MINIMALLY INVASIVE THORACIC SURGERY PRINCIPLES AND PRACTICE OF THORACOSCOPIC TECHNIQUE MARCO SCARCI, PIERGIORGIO SOLLI, ALAN DL SIHOE
INDEX
ABCDEFGHIJKLMNOPQRSTUVWXZ
Note: Page numbers in bold or italic refer to tables or figures respectively.
A
Ablative therapy, 9
Absent/fused fissure, 67
Active drainage, 159, 160
Acute respiratory distress syndrome (ARDS), 23
Adhesions, 72
pleural, 67, 68
preoperative detection of, 67
Adson test, 101
Air-flow-pleural pressure, 160–2, 161–2
Air leakage
prolonged, 159, 160
VATS lobectomy and, 10–11
Airway bypass procedure, 81
American College of Surgeons Oncology Group Z0030 randomized clinical trial, 5
American Thoracic Society, 85
Analgesia, 10, 24
Anesthesia, 10
and fluid management, 23
general. See General anesthesia (GA)
and lung isolation. See Lung isolation
for medical thoracoscopy, 165
monitoring, 23–4
for robotic thoracic surgery, 25
for VATS pneumonectomy, 41–2
for VATS thymectomy, 89
for video-assisted thoracoscopic surgery, 25
Anterior mediastinal tumors, bilateral VATS approach for, 92, 92–3, 93, 94
Anterior mediastinum, robotic surgery in, 119
ectopic mediastinal parathyroid adenoma, 120, 120–1, 121
posterior mediastinal lesion resection, 121, 121, 122
thymic lesions, 119–20
Anterior segmental artery/vein, right upper lobe segmentectomy, 59, 59, 60, 61
Aortopulmonary window, 38
Apical segmental vein
left upper lobe segmentectomy, 61, 61, 62
right upper lobe segmentectomy, 57, 57–8, 58
ARDS. See Acute respiratory distress syndrome (ARDS)
Assisted VATS (a-VATS) lobectomy, 5
Azygos vein, 38, 38
B
BELIEVER HiFi study, 76
Benign lesions, 47
Bilateral VATS
approach for thymomas and anterior mediastinal tumors, 92, 92–3, 93
tumor characteristics for, 94
Biopsy
endobronchial ultrasound guided fine-needle aspiration, 123
lung, 74, 74
of pericardium, 95
Biportal VATS. See Two-port VATS
Bleeding, 68–9, 69
Bronchial anastomosis, 48, 48–9, 49
Bronchial blockers, 21–2, 22
double-lumen tube vs., 23
Bronchoscopic thermal vapor ablation (BTVA), 81
Bronchoscopy, 21, 23, 86. See also Electromagnetic navigation bronchoscopy (ENB)
Bronchus, 43, 43
transection of, 48, 48
BTVA. See Bronchoscopic thermal vapor ablation (BTVA)
C
Cancer and Leukemia Group B (CALGB), 5, 31
Cardiac tamponade, 95
Catamenial pneumothorax, 73
Cervicoaxillary canal, 102
Chest drainage systems. See Drainage systems
Chest wall reconstruction, 54–5
Chest wall resections
robotic lobectomy and, 125–6
VATS en bloc. See VATS en bloc chest wall resections
Chronic obstructive pulmonary disease (COPD), 75, 76, 78. See also Emphysema
pathway for lung volume reduction in, 77
Chylothorax, 70, 107
etiology of, 107
evaluation of, 107
mortality rate, 107
nonoperative management, 107, 108
operative management. See Operative management, of chylothorax
Clinical pathways, in MITS, 11, 27–9
feedback, 28
intraoperative factors, 28
postoperative care, 28
preoperative factors, 27
Collateral ventilation (CV), 76, 77–8
Complete VATS (c-VATS) lobectomy, 5, 7
Computed tomography (CT), 67, 71, 76, 85, 86, 86, 107
angiography, 101–2
of chest, 155, 155
for diaphragmatic function evaluation, 111
of thorax, 95
COPD. See Chronic obstructive pulmonary disease (COPD)
Costoclavicular space, anatomy of, 102, 102
Cough, 148
COX-2 inhibitor, 24
CT. See Computed tomography (CT)
c-VATS lobectomy. See Complete VATS (c-VATS) lobectomy
Cystic fibrosis, pneumothorax in, 73
D
Da Vinci Surgical System, 7, 119, 120, 123
Decortication, 86, 108
Deep sedation. See General anesthesia (GA)
Diaphragmatic dysfunction, 111–112, 112
Digital dissection, 86
Digital drainage, 11
Doppler catheter, 81–2
Dorsal segmental artery/vein
left lower lobe segmentectomy, 64–5, 65–6
right lower lobe segmentectomy, 60, 61
Double-lumen tube, 21, 21–2, 71
bronchial blocker vs., 23
Drainage systems, 167
active, 159, 160
electronic, 160
passive, 159
E
EASE. See Exhale airway stents for emphysema trial (EASE)
EBUS. See Endobronchial ultrasound (EBUS)
EBUS-FNA biopsy. See Endobronchial ultrasound guided fine-needle aspiration (EBUS-FNA) biopsy
EBUS-TBNA procedure, 149–50, 150
adequacy of, 151
complications of, 153
for diagnosis of sarcoidosis, 152
linear, 150
and lung cancer, diagnosis and staging of, 150–1
for mediastinal lymphadenopathy diagnosis, 152
sensitivity of, 150
for suspected lymphoma investigation, 152–3
EBV therapy. See Endobronchial valve (EBV) therapy
EELV. See End-expiratory lung volume (EELV)
Electromagnetic navigation bronchoscopy (ENB), 11, 155
clinical applications of, 157–8
effectiveness of, 157
planning phase, 155, 155–6, 156
procedure set-up, 156, 156
registration phase, 156
target lesion, leading to, 156, 157
and tissue sampling, 156–7
Electronic drainage systems, 160
ELS. See Emphysematous lung sealant (ELS)
ELVR. See Endoscopic lung volume reduction (ELVR)
Emphysema, 75
bronchoscopic thermal vapor ablation, 81
emphysematous lung sealant technique, 81
endobronchial valve therapy for. See Endobronchial valve (EBV) therapy
exhale airway stents, 81–2
lung volume reduction coil, 79, 81
lung volume reduction surgery, 82
Emphysematous lung sealant (ELS), 81
Empyema
uniportal VATS for, 144
VATS for, 1
Empyema thoracis
diagnosis of, 86
management of, 86
mortality rate for, 85
principles of surgery, 85
stages of, 85, 85–6, 86
ENB. See Electromagnetic navigation bronchoscopy (ENB)
En bloc chest wall resection, VATS. See VATS en bloc chest wall resections
End-expiratory lung volume (EELV), 78
Endobronchial ultrasound (EBUS), 11, 149
cost-effectiveness of, 153
and EUS, 151
and investigation of isolated mediastinal lymphadenopathy, 152–3
linear probe, 149, 149, 150
radial probe, 149, 149
training and service provision, 153
with transbronchial needle aspiration. See EBUS-TBNA procedure
Endobronchial ultrasound guided fine-needle aspiration (EBUS-FNA) biopsy, 123
Endobronchial valve (EBV) therapy, 75–6
benefit of, 76
collateral ventilation, 77–8
complications associated with, 78–9
cost-effectiveness of, 79
feasibility of, 76
patient selection, 76, 77
physiological measures, 78
prognosis, 79, 80
safety profile, 78–9
surgical LVR vs., 79
Endometriosis, 73
Endoscopic lung volume reduction (ELVR), 75
Endoscopic ultrasound (EUS)
cost-effectiveness of, 153
EBUS and, 151
Enhanced recovery after surgery (ERAS), 24–5, 27
Equipment malfunction, 69
ERAS. See Enhanced recovery after surgery (ERAS)
EUROVENT study, 76
EUS. See Endoscopic ultrasound (EUS)
Exhale airway stents for emphysema trial (EASE), 81–2
Exudative stage, of empyema, 85, 85
F
FEV1. See Forced expiratory volume in one second (FEV1)
Fiberoptic bronchoscopy, 21, 23
Fibrinopurulent stage, of empyema, 85, 85–6
Fine-needle aspiration (FNA), 71
Fluid management, 23
Fluorescence imaging, 120
Fluoroscopy, 111
FNA. See Fine-needle aspiration (FNA)
Foley catheter, 28
Forced expiratory volume in one second (FEV1), 6, 75, 76, 123
Forced vital capacity (FVC), 6, 111–12
Fused fissure, 67
FVC. See Forced vital capacity (FVC)
G
Gabapentin, 10
General anesthesia (GA), 145
after-effects of, 10
for emphysematous lung sealant, 81
for nonintubated VATS, 146, 147
with single lung ventilation, 120
and spontaneous ventilation, 22
for thoracic surgery, 25
and three-port VATS approach, 96
for VATS pneumonectomy, 41
H
Haller index, 115
Healthcare information systems, 28–9
Health information technology (HIT), 29
Health-related quality of life (HRQOL), 1
Hilar structures, 3
HIT. See Health information technology (HIT)
HRQOL. See Health-related quality of life (HRQOL)
Hypercapnia, 147
Hypoxia, 147
I
Iatrogenic chylothorax, 107
IBV. See Intrabronchial valve (IBV)
ICG. See Indocyanine green (ICG)
Immunosurveillance, 6
Incisions
in segmentectomy, 57
in VATS en bloc chest wall resection, 54
in VATS pneumonectomy, 42
Indocyanine green (ICG), 120
Induction therapy, 125
Inferior pulmonary vein, 33–4
Interstitial lung disease (ILD)
uniportal VATS for, 143
VATS for, 74, 74
Intrabronchial valve (IBV), 75
Intraoperative complications
absent/fused fissure, 67, 67
bleeding, 68–9, 69
equipment malfunction, 69
during mediastinal lymphadenectomy, 70
pleural adhesions, diffuse/complete, 67, 68
pulmonary hilum, 67–8, 68
Intubated VATS, 148, 148
Invasive thymomas, VATS thymectomy for, 91, 91
Isolated mediastinal lymphadenopathy, investigation of, 152–3
J
Jacobaeus, Hans Christian, 3
K
Kerrison forceps, 103
L
LAM. See Lymphangioleiomyomatosis (LAM)
Left lower lobe, dorsal segmentectomy, 64–5, 65–6
Left lower VATS lobectomy, 34–5
Left main bronchus (LMB), 40, 40, 41
Left main pulmonary artery (LMPA), 38, 39
Left paratracheal lymph nodes, dissection of, 38–9, 39
Left-sided double-lumen tube, 21, 21–2
Left upper lobe, uniportal VATS segmentectomy
apical segmentectomy, 61, 61, 62
lingulectomy, 63–4, 64, 65
posterior segmentectomy, 62, 62, 63
trisegmentectomy, 62–3, 63, 64
Left upper VATS lobectomy, 34
Lewis, Ralph, 3
Linear probe EBUS, 149, 149, 150
with TBNA, 150
LLV. See Lower lobe vein (LLV)
LMB. See Left main bronchus (LMB)
LMPA. See Left main pulmonary artery (LMPA)
Lobectomy
robotic. See Robotic lobectomy
VATS. See VATS lobectomy
Lower lobe vein (LLV), 140
Lung biopsy, for interstitial lung disease, 74, 74
Lung cancer
diagnosis and staging of, 150–1
lobectomy for. See VATS lobectomy
patients, questionnaires to assess QoL in, 5–6
thoracic surgery approaches for, 8
Lung collapse, 147, 147
Lung isolation, 21, 89
bronchial blocker, 21–2, 22, 23
double-lumen tube placement, 21, 21–2
Lung movements, 148
Lung volume reduction coil, 79, 81
Lung volume reduction surgery (LVRS), 2, 75, 82
Lymphadenectomy, 140
Lymphangioleiomyomatosis (LAM), 107
Lymph node dissection, 37
mediastinal. See Mediastinal lymph node dissection (MLND)
single-port VATS, 140
Lymph nodes
dissection. See Lymph node dissection
paratracheal, 38–9, 39
subcarinal, 38, 38, 40, 40, 41
M
Magnetic mini-mover procedure (3MP), 116
Magnetic resonance imaging (MRI), 111, 112
Mediastinal lymphadenopathy, diagnosis of, 152
Mediastinal lymph node dissection (MLND), 37
complications during, 70
robotic lobectomy for, 123–4
by VATS. See VATS mediastinal lymph node dissection
Mediastinoscopy, 123
Mediastinum, 119
anterior, robotic surgery in, 119–22
re-staging of, 151–2
Medical thoracoscopy (MT), 163
anesthesia for, 165
and chest drainage, 167
complications of, 167–8, 168
documentation, 167
equipment for, 163, 164
inspection, 166
patient positioning, 166
pleural sampling in, 166, 167
and pneumothorax, 166
preprocedure evaluation, 164–5
talc insufflation at, 167
video-assisted thoracoscopic surgery vs., 163, 163
Medium lobe vein (MLV), 140
MG. See Myasthenia gravis (MG)
Mild bleeding, 68
Minimally invasive thoracic surgery (MITS). See also Video-assisted thoracic surgery (VATS)
benefits of, 1
clinical pathways in, 11, 27–9
defined, 1
evidence for, 1–2
evolution of, 7
future use of, 2
goals, 28
historical overview of, 3
program, 17–19
MLND. See Mediastinal lymph node dissection (MLND)
MLV. See Medium lobe vein (MLV)
Morbidity, VATS pneumonectomy, 43
Mortality rate
for chylothorax, 107
for empyema thoracis, 85
for VATS pneumonectomy, 43, 44
3MP. See Magnetic mini-mover procedure (3MP)
MRI. See Magnetic resonance imaging (MRI)
MT. See Medical thoracoscopy (MT)
Multi-port VATS, 7, 8, 9
Myasthenia gravis (MG), 119–20
uniportal VATS for, 90–1
Mycobacterium tuberculosis, inspection of, 152
N
Nasogastric tube placement, 28
National Emphysema Treatment Trial (NETT), 2, 75
National Health Service, 17
Natural killer (NK) cells, 6
Natural orifice surgery, 9
Natural orifice transluminal endoscopic surgery (NOTES), 95, 99
Near-infrared (NIR) imaging, 120
Needlescopic VATS (nVATS), 8, 9, 95, 129–31, 130, 131
instruments for, 134
intraoperative view during, 131, 131
pericardial window, 96, 97, 98
perioperative care, 133
step-wise training, 133–4
troubleshooting, 134
Nerve compression, 101
NETT. See National Emphysema Treatment Trial (NETT)
NIR imaging. See Near-infrared (NIR) imaging
NK cells. See Natural killer (NK) cells
Nonintubated VATS
advantages of, 145, 145
awake technique, 146
contraindications to, 146, 146
conversion to intubated VATS, 148
general anesthesia for, 146, 147
intraoperative complications, 147–8
patient selection for, 145–6
preparation for, 146
regional anesthesia techniques, 146–7
sedation usage, 146
types of, 145
Non-small cell lung carcinoma (NSCLC), 53
Non-thymomatous myasthenia gravis, VATS thymectomy for, 89, 90, 90–1
NOTES. See Natural orifice transluminal endoscopic surgery (NOTES)
NSCLC. See Non-small cell lung carcinoma (NSCLC)
Nuss technique, 116–17, 117
nVATS. See Needlescopic VATS (nVATS)
O
One-lung ventilation, 22–3, 23, 96
Open lobectomy, VATS lobectomy vs., 41
Open pneumonectomy, VATS pneumonectomy vs., 44
Open thoracotomy, VATS vs., 1
Operative management, of chylothorax, 107–8, 108
decortication, 108
pleurodesis, 108, 108–9, 109
thoracic duct ligation, laparoscopic approach, 110
thoracic duct ligation, minimally invasive VATS/robotic, 109, 109–10
Operative techniques, of VATS pneumonectomy
bronchus, 43, 43
closure, 43
incisions in, 42
overview of, 42, 42
patient positioning, 42
thoracoscopic exploration, 42
Organization stage, of empyema, 86, 86
P
PA. See Pulmonary artery (PA)
Paget–Schroetter syndrome, 104
Pain, 101
neuropathic, pharmacotherapy annd, 10
VATS lobectomy and, 4, 5
PAL. See Prolonged air leak (PAL)
Paraaortic lymph nodes, dissection of, 38, 39
Paraesthesia, 101
Parapneumonic effusion, 85
diagnosis of, 86
management of, 86
Paratracheal lymph nodes, 38
left, 38–9, 39
Passive drainage, 159
Patient-controlled analgesia (PCA), 24
PCA. See Patient-controlled analgesia (PCA)
Pectus excavatum, 115, 115–16
chest X-ray of, 116
etiopathogenesis, 115
medical care, 116
Nuss technique for, 116–17, 117
PEEP. See Positive end-expiratory pressure (PEEP)
Pericardial effusion (PE)
causes of, 95
prognosis of, 95
Pericardial window
subxiphoid, 95–6
uniportal VATS, 143–4
VATS. See VATS pericardial window
PET. See Positron emission tomography (PET)
PET-CT scan. See Positron emission tomography-computed tomography (PET-CT) scan
Pharmacotherapy, 10
Physiotherapy, 10, 102
Pleural adhesions, diffuse/complete, 67, 68
Pleural effusion, 85–6, 107, 144
Pleural pressure, 160–2, 161–2
Pleurodesis, 107, 108, 108–9, 109
Pleuroscopy, 163
equipment and personnel, 163–4, 164, 165
historical overview of, 163
medical. See Medical thoracoscopy (MT)
Plication, of diaphragm, 112, 113
Pneumonectomy, VATS. See VATS pneumonectomy
Pneumothorax, 78
catamenial, 73
in cystic fibrosis, 73
medical thoracoscopy and, 166
principles of, 71–2
spontaneous, 22, 71
VATS for, 1–2, 71–3, 72, 73. See also VATS pneumonectomy
Polymeric lung volume reduction, 81
Port placements, for VATS lobectomy, 37, 37
Positive end-expiratory pressure (PEEP), 22, 23
Positron emission tomography (PET), 71
Positron emission tomography–computed tomography (PET-CT) scan, 123
Posterior segmental artery/vein
left upper lobe segmentectomy, 62, 62, 63
right upper lobe segmentectomy, 58, 58–9
Prolonged air leak (PAL), 159, 160
Protective lung ventilation, 22–3, 23
Pulmonary artery (PA), 31–2
dissection of, 42, 43
Pulmonary function, 27
Pulmonary hilum, 67–8, 68
Pulmonary veins (PVs), 42
Q
QoL. See Quality of Life (QoL)
Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool, 152
Quality of Life (QoL), 5–6, 75, 78
Questionnaires, to assess lung cancer patients, 5–6
R
Radial probe EBUS, 149, 149
RATS. See Robot-assisted thoracic surgery (RATS)
Re-expansion, of collapsed lung, 147
RENEW trial, 79
Rib spreading, 1
during thoracotomy, 5
VATS lobectomy and, 5
Right lower lobe, dorsal segmentectomy, 60, 61
Right lower VATS lobectomy
operative steps, 33–4
patient positioning, 33
ports position, 33
Right middle VATS lobectomy
operative steps, 32–3
patient positioning, 32
port position, 32
Right-sided double-lumen tube, 21, 21–2
Right upper lobe, uniportal VATS segmentectomy
anterior segmentectomy, 59, 59, 60, 61
apical segmentectomy, 57, 57–8, 58
posterior segmentectomy, 58, 58–9
Right upper VATS lobectomy
needlescopic, intraoperative view during, 131, 131
operative steps, 31–2
patient positioning, 31
port position, 31
two-port VATS, 132–3
Robot-assisted thoracic surgery (RATS), 7–8, 25
nVATS vs., 8
Robotic lobectomy, 123
and chest wall resection, 125–6
docking for, 123
evaluation of candidates for, 123
and induction therapy, 125
intraoperative complications, 126, 126
left lower, 125
patient positioning/port placement, 123–4, 124
preparation for, 123
results reported in series of, 127
right lower, 125
right middle, 124–5
right upper, 124
sleeve/bronchoplastic technique, 126
wedge resection, 124
Robotic surgery, in anterior mediastinum, 119
ectopic mediastinal parathyroid adenoma, 120, 120–1, 121
posterior mediastinal lesion resection, 121, 121, 122
thymic lesions, 119–20
Roos technique, 102, 103
S
Sarcoidosis, diagnosis of, 152
SBRT. See Stereotactic body radiation therapy (SBRT)
Scalene triangle, anatomy of, 102, 102
SCAT. See Suction-compressing angiorrhaphy technique (SCAT)
Segmentectomy, 10, 57
incision placement, 57
indications, 57
left lower lobe dorsal, uniportal VATS, 64–5, 65–6
left upper lobe, uniportal VATS. See Left upper lobe, uniportal VATS segmentectomy
patient positioning, 57
right lower lobe dorsal, uniportal VATS, 60, 61
right upper lobe, uniportal VATS. See Reft upper lobe, uniportal VATS segmentectomy
uniportal VATS, 140, 141
SGRQ. See St George's Respiratory Questionnaire (SGRQ)
Single-port VATS. See Uniportal VATS
6-minute walk test (6MWT), 76, 78
Sleeve lobectomy
robotic, 126
VTAS. See VATS sleeve lobectomy
Sniff test, 111
Solitary pulmonary nodule (SPN), 71, 72
SPN. See Solitary pulmonary nodule (SPN)
Spontaneous pneumothorax, 22, 71
primary, uniportal VATS for treatment of, 143
VATS for, 72, 72–3, 73
Stereotactic body radiation therapy (SBRT), 9
Stereotactic radiosurgery, 9, 157
St George's Respiratory Questionnaire (SGRQ), 76, 79
Subcarinal lymph nodes, dissection of, 38, 38, 40, 40, 41
Sublobar resection, VATS lobectomy and, 9–10
Subxiphoid pericardial window (SXP), 95–6
Suction-compressing angiorrhaphy technique (SCAT), 69, 69
Superior vena cava (SVC), 38, 38
Supraclavicular approach, TOS surgery, 102
Surgical lung volume reduction (LVR), 75, 76
EBV therapy vs., 79
videothoracoscopic approach, 102–4, 103, 104
SVC. See Superior vena cava (SVC)
SXP. See Subxiphoid pericardial window (SXP)
Sympathectomy, uniportal VATS and, 143
T
Talc insufflation, at medical thoracoscopy, 167
TEMLA. See Transcervical extended mediastinal lymphadenectomy (TEMLA)
Thoracic duct
embolization of, 107
ligation, minimally invasive VATS/robotic, 109, 109–10
location of, 109
Thoracic epidural analgesia, 24
Thoracic outlet syndrome (TOS)
anatomical considerations, 102, 102
causes of, 101, 101
clinical aspects of, 101
diagnosis of, 101–2
historical perspective, 101
posterior approach, 102
supraclavicular approach, 102
surgical indications in, 102
transaxillary approach, 102, 103
Thoracoscopic adhesiolysis, 67
Thoracoscopic lobectomy. See VATS lobectomy
Thoracoscopy. See Pleuroscopy
Thoracotomy, 1, 3
conversion rate from VATS pneumonectomy to, 43, 44
posterior technique, 102
rib-spreading during, 5
sleeve lobectomy by, 47. See also VATS sleeve lobectomy
VATS and, similarity between, 6
Three-port strategy
for needlescopic VATS, 129–31, 130
VATS lobectomy, 7, 8, 9
VATS pericardial window, 96
Thymectomy. See VATS thymectomy
Thymomas
bilateral VATS approach for, 92, 92–3, 93, 94
VATS thymectomy for, 89, 91, 91
T1N0 NSCLC randomized trial, 10
Transbronchial needle aspiration (TBNA), EBUS with. See EBUS-TBNA procedure
Transcervical extended mediastinal lymphadenectomy (TEMLA), 152
Transesophageal echocardiography, 24
Transthoracic needle aspiration (TTNA), 155
Two-port VATS, 8, 9, 131–2
instruments for, 134
perioperative care, 133
port strategy for, 132
right upper lobectomy, intraoperative view during, 132–3
step-wise training, 133–4
troubleshooting, 134
U
Ultrasound, 86, 111. See also Endobronchial ultrasound (EBUS); Endoscopic ultrasound (EUS)
Uniportal VATS, 8–9, 9, 11, 95, 137
complex resections, 141–2
instruments, 137–8
for interstitial lung disease, 143
for intrathoracic conditions, 144
left lower lobe dorsal segmentectomy, 64–5, 65–6
left upper lobe segmentectomy. See Left upper lobe, uniportal VATS segmentectomy
lower lobectomy, 138, 139
lymphadenectomy, 140
material used in, 137
middle lobectomy, 140
for myasthenia gravis, 90–1
pericardial window, 143–4
pericardial window approach, 97–9, 98
for plication of diaphragm, 112
pneumonectomies, 141
positioning during, 137–8
for primary spontaneous pneumothorax treatment, 143
principles of, 143
right lower lobe dorsal segmentectomy, 60, 61
right upper lobe segmentectomy. See Right upper lobe, uniportal VATS segmentectomy
segmentectomy, 140, 141
and sympathectomy, 143
upper lobectomy, 138–40, 139–40
V
VATS. See Video-assisted thoracic surgery (VATS)
VATS decortication, 86
VATS en bloc chest wall resections, 53–5
incision placement, 54
outcomes of, 55
patient positioning, 53
patient selection, 53
planned area of, 54, 54
technical challenges associated with, 53
VATS lobectomy, 3–4, 31–5
and air leakage, 10–11
clinical research, 12–13
contraindications, 31
defined, 5
description of, 31
indications, 31
left lower, 34–5
left upper, 34
and levels of NK cells, 6
open lobectomy vs., 41
perioperative care, 10
port placements for, 37, 37
and postoperative pain, 4
and Quality of Life, 5–6
renaissance of, 4–5
right lower. See Right lower VATS lobectomy
right middle. See Right middle VATS lobectomy
right upper. See Right upper VATS lobectomy
single-direction, 67
sleeve. See VATS sleeve lobectomy
studies, quality of, 5–6
and sublobar resection, 9–10
surgical approaches for, 5
thoracotomy and, similarity between, 6
three-port strategy, 7
VATS mediastinal lymph node dissection, 37
left, 38–9, 39–40
right, 38
VATS pericardial window, 96
approaches, 95
case studies, 96, 97
indications, 95
natural orifice transluminal endoscopic surgery, 99
needlescopic, 96, 97, 98
patient selection, 95
preoperative planning, 95
uniportal approach, 97–9, 98
VATS plication, of diaphragm, 112, 113
VATS pneumonectomy
anesthesia for, 41–2
benefits of, 41
complications after, 43
contraindications to, 41
conversion rate to thoracotomy, 43, 44
defined, 41
mortality rate, 43, 44
open pneumonectomy vs., 44
operative techniques of. See Operative techniques, of VATS pneumonectomy
outcomes of, 44
patient selection for, 41
postoperative analgesia for, 42
preoperative evaluation for patients, 41
uniportal, 141
VATS sleeve lobectomy, 47–50, 68, 68
benefits of, 49
clinical outcomes, 49–50
complications, 49
patient characteristics, 47
patient positioning, 47
postoperative care, 49
technical considerations, 47–9, 48–9
technique of, 47
VATS thymectomy
classifications of, 89
clinical indications for, 89
for invasive thymomas, 91, 91
for non-thymomatous myasthenia gravis, 89, 90, 90–1
patient positioning for, 89, 89
right, port and instrument placements for, 89, 90
surgical technique, 89, 89–90, 90
for thymomas, 89, 91, 91
Ventilation
protective lung, 22–3, 23
spontaneous, 22
Video-assisted thoracic surgery (VATS), 17
advantages of, 71
advent of, 129
anesthetic techniques, 21–5
bilateral. See Bilateral VATS
for empyema, 1
evolution of, 8, 8–9, 9, 11–13, 129
for interstitial lung disease, 74, 74
intraoperative complications and conversions, 67–70
lobectomy. See VATS lobectomy
LVRS through, 2
medical thoracoscopy vs., 163, 163
needlescopic, 8, 9
nonintubated. See Nonintubated VATS
open thoracotomy vs., 1
overview of, 3
for pneumothorax, 1–2, 71–3, 72, 73
for solitary pulmonary nodule, 71, 72
for spontaneous pneumothorax, 71–3, 72, 73
two-port, 8, 9
uniportal. See Uniportal VATS
Videothoracoscopy, 102–4, 103, 104
W
Wedge resection, 124
X
Xiphoid process, 95
Z
Zephyr valve, 75
×
Chapter Notes

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MINIMALLY INVASIVE THORACIC SURGERY PRINCIPLES AND PRACTICE OF THORACOSCOPIC TECHNIQUE
MINIMALLY INVASIVE THORACIC SURGERY PRINCIPLES AND PRACTICE OF THORACOSCOPIC TECHNIQUE
Edited by MARCO SCARCI MD FRCS(Eng) FCCP Consultant Thoracic Surgeon University College London Hospital London, UK PIERGIORGIO SOLLI MD PhD Director of Thoracic Surgery Maggiore ‘Carlo Alberto Pizzardi’ Hospital Bellaria ‘Carlo Alberto Pizzardi’ Hospital Bologna, Italy ALAN DL SIHOE MBBChir MA(Cantab) FRCSEd(CTh) FCSHK FHKAM FCCP Clinical Associate Professor Department of Surgery Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong Chief of Thoracic Surgery The University of Hong Kong Shenzhen Hospital Shenzhen,China
© 2018 JP Medical Ltd.
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The rights of Marco Scarci, Piergiorgio Solli and Alan DL Sihoe to be identified as editors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.
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Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the editors assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
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9781909836402
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Preface
Minimally Invasive Thoracic Surgery is intended for practicing thoracic and cardiothoracic surgeons who are new to the world of advanced video-assisted thoracic surgery. Experienced surgeons will also find a wealth of information and tips to improve their procedures.
The book is written by leaders in the field, with proven experience in minimally invasive techniques. We have aimed to deliver a concise yet comprehensive guide on how to treat a wide spectrum of conditions using the thoracoscopic approach.
Minimally Invasive Thoracic Surgery covers a wide range of minimally invasive procedural techniques with detailed explanations of how the reader can reproduce them. Chapters 1–5 outline the general principles of minimally invasive thoracic surgery: history, rationale, anesthetic techniques and, in an era of the multi-disciplinary team approach, how to set up a surgical program. Chapters 6–13 discuss all aspects of lung resections, from wedge resections to complex resections (pneumonectomies, en-bloc chest wall resections). Later chapters cover a number of benign conditions that can be successfully treated using video-assisted thoracic surgery (VATS), with two chapters on the more recent role of robotic surgery, now emerging as a standard technique performed by most thoracic surgeons. The last two chapters are dedicated to endobronchial ultrasonography (EBUS) and navigational bronchoscopy which, even if not firmly in the surgical arena, are still relevant to many thoracic surgeons.
We hope Minimally Invasive Thoracic Surgery will help the reader consolidate his or her understanding of clinical concepts and technical procedures, and provide an overview of the latest best practice perioperative care in minimally invasive thoracic surgery.
Marco Scarci
Piergiorgio Solli
Alan DL Sihoe
August 2017
To my mother and father: vobis pagina nostra dedicatur.
MS
To my wife Manuela and my daughters Aurora and Sabrina, who have always understood and supported the rather chaotic life I lead.
PS
I would like to dedicate this work to Kok Keng and Sun Ming Sihoe – the best father and mother in the world. As the Chinese saying goes: ‘A doctor has the heart of a parent’; my parents showed me what caring with a parental heart truly means.
AS
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