Video-assisted thoracic surgery right upper lobe bronchial sleeve resection

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Video-assisted thoracic surgery (VATS) is widely used but has controversies regarding sleeve bronchial lobectomy for advanced central lung cancer.
• Technical challenges, operative time, lymph node dissection extent, and complications remain areas of debate.

Purpose of the Study:

• To evaluate the feasibility and outcomes of VATS sleeve bronchial lobectomy for locally advanced central lung cancer.
• To identify optimal surgical techniques and incision placement for improved outcomes.

Main Methods:

• A 66-year-old male with squamous cell carcinoma involving the right upper lobe bronchus and main bronchus underwent VATS sleeve lobectomy.
• The procedure involved double-lumen intubation, left lateral decubitus position, and specific port placements for camera and instruments.
• Mediastinal lymph node dissection preceded bronchial mobilization and reconstruction using interrupted absorbable sutures for end-to-end anastomosis.

Main Results:

• The patient experienced no postoperative complications and was discharged 8 days after surgery.
• The chosen anterior axillary incision facilitated easier anastomosis with reduced operator strain.

Conclusions:

• The anterior axillary incision (3rd intercostal space) is recommended for right upper lobe sleeve resection to optimize surgical ergonomics and anastomosis.
• Performing mediastinal lymph node clearance before bronchial transection improves surgical exposure and avoids tension on the anastomosis.
• Interrupted sutures are a safe and effective method for VATS bronchial anastomosis.