Thoracoscopic Fissureless Lobectomy Using a New Temporaly Segmental Bronchus Incision Technique
Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
OBJECTIVE: Several thoracoscopic fissureless lobectomy techniques have been reported but the indications remain controversial. Traditional technique of fissureless lobectomy is to exposure of the pulmonary artery at the fissure using electrocautery at first, but persistent air leak can occur after lobectomy. Therefore the fissure should be stapled completely after dissecting arteries or between artery and lung parenchyma. Moreover, 'Fissure first' technique including the traditional procedure and thoracoscopic tunnel technique can not be used in some patients because the pleural fissure line is uncertain especially in patients with complete fused fissure.In thoracoscopic fissueless lobectomy, one of the reasons for conversion to open lobectomy is the swelling or inflammation of lymph nodes between the lobar bronchus and the adjacent pulmonary artery. We developed a thoracoscopic technique of fused fissure lobectomy for patients with lung cancer, advocate T-BIT (temporary segmental bronchus incision technique) and describe its application for lung cancer patients with fused fissures.
METHODS: T-BIT involves initial segmental bronchus incision before lobar bronchus stapling to safely dissect the lymph nodes between the lobar bronchus and the pulmonary artery. And for complete fused fissure, Performing 'Hilum first, fissure last'method, we used intra-venous ICG method after dealing with all lobe vessels.Ten patients who underwent thoracoscopic fissureless lobectomy with T-BIT between August 2014 and November 2016 were included in the study. Seven patients underwent left upper lobectomy, one underwent left lower lobectomy, and two underwent right middle lobectomy.
RESULTS: With T-BIT, complete peribronchial lymph node dissection was easily performed in all patients. There were no intraoperative complications, such as pulmonary artery bleeding or pulmonary paraenchymal injury. The postoperative chest tube drainage time was 2.5 ± 0.5 days, postoperative persistent air leak did not occur . The length of hospital stay was (5.3 +/-2.1 )same compared with non-fissureless lobectomy patients(5.1+/-3.1).
CONCLUSIONS: T-BIT thoracospically appears useful for lymph node dissection in thoracoscopic fissureless lobectomy. This technique prevent conversion to open lobectomy and persistent air leak, can be performed safely at no additional cost.
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