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Early Clinical Outcomes from VATS Sleeve Resection and Bronchoplasty Utilizing 3D Thoracoscope
Yong Won Seong, Dong Jin Kim, Hyo Joon Jang, Sukki Cho, Sanghoon Jheon, Kwhanmien Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
Purpose : Thorascopic sleeve resection with bronchial anastomosis or bronchoplasty is a technically demanding procedure due to small incisions with relatively difficult intrathoracic handling of endoscopic instruments and ambiguous spatial perception from conventional two-dimensional image. Three-dimensional image may be helpful especially in spatial perception, but there have been rare reports about these procedures utilizing 3D thoracoscope. We performed this study to evaluate early clinical outcomes from thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope.
Methods : Data from a total of 29 patients who underwent VATS sleeve lobectomy or bronchoplasty at our institution from December 2015 to July 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 30˚ three-dimensional thoracoscope. Twenty-three (79%) were male, mean age was 65.9±9.4 years. Twelve patients (41.4%) underwent sleeve resection with bronchial anastomosis, 17 (58.6%) underwent bronchoplasty, and one (3.4%) underwent sleeve resection with concomitant PA procedure.
Results : Pathologic report revealed squamous cell carcinoma (69.0%), adenocarcinoma (17.2%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (3.4%). There were no (0.0%) operative mortalities. One patient died a few months later from systemic recurrence of sarcomatoid carcinoma. There were no (0.0%) anastomotic failure from postoperative bronchoscopy. Median postoperative 24 hr. drain amount was 320mL. Median chest tube days and hospital days were 4 and 6, respectively. There was one delayed bronchopleural fistula in a patient with previous definitive CCRT.
Conclusion : Thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope is safe and effective with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed.
Methods : Data from a total of 29 patients who underwent VATS sleeve lobectomy or bronchoplasty at our institution from December 2015 to July 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 30˚ three-dimensional thoracoscope. Twenty-three (79%) were male, mean age was 65.9±9.4 years. Twelve patients (41.4%) underwent sleeve resection with bronchial anastomosis, 17 (58.6%) underwent bronchoplasty, and one (3.4%) underwent sleeve resection with concomitant PA procedure.
Results : Pathologic report revealed squamous cell carcinoma (69.0%), adenocarcinoma (17.2%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (3.4%). There were no (0.0%) operative mortalities. One patient died a few months later from systemic recurrence of sarcomatoid carcinoma. There were no (0.0%) anastomotic failure from postoperative bronchoscopy. Median postoperative 24 hr. drain amount was 320mL. Median chest tube days and hospital days were 4 and 6, respectively. There was one delayed bronchopleural fistula in a patient with previous definitive CCRT.
Conclusion : Thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope is safe and effective with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed.
책임저자: Kwhanmien Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
발표자: Yong Won Seong, E-mail : arqjoker@gmail.com