suite 240E, Los Angeles, CA 90048, USA.
Thoracic Surgery Clinics
|July 27, 2015
Summary
Video-assisted thoracic surgery (VATS) after cardiac surgery requires careful technique to protect internal mammary artery grafts. This guide details methods to minimize risks during VATS lobectomy in patients with prior sternotomy.
Area of Science:
- Thoracic Surgery
- Cardiothoracic Surgery
- Surgical Oncology
Background:
- Video-assisted thoracic surgery (VATS) lobectomy is standard for early-stage lung cancer.
- Performing VATS after median sternotomy for cardiac surgery poses risks to grafts.
- Internal mammary artery grafts are particularly vulnerable.
Purpose of the Study:
- To describe techniques for minimizing internal mammary artery graft damage during VATS anatomic pulmonary resection.
- To review existing data on VATS following median sternotomy.
- To provide strategies for preventing, treating, and mitigating complications.
Main Methods:
- Review of clinical data and surgical techniques for VATS after median sternotomy.
- Description of specific procedural steps to protect grafts.
- Discussion of intraoperative crisis management.
Main Results:
- Techniques exist to significantly reduce the risk of graft injury during VATS.
- Proactive management strategies can mitigate potential complications.
- Safe performance of VATS lobectomy is achievable in this patient cohort.
Conclusions:
- VATS lobectomy can be safely performed after prior median sternotomy with careful planning and technique.
- Protecting internal mammary artery grafts is paramount.
- Adherence to described methods enhances patient safety and surgical outcomes.
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