[Dealing with Pleural Adhesion in Video-assisted Thoracoscopic Surgery]

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Pulmonary Medicine

Background:

• Pleural adhesions between visceral and parietal pleura complicate video-assisted thoracoscopic surgery (VATS).
• Successful VATS in the presence of adhesions requires careful preoperative assessment and intraoperative management.
• Conversion to thoracotomy may be necessary if adhesions are severe.

Purpose of the Study:

• To describe specific approaches and techniques for performing VATS in patients with significant pleural adhesions.
• To outline strategies for managing pleural injuries encountered during VATS for adhesions.
• To present methods for facilitating visceral pleura repair in challenging VATS cases.

Main Methods:

• Preoperative evaluation of pleural adhesion extent using chest ultrasonography to assess visceral sliding.
• Strategic planning of incision sites (utility, camera, and third ports) based on adhesion assessment.
• Extra-pleural detachment of adhesions around injured visceral pleura to aid repair.
• Utilization of free mediastinal fat tissue as biological pledgets for suturing pleural injuries.

Main Results:

• Chest ultrasonography aids in planning VATS port placement for patients with pleural adhesions.
• Extra-pleural detachment facilitates the repair of injured visceral pleura.
• Mediastinal fat tissue provides effective support for suturing pleural defects during VATS.

Conclusions:

• VATS can be successfully performed in patients with pleural adhesions by employing meticulous techniques.
• Preoperative assessment and specialized intraoperative strategies are crucial for managing pleural adhesions during VATS.
• The described methods, including extra-pleural detachment and the use of mediastinal fat, enhance the safety and efficacy of VATS in complex cases.