Single Port Lul Lobectomy Combined With Adrenalectomy And Posterior Hepatic Segmentectomy
Dohyung kim, Mi hee Lim, Bong Soo Son.
Pusan national university Yangsan Hospital, Yangsan, Korea, Republic of.
OBJECTIVE: Lobectomy and mediastinal lymph node dissection(MLND) using single port video-assisted thoracosopic surgery (VATS) has many advantages in postoperative pain and recovery time. However, if the patients have huge lung mass, we could not perform the single port VATS. If there is another way to remove huge mass, it can be performed a single port VATS to relieve the pain of the patients and reduce the recovery time.
METHODS: A 63-years old man, heavy smoker, presented to hospital complained of cough and blood tinged sputum for 3 month. He has 6.4cm sized lung lesion in left lingular segment with left interlobar and hilar, AP window LN enlargement on initial chest CT. Because of 4.9cm sized right adrenal gland nodule, his clinical stage was stage IV(cT2N2M1b) and planned to adrenalectomy for pathologic diagnosis of adrenal gland. And we planed to co-operation with general surgery team to use their subcostal skin incision to remove huge lung mass with substernal dissection.
RESULTS: Substernal dissection was successful and we can eliminate the huge primary lung cancer with 3cm skin incision.
CONCLUSIONS: In this report, we describe a patient with primary large lung cancer and metastatic region on adrenal gland. Because of huge lung mass (6.4cm), we thought that single port VATS is impossible for this patients at first time. However, substernal approach combined with adrenalectomy and hepatic segmentectomy let us carry out single port VATS.
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