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Subcostal Specimen Removal in Completely Portal Robotic Lobectomy
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Contralateral thoracoscopic lobectomy in postlobectomy patients.

Manabu Yasuda1, Ryoichi Nakanishi2, Shinji Shinohara1

  • 1Department of Thoracic Surgery, Shin-kokura Hospital, Federation of National Public Service, Personnel Mutual Aid Associations, Kitakyushu, Japan.

Journal of Thoracic Disease
|December 10, 2017
PubMed
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Performing thoracoscopic lobectomy after a previous contralateral lobectomy poses oxygenation challenges. Careful preoperative pulmonary function assessment is crucial for patient safety during one-lung ventilation.

Area of Science:

  • Thoracic Surgery
  • Pulmonary Medicine
  • Anesthesiology

Background:

  • Thoracoscopic lobectomy is challenging in patients with prior contralateral lobectomy due to potential oxygenation issues during one-lung ventilation.
  • Maintaining stable oxygenation is critical for surgical success in these complex cases.

Purpose of the Study:

  • To evaluate the feasibility and challenges of thoracoscopic lobectomy in patients who have undergone a previous contralateral lobectomy.
  • To identify predictors of perioperative oxygenation difficulties in this patient cohort.

Main Methods:

  • Retrospective analysis of 14 patients undergoing thoracoscopic lobectomy post-contralateral lobectomy (2008-2015).
  • Assessment of preoperative predicted pulmonary function, including forced expiratory volume in 1 second (FEV1) and remaining lung segments.
Keywords:
Thoracoscopic lobectomypredicted postoperative lung functionspecial oxygenation technique

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  • Evaluation of oxygenation strategies employed for challenging cases.

    • Main Results:

    • Four out of 14 patients experienced insufficient perioperative oxygenation with standard one-lung ventilation.
    • Predictive factors for oxygenation failure included predicted postoperative FEV1 <800 mL/m² and ≤5 contralateral residual segments.
    • Specialized ventilation techniques (lobe-selective bronchial blockade, intermittent positive airway pressure, high-frequency jet ventilation) were used in affected patients.

    Conclusions:

    • Preoperative pulmonary function evaluation is essential for patients undergoing thoracoscopic lobectomy after contralateral lobectomy.
    • Identifying patients at risk for hypoxemia allows for planning of advanced ventilation strategies.
    • Careful patient selection and tailored anesthetic management are key to successful outcomes.