Improving the Procedures of Video-assisted Thoracoscopic Surgery Bronchial Sleeve Lobectomy for Lung Cancers

Objective To modify and improve the procedures of video-assisted thoracoscopic surgery (VATS) bronchial sleeve lobectomy for lung cancers. Methods From December 2010 to July 2012, 11 patients with non-small cell lung cancers underwent VATS bronchial sleeve lobectomy in our department, which included 7 cases of right upper lobectomy, 3 cases of left upper lobectomy and 1 case of left lower lobectomy. We modified the surgical procedures in relation to the distribution of VATS ports, the techniques of dissecting hilar structures and the method of bronchial reconstruction. The position of incisions for the left side differed from the right side. The lobe was resected with the technique of "hollow out" and the bronchus was reconstructed using a running prolene stitch. Results Blood loss of these 11 patients ranged from 50-400 (median 200) mL. The operations were completed within 200-320 (median 235) minutes and the duration needed for bronchial reconstruction ranged from 35 to 60 (median 50) minutes. A total of 8-28 (median 15) lymph nodes were dissected. There was no conversion to thoracotomy or blood transfusion. Chest drainage tubes were removed within 2-12 (median 3) days after surgery. The patency of bronchial anastomosis was confirmed by bronchoscopy. Postoperative complications occurred in three patients, which included one case of bronchial pleural fistula (BPF) and two cases of pneumonia. The patient suffered from BPF died 49 days after surgery from intrabronchial bleeding. The postoperative hospital stay of those patients ranged from 8 to 49 (median 8) days. The reconstructed bronchus continued to work well during the three month follow-up visits. Conclusion VATS bronchial sleeve lobectomy is feasible and safe. The modifications of the surgical procedures may promote the use of this complex operation.