Early Clinical Outcomes Of Thoracoscopic Sleeve Resection And Bronchoplasty─Safety And Efficacy Of Three-dimensional Thoracoscope
Yong W. Seong, Dong Jin Kim, Hyo Joon Jang, Sukki Cho, Sanghoon Jheon, Kwhanmien Kim.
Seoul National University Bundang Hospital, Seongnam, Korea, Republic of.
Background: Video-assisted thoracoscopic surgery (VATS) sleeve resection with bronchial anastomosis or bronchoplasty is a technically demanding procedure due to relatively difficult intrathoracic handling of endoscopic instruments and ambiguous spatial perception from conventional two-dimensional image. Three-dimensional endoscopic surgery has been reported to be helpful in decreasing operation time and improving spatial perception with less surgical errors, but there have been rare reports about relatively difficult thoracoscopic procedures utilizing 3D thoracoscope. We performed this study to evaluate early clinical outcomes of thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope. Methods: Data from a total of 36 patients who underwent thoracoscopic sleeve lobectomy or bronchoplasty at our institution from December 2015 to October 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 10mm, 30° three-dimensional thoracoscope. Twenty-three patients (81%) were male, and mean age was 65.9±9.4 years. Fourteen patients (38.9%) underwent sleeve resection with bronchial anastomosis, 22 (61.1%) underwent wedge or simple bronchoplasty, and one patient who received sleeve resection received concomitant PA procedure. Bronchial anastomosis sites were not covered with viable tissue flaps. Results: There was no (0%) intrathoracic suture needle injury from spatial misperception during bronchoplasty or sleeve anastomosis. There was no (0%) operative mortality. Pathologic report revealed squamous cell carcinoma (63.9%), adenocarcinoma (19.4%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (2.8%). One (2.8%) late mortality was due to systemic recurrence of sarcomatoid carcinoma. There was no (0.0%) anastomotic failure. Mean number of dissected lymph nodes were 27.4±13.2, and mean operation time was 216.8±60.0 minutes. Median postoperative 24-hour drain amount was 315mL. Median chest tube days and hospital days were 4 and 6, respectively. Two patients (5.6%) had complications greater than Clavien-Dindo grade II─one case of ARDS, and the other case of delayed bronchopleural fistula in a patient who underwent preoperative definitive CCRT with radiation dose of 66 Gy. This bronchopleural fistula spontaneously healed after percutaneous catheter drainage. Conclusion: Thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope is a safe and effective procedure with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed. 
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