Two-port intrapericardial left VATS pneumonectomy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Cardiothoracic Surgery

Background:

• Pneumonectomy is a critical intervention for locally advanced lung cancers invading the pulmonary hilum.
• An intrapericardial approach is sometimes required for safe management of pulmonary vessels when extrapericardial dissection is not feasible.
• Video-assisted thoracoscopic surgery (VATS) offers a minimally invasive option for complex thoracic procedures.

Discussion:

• This case report describes a novel two-incision VATS technique for left pneumonectomy with an intrapericardial approach.
• The technique involved intrapericardial isolation and closure of pulmonary vessels due to proximal involvement.
• Radical lymphadenectomy and bronchial stump coverage with a pericardial flap were integral parts of the procedure.

Key Insights:

• Intrapericardial VATS pneumonectomy is a feasible, albeit complex, approach for managing hilar lung cancers with extensive hilar involvement.
• The described technique facilitates safe handling of critical hilar structures in challenging oncological resections.
• Successful application of this VATS strategy led to a positive patient outcome with early discharge.

Outlook:

• Further research could explore the long-term oncological outcomes and recurrence rates following this specialized VATS technique.
• Standardization of the intrapericardial VATS pneumonectomy approach may expand its applicability in treating advanced lung malignancies.
• This approach may offer a less invasive alternative to open thoracotomy for select patients with complex hilar tumors.