Technique Of Robot-assisted Thoracoscopic Lobectomy For Intralobar Pulmonary Sequestration: Single Center Experience
Piotr Yablonskii, Grigorii Kudriashov, Igor Vasilev, Ivan Zaicev, Olga Volodich, Andrey Kozak.
Saint-Petersburg Research Institute Phthisiopulmonology, Saint-Petersburg, Russian Federation.
OBJECTIVE: Intralobar pulmonary sequestration (IPS) is a rare congenital condition, which accompanied with abnormal arterial blood supply in the part of the lung and absence of bronchial communication with the normal tracheobronchial tree (Lu-Ming Wang, 2016). Recently, standard approaches for surgery were VATS or thoracotomy. The role of robotic surgery for this pathology is few studied (Melfi F.M., 2011). We report two cases of robot-assisted thoracoscopic (RATS) lobectomy for IPS.
METHODS: Between 2013 and 2016, two females (15 and 25 years old) with IPS were underwent RATS pulmonary lobectomy. The disease was presented with an unproductive cough and recurrent pneumonic infiltration in the left lower lobe. The diagnosis was made by chest CT. There was secondary non-tuberculosis mycobacterial infection (NTBI) in the first case, which required an accurate preoperative course of antibacterial therapy.
RESULTS: The feature of surgery was careful division of the abnormal vessels. We used VATS-based approach and inserted three robotic and one assistant port as low as possible. The first step of operation was a division of pulmonary ligament and isolation of additional vessel. Other measures of operation were standard steps for left lower lobectomy. Operative time was 515 and 245 min. There were one and three additional vessels from the descending thoracic aorta in first and second cases respectively. Adhesions in the hilum were denser in the case of combination IPS and NTMI. There were no major postoperative complications. Prolonged (>5 days) chest tube was in first case due to high daily drainage of serous fluid. Seroma in the area of assistant port was in second case (without additional intervention). Examination of three and one years after surgery showed no any data about later complications.
CONCLUSIONS: Robotic approach is a viable alternative procedure for IPS in some patients. Adhesions in the hilum and cavity in the lung are not a contraindication for robotic surgery.
A-D - Chest CT before operation. E-G - Steps of RATS lobectomy for IPS. K-N - Specimen.
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