Video-assisted thoracoscopic surgery bronchial sleeve lobectomy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Procedures

Background:

• Sleeve lobectomy (SL) is a viable alternative to pneumonectomy for central non-small cell lung cancer (NSCLC).
• Advancements in video-assisted thoracoscopic surgery (VATS) enable minimally invasive performance of complex procedures like SL.

Purpose of the Study:

• To describe the VATS approach for sleeve lobectomy in NSCLC patients.
• To highlight essential pre-operative assessments and surgical principles for VATS SL.

Main Methods:

• Pre-operative evaluation including flexible fiber-optic bronchoscopy and multidisciplinary team discussion.
• VATS approach utilizing 1 to 3-4 port incisions.
• Adherence to open SL principles: achieving free bronchial margins, tension-free anastomosis, avoiding luminal disparity, and en-bloc resection.

Main Results:

• VATS SL can be performed with variable port numbers and anastomosis techniques.
• Complex associated resections like arterioplasty or double sleeve are feasible.
• Successful VATS SL relies on fundamental surgical principles and meticulous technique.

Conclusions:

• VATS sleeve lobectomy is an effective minimally invasive surgical option for central NSCLC.
• Comprehensive pre-operative planning and adherence to established surgical tenets are crucial for VATS SL.
• Post-operative enhanced recovery pathways are vital for optimal patient outcomes.