Completion Middle Lobectomy With Videothoracoscopy
Cagatay Tezel, Talha Dogruyol, Ilker Kolbas, Serdar Evman, Levent Alpay, Volkan Baysungur.
Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
Completion lobectomy is a complex procedure performed mostly in tumor recurrence or after the presence of complications like lobar torsion or bronchopleural fistula. This operation is generally done via open techniques. Here we present a case of completion middle lobectomy via videothoracoscopy (VATS) after an upper lobectomy with thoracotomy.
50 year old man was admitted with hemoptysis. Thorax computed tomography (CT) showed 8x7 cm mass in the right upper lobe. Fiberoptic bronchoscopy revealed that the right upper lobe posterior ostium was obstructed with mass and the biopsy was reported as adenocarcinoma. The maximum standard uptake value (SUVmax) was 43.5 in positron emission tomography. The patient underwent right upper lobectomy by thoracotomy. Suspicion of lobar torsion was seen on postoperative chest x-ray and CT as well as in rigid bronchoscopy. Completion middle lobectomy was performed on the 2nd postoperative day by VATS. Patient was discharged on the 4th postoperative day after the second operation (Video).
Reoperations in thoracic surgery like completion lobectomies are tough procedures for patients as these operations usually present with more complications. Also they are technically challenging procedures for thoracic surgeons. Performing these operations via open techniques brings more burden to the patient. Minimally invasive surgery is generally accepted as beneficial in terms of pain, cosmetics and hospital discharge time in literature. Therefore we believe that all operations must be tried or even forced to be completed with minimally invasive techniques if possible.
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